Pulpal inflammatory disease

Classification of pulpitis

  • Acute and symptomatic
    • Reversible pulpitis
    • Irreversible pulpitis
    • Partial necrosis
    • Necrosis
  • Chronic and asymptomatic
    • Hyperplastic pulpitis (pulp polyp)
    • Internal resorption
    • Pulpal calcification

Treatment of pulpitides

  • Reversible pulpitis
    • Remove caries
    • If caused by recent restoration - reassure patient
  • All other pulpitides
    • RCT
    • Extraction

Reversible pulpitis

  • Sharp pain of short duration, intermittent
  • Pain is non-spontaneous - requires stimulus

Irreversible pulpitis

  • Usually sharp, severe pain on stimulation (cold)
  • Pain is prolonged and can be dull with time
  • Pain is often spontaneous
  • Pain is often localized early, more diffuse with time
  • OTC analgesics may not help

Partial necrosis

  • Symptoms similar to irreversible pulpitis
  • Pain can be referred
  • Cold water relieves pain

Necrosis

  • Asymptomatic to severe pain
  • Usually no response to EPT

Hyperplastic pulpitis (pulp polyp)

  • Chronic pulpitis usually in children and young adults
  • Follows carious pulp exposure with loss of crown and exposure of pulp chamber
  • Most common in molars due to large pulp chamber in younger people
  • Generally asymptomatic

Internal resorption

  • Example: pink tooth of mummery
  • Evidence that pulp is vital but disturbed

Pulpal calcification

  • Excessive dentin forms as a result of trauma
  • Can fill all or part of pulp space
  • Tooth will be discolored in most cases