Pulpitis is a dental condition where the tooth nerve's pulp tissue becomes inflamed which is a common cause for a toothache. However, treatment to relieve it is much more complex than it seems. There are different types of pulpitis and the causes of it are even more varied.
Therefore, throwing random home remedies at this painful tooth condition may do little to alleviate the pain. The best course of action is to see a dentist to get a proper diagnosis so that you can treat the root cause with the correct type of treatment.
Table of Contents:
Overview
Pulpitis literally means pulp inflammation and it is derived from the two words, "pulp" and "itis". In layman's terms, you have tooth nerve inflammation since the pulp which is located in the center of the tooth houses all of the nerves and blood vessels.
The most notable symptom of this condition is tooth nerve pain (gangrenous pulp pain).
Types of pulpitis
There are two types of pulpitis. One of them is significantly more painful and consequently requires more extensive dental treatment than the other.
Reversible pulpitis: If your pulpitis is reversible, it means that the tooth nerve can recover from an unhealthy state back to a healthy one. That is assuming you give it the right type of treatment.
Irreversible pulpitis: If your pulpitis is irreversible, your pulp has reached the point of no return and can no longer heal. Ultimately, the infected nerve will need to be removed with a root canal since the tooth is dying or may already have been dead.
Of course, the lesser of the two evils is reversible pulpitis since the symptoms are not as severe and the treatment is also not as extensive.
So, which one do you have?
Prevalence
According to the latest data, there were 2 million emergency department visits that were dental related in 2018. About 85% of those visits were due to diseases of the pulp.
Those were all hospital visits but for outpatient care at dentist and endodontist offices, the numbers are staggering. According to the AAE (American Association of Endodontists), approximately 15 million root canals are done every year.
In summary, pulpitis is very common.
Symptoms
Toothache and sensitivity are the most common symptoms of pulpitis. The severity is typically worse with irreversible pulpitis which is why it is important to distinguish which one you have.
Symptoms of reversible pulpitis:
Pain is NOT random and NOT spontaneous.
Symptoms are triggered by stimuli such as when you're eating, chewing, or drinking.
Sensitive to cold, hot, sour, sweet, spicy, or acidic foods/beverages.
Pain may be sharp but only lasts for a brief moment.
Typically this condition will not hurt if you're not doing anything.
Signs of irreversible pulpitis:
Pain can be random and spontaneous.
Patients often describe it as a toothache that comes and goes.
Throbbing type of pain that lingers.
Can be sharp or dull discomfort.
Pain that can wake you up in the middle of the night.
Sensitive to cold, hot, sour, sweet, spicy, or acidic foods/beverages.
There is no rhyme or reason as to when the symptoms are triggered.
Can hurt even if you're not using your mouth.
Ultimately, if your pulpitis is reversible but you leave it untreated, it will progress to the irreversible form. If you manage to bear through the pain of an irreversible pulp, the tooth will die.
Strangely enough, a dead tooth may stop hurting you but the bad news is that it can develop into a periapical abscess. Once you swell up, the excruciating pain will return once more.
Causes
The etiology of pulpitis can be vast because any type of symptomatic dental condition can lead to it. Typically they all result in injury or insult to the pulp tissue of the tooth.
Potential causes of pulpitis:
Tooth decay: Cavities form when bacteria in your mouth digest sugar and produce acidic byproducts. This acid is potent enough to dissolve through your enamel and form holes.
Fracture: If you bite on hard foods, you can chip a tooth which may cause it to be bruised.
Concussion: Teeth can sustain concussions from blunt force impact such as sports injuries or motor vehicle collisions. Usually results in temporary reversible pulpitis.
Dental procedures: The pulp can be inflamed when it undergoes dental treatment. The chances increase the closer your dentist needs to drill to the nerve. Consequently, large cavity fillings that are close to the nerve can irritate it.
Bruxism: Parafunctional night time teeth grinding habit can wear through the enamel and lead to teeth sensitivity. If it is severe enough the grinding can even reach the pulp.
Dental abscess: Any type of infection in or around the tooth can lead to nerve inflammation and toothache.
Teeth whitening: Excessive whitening of the teeth can lead to mild pulpitis. However, in severe cases such as for bleachorexia, the damage may even be permanent.
Diagnosis
Your dentist can diagnose the type of pulpitis that you have by doing a comprehensive clinical exam which includes the pulp vitality test.
Diagnostic tests:
Dental history: Any past history of dental treatment; taking any medications
Chief complaint: How long it's been hurting; symptoms; duration of pain; location; onset; triggering stimuli; what gives it relief
Clinical exam: Facial symmetry; sinus tract; soft tissue appearance; periodontal status (probing, mobility); tooth decay; any dental restorations present?
Pulp testing: These are pulp vitality tests - cold test, heat test, and electric pulp test.
Periapical testing: Percussion (tooth tapping), palpation, tooth slooth test (bite test)
Radiographic analysis: Take an x-ray to see if there are any radiograpic changes. Teeth that need root canals do look different on x-rays.
Additional tests: Transillumination, selective anesthesia test (numb the tooth to see if pain dissipates), test cavity (drill into tooth)
Using all of the information gathered from the tests above, your dentist will be able to come up with a pulpal diagnosis and a periapical one.
Endodontic diagnoses
It is imperative to have the correct endodontic diagnosis because each one will dictate a different treatment. If the assessment was wrong then the wrong procedure will be prescribed which means the outcome will be unsuccessful.
Pulpal diagnosis
Normal pulp. The pulp is healthy and no treatment is needed.
Reversible pulpitis
Symptomatic irreversible pulpitis
Asymptomatic irreversible pulpitis
Pulp necrosis. The tooth is dead.
Previously treated. Tooth already had a root canal completed.
Previously initiated therapy. Had a pulpotomy or root canal started but never finished.
Periapical diagnosis
Normal apical tissues. Tooth is normal and healthy.
Symptomatic apical periodontitis.
Asymptomatic apical periodontitis.
Chronic apical abscess. An abscess is present at the root tip.
Acute apical abscess. Typically characterized by acute onset of symptoms with pain and swelling.
Condensing osteitis. A diffuse radiopaque lesion located around the apex of the tooth. It is a low grade inflammatory reaction.
Treatment
Treatment for reversible pulpitis is very different from irreversible pulpitis so you better get the diagnosis right. The procedures for the former tend to be less invasive, less complex, and also less costly. The latter is more complicated and more costly.
Try to have your tooth nerve pain treated as soon as possible so it doesn't get worse.
Reversible pulpitis treatment
Most commonly this condition is caused by a small cavity, broken filling, gum issue, or worn through enamel. All your dentist needs to do is remove the source of irritation and the pulp should recover shortly afterwards.
Dental filling. Any defect can be repaired and restored with a tooth filling, composite or amalgam restoration will work.
Bonding. Worn through enamel or small chips can be re-bonded.
Sensitivity treatment. Fluoride treatment or use of desensitizing toothpaste can reduce or eliminate teeth sensitivity.
Teeth cleaning. Sometimes all you needed was just a good dental cleaning. Remove all of that plaque and tartar which may have been irritating your teeth and gums.
Irreversible pulpitis treatment
Irreversible pulpitis requires more complex treatment because it needs to remove the pulp tissue. This condition is irreversible meaning it is past the point of repair.
Root canal. Your dentist or endodontist can extirpate the nerve from the tooth to kill it permanently. Afterwards you should consider protecting the tooth with a dental crown.
Tooth removal. If a root canal is too costly, you may be left with no choice but to extract the tooth. This option may also be needed if the infection is too severe for the tooth to be saved.
Antibiotics and home remedies are NOT a valid form of treatment for pulpitis that is irreversible. The condition is permanent so you can't use a temporary solution to treat a permanent problem. Only definitive treatment can treat an irreversible problem.
Complications
If left untreated, pulpitis can progress from reversible to the irreversible form. From there it can morph to much more serious complications such as abscess and swelling.
Signs of a complication:
Pain
Fever
Swollen neck glands
Condition not improving
Osteomyelitis
Treatment only becomes more expensive if you procrastinate and delay treatment.
Prevention
The best way to prevent pulpitis is with good oral hygiene and routine dental check ups.
Brushing your teeth two times a day for at least 2 minutes with fluoride or hydroxyapatite toothpaste.
Flossing every night before bed.
Seeing your dentist for routine cleanings and checkups.
Wearing a night guard if you grind your teeth at night.
Avoid sugar and carbohydrates as much as possible
If you experiencing any type of tooth pain or sensitivity, let your dentist know right away.
Outlook
Pulpitis is treatable but depending on which type you have, the solution may be more involved and costly. If you're able to get it treated early, you may be able to reverse it and help your tooth pulp recover back to a normal healthy state.
However, when left to its own accord, it will no doubt get worse and potentially cause irreversible damage to your tooth.
