Toothache
 

What is Pulpitis?

Pulpitis is where the living part of your tooth aka the dental pulp becomes inflammed.

The dental pulp is made up of blood vessels and nerves and is responsible for nourishing the hard parts of the tooth. Yes, our teeth are actually alive. This means that they respond to any kind of trauma or insult such as dental caries, being prepared for a crown or just sensitivity to cold things.

Our teeth can respond in a number of ways- by retreating away from the problem, by laying down more dentine to create more of a barrier, or by sending more natural defence to the area. We do this last part by opening up our blood vessels, a process known as, you guessed it, 'inflammation'.

Unlike the rest of our bodies, where this inflammation has room to spread and expand, there is not a lot of space inside a little tooth. As a result we experience pain as the pressure builds up, pushing on the nerves inside.

We can divide pulpitis into two categories, which help us decide on the most appropriate treatment:
  • Reversible Pulpitis. This is a mild inflammation of the pulp, that with appropriate treatment will settle down and return to normal.
  • Irreversible Pulpitis. This is a severe inflammation from which the pulp is unlikely to recover. The swelling inside the tooth is so great that it essentially strangles itself, cutting off its own blood supply. The tooth is likely to die and therefore will require either a root canal treatment or an extraction.
In reality, inflammation of the pulp is a spectrum of changes and we need to appreciate this when interpreting the symptoms, it is not always cut and dry. The classic symptoms of each are discussed below.

If left untreated (i.e. the problem isn't removed) reversible pulpitis is likely to progress to irreversible pulpitis given time. Certainly if dental decay is responsible and you don't get a filling, this will almost certainly be the case.

You can see why it makes sense to see a dentist sooner rather than later if you get any symptoms, that is unless you would rather have a root canal treatment than a filling.

Causes and Symptoms of Reversible Pulpitis?

The classic symptoms of reversible pulpitis are a short sharp pain when having something cold or sweet to eat or drink that lasts only as long as the contact or for just a few seconds afterwards.

What can cause reversible pulpitis?
  • Dental decay- that has gone through enamel into dentine but is not yet near the nerve.
  • Exposed root- from gum recession caused by toothbrush abrasion or periodontitis.
  • Dental work- having fillings or a crown by the dentist; even scaling if you have lots of root showing
  • A fracture- of the tooth that goes into dentine but not the pulp chamber
  • A cracked tooth- where the crack doesn't extend into the nerve.

The longer the pain lasts the more inflammation that is going on inside your tooth. Unfortunately the symptoms seen by the dentist when pulpitis is present, can vary quite a lot and pain is a fairly subjective sensation. This means that it's hard to determine exactly what is going on inside the tooth and sometimes the situation is borderline irreversible pulpitis.

In these circumstances, I personally choose to place a good filling with an antibacterial lining and see how the patient goes. I let them know, that we aren't really sure if the nerve is going to live or if it will die off, and if they get pain which wakes them at night, or the tooth becomes tender to bite on, then they will be looking at a root canal treatment or an extraction. Other dentists will start the root canal or extract the tooth straight away- a more sure fire way to stop the pain but once done, there's no going back.

Causes and Symptoms of Irreversible Pulpitis?

Classic complaints when the swelling inside your tooth is reaching the point at which it is not going to recover include:

  • Pain lasting a few minutes,or even up to an hour after the stimulus (such as cold) is removed
  • Pain occurring spontaneously for no reason
  • When the tooth starts becoming painful to 'hot' things
  • Pain that goes up and down between your top and bottom jaw, and up to your ear
  • Pain that disturbs your sleep repeatedly, or keeps you up all night- this is a more definite sign of irreversible pulpitis .
Sometimes reversible symptoms will go unnoticed and the first sign of a problem is a raging toothache. This is why it is important to see a dentist regularly (even if you aren't having any problems) because we pick this sort of stuff up early either on the examination, or via the routine screening x-rays.

What can cause irreversible pulpitis?

  • Very deep fillings- that are close to the nerve
  • Deep dental decay- that extends deep into dentine or into the nerve
  • Destructive crown preparations- on teeth that are not root filled
  • Orthodontic movement- very occasionally, if the tooth is moved too quickly through bone, this can cut off the tooth's blood supply
  • Trauma- a fracture that exposes the nerve of the tooth or a blow that moves the nerve too much in its socket
  • A cracked tooth- where the crack extends into the nerve
  • Extreme sensitivity.

Dentine is made up of a series of tubes and as you get closer to the nerve, these tubes get wider and wider permitting more bacteria to enter. The more bacteria that enter, the greater the inflammation, and the more likely irreversible pulpitis becomes.