Pulpitis

Pulpitis is inflammation of the dental pulp, the soft tissue inside the tooth that contains nerves and blood vessels. It is classified as reversible, when the pulp can recover once the cause is removed, or irreversible, when the pulp cannot recover and needs root canal treatment or extraction.

Why It Matters

Pulpitis is one of the most common causes of toothache. The pulp is enclosed in hard tissue, so inflammation and swelling have little room to expand, which is why the pain can be intense. Untreated irreversible pulpitis usually leads to death of the pulp, after which infection can spread out of the root tip and form a periapical abscess. If the pain suddenly stops, it may mean the nerve has died rather than healed.

Clinical Details

• Causes: Most often deep decay; also cracks, trauma, deep or leaking fillings, and repeated dental work on the same tooth.
• Reversible pulpitis: A short, sharp pain triggered by cold or sweet things that fades within seconds of removing the trigger. There is no spontaneous pain.
• Irreversible pulpitis: Pain that lingers after the trigger, comes on by itself, throbs, or disturbs sleep. It can be hard to tell which tooth it comes from.
• Diagnosis: The history of the pain, cold testing, tapping and bite tests, and X-rays.
• Treatment: Reversible pulpitis is treated by removing the cause, such as decay or a leaking filling, and protecting the pulp. Irreversible pulpitis is treated with root canal treatment or extraction; in selected cases, vital pulp therapy that preserves part of the pulp may be considered.

FAQ

Can pulpitis heal on its own?

Reversible pulpitis can settle once the cause is treated. Irreversible pulpitis does not heal, even if the pain comes and goes.

Do antibiotics help pulpitis?

No. Pulpitis is inflammation inside the tooth, and antibiotics do not relieve it. Pain is resolved by treating the tooth itself.

Is pulpitis an emergency?

Severe pain warrants a prompt dental appointment. Swelling of the face, fever or difficulty swallowing suggests spreading infection and needs urgent care.