Inside the innermost part of each tooth is an area called the pulp. The pulp contains the blood, supply, and nerves for the tooth. Pulpitis is a condition that causes painful inflammation of the pulp. It can occur in one or more teeth, and is caused by bacteria that invade the tooth’s pulp, causing it to swell.
There are two forms of pulpitis: reversible and irreversible. Reversible pulpitis refers to instances where the inflammation is mild and the tooth pulp remains healthy enough to save. Irreversible pulpitis occurs when inflammation and other symptoms, such as pain, are severe, and the pulp cannot be saved.
Irreversible pulpitis may lead to a type of infection called periapical abscess. This infection develops at the root of the tooth, where it causes a pocket of pus to form. If not treated, this infection can spread to other parts of the body, such as the sinuses, jaw, or brain.
Both types of pulpitis cause pain, though the pain caused by reversible pulpitis may be milder and occur only while eating. The pain associated with irreversible pulpitis may be more severe, and occur throughout the day and night.
Other symptoms of both forms of pulpitis include:
- sensitivity to hot and cold food
- sensitivity to very sweet food
Irreversible pulpitis may include additional symptoms of infection, such as:
- running a fever
- swollen lymph nodes
- bad breath
- bad taste in the mouth
In a healthy tooth, the enamel and dentin layers protect the pulp from infection. Pulpitis occurs when these protective layers are compromised, allowing bacteria to get into the pulp, causing swelling. The pulp remains trapped inside the tooth’s walls, so the swelling causes pressure and pain, as well as infection.
The enamel and dentin layers can become damaged by several conditions, including:
Anything that increases the risk of tooth decay, such as living in an area without fluoridated water or having certain medical conditions, such as diabetes, may increase the risk of pulpitis.
Children and older adults may also be at increased risk, but this is largely determined by quality of dental care and oral hygiene habits.
Lifestyle habits may also increase the risk for pulpitis, including:
- poor oral hygiene habits, such as not brushing teeth after meals and not seeing a dentist for regular checkups
- eating a diet high in sugar, or consuming foods and drinks which promote tooth decay, such as refined carbohydrates
- having a profession or hobby that increases your risk of impact to the mouth, such as boxing or hockey
- chronic bruxism
Pulpitis is typically diagnosed by a dentist. Your dentist will examine your teeth. They may take one or more X-rays to determine the extent of tooth decay and inflammation.
A sensitivity test may be done to see if you experience pain or discomfort when the tooth comes in contact with heat, cold, or sweet stimuli. The extent and duration of your reaction to the stimuli can help your dentist decide if all, or only part, of the pulp has been affected.
An additional tooth tap test, which uses a lightweight, blunt instrument to gently tap on the affected tooth, can help your dentist determine the extent of the inflammation.
Your dentist may also analyze how much of the tooth’s pulp is damaged with an electric pulp tester. This tool delivers a tiny, electrical charge to the tooth’s pulp. If you’re able to feel this charge, your tooth’s pulp is still considered viable, and the pulpitis is most likely reversible.
Treatment methods vary depending on whether your pulpitis is reversible or irreversible.
If you have reversible pulpitis, treating the cause of the inflammation should resolve your symptoms. For example, if you have a cavity, removing the decayed area and restoring it with a filling should relieve your pain.
If you have irreversible pulpitis, your dentist may recommend you see a specialist, such as an endodontist. If possible, your tooth may be saved through a procedure called a pulpectomy. This is the first part of a root canal. During a pulpectomy, the pulp is removed but the rest of the tooth is left intact. After the pulp is removed, the hollow area inside of the tooth is disinfected, filled, and sealed.
In some instances, your entire tooth will need to be removed. This is known as a tooth extraction. Tooth extraction may be recommended if your tooth has died and cannot be saved.
After a pulpectomy or tooth extraction, let your surgeon know if you experience any of these symptoms:
- severe pain, or pain which intensifies
- swelling inside or outside of the mouth
- feelings of pressure
- a recurrence or continuation of your original symptoms
Pain management, both before and after treatment, is usually done with nonsteroidal anti-inflammatory (NSAIDs) drugs. These provide relief from pain and inflammation.
Talk to your dentist about the brand of NSAID and dosage that’s right for you. If you need a root canal or tooth extraction, your surgeon may prescribe stronger pain medication.
Pulpitis can often be avoided by practicing good oral hygiene and visiting a dentist regularly. Reducing or eliminating sweets, such as sugary colas, cake, and candy, can also help.
If you have bruxism, a tooth guard may help protect your teeth.
See your dentist if you notice any pain in your mouth. If you have pulpitis, treating it early may help prevent irreversible pulpitis. Reversible pulpitis is treated by removing the cavity and filling the tooth. A root canal or tooth extraction may be used for irreversible pulpitis.