Pulpitis

What is pulpitis?

Pulpitis is an inflammation of the dental pulp.
It is the single most important disease process affecting the dental pulp.
It accounts for virtually all pulpal disease of any clinical significance.

Symptoms of pulpitis

  1. Pain which is difficult to localize
  2. The pain may radiate to the adjacent jaw and occasionally to the face, ear or neck
  3. It may be triggered by any of the following:
    • Cold or hot stimulants
    • Arecumbent position
    • Occasionally by mastication when food particles get into a carious cavity.

Types of pulpitis

Pulpitis can be classified into two:

  1. Reversible pulpitis
  2. Irreversible pulpitis

It is important to determine whether pulpitis is reversible or irreversible

1. Reversible pulpitis:

  • The pulp can recover with removal of stimulus:
  • Pain lasts for only a few moments after removal of the initiating stimulus

2. Irreversible pulpitis:

  • The pulp cannot recover even after removal of stimulus
  • It is characterized by pain which lingers for at least one minute after removal of stimulus
  • This type may be spontaneous

Complications of pulpitis

The sequelae of untreated pulpitis (in the order in which they occur) are:

  1. Reversible pulpitis
  2. Irreversible pulpitis
  3. Pulpal necrosis
  4. Apical periodontitis
  5. Periapical abscess
  6. Cellulitis

Note that the complications are serially arranged.

Investigations

Of primary importance is the use of a pulp tester to test the vitality of the pulp
The following can be used:

  • Electric pulp tester
  • Cold or hot water bath
  • Ethyl chloride spray
  • Hot gutta percha sticks
  • Ice sticks

Treatment for pulpitis

Treatment objectives

  1. To exclude the pulp from the stimulus (or stimuli) in reversible pulpitis.
  2. To remove the pulp in irreversible pulpitis

Non-drug treatment

Reversible:

  • Indirect pulp capping
  • Direct pulp capping
  • Conventional filling using amalgam, composite or GIC
  • Desensitization with strontium chloride

Irreversible:

  • Root canal therapy
  • Extraction

Drug treatment

Paracetamol
Adult: 500 mg-1 g orally every 4-6 hours (to a maximum of 4 g) for 5-7 days
Child: frequency and duration of treatment same as adult :

  • 6-12 years: 250 – 500 mg;
  • 1-5 years: 125-250 mg;
  • 3 months – 1 year: 125-250 mg for 5-7days

NSAIDs may be required in some patients

Adverse drug reactions

Aspirin and other NSAIDs

  • Gastrointestinal haemorrhage, allergic reactions.
  • Do not prescribe for patients with peptic ulcer disease
  • May exacerbate symptoms in asthmatics
  • Aspirin is contraindicated in children less than 16 years as it may precipitate Reye’s syndrome

Prevention

  • Prevent dental caries (the most important cause of pulpitis)
  • Seek prompt dental attention.