AtlasDentalPulpitis

Dental Diseases

Pulpitis

aka Pulp Inflammation · Toothache

Inflammation of the dental pulp, classified as reversible or irreversible, commonly caused by caries, trauma, or restorations.

Reversible
Transient pain, no spontaneous symptoms
Irreversible
Spontaneous, lingering, nocturnal
Treatment
RCT or extraction

§ figuresFigures (1)

Fig. 1Zones of pulp cell free zone cell rich zone odontoblastic processes pulp core

“Zones of pulp histology” · Mohammed Ruhana · CC BY-SA 4.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Pulpitis figures pending faculty review.

§ overviewOverview

Inflammatory response of dental pulp to bacterial, mechanical, thermal, or chemical irritants.

§ icdICD Classification

K04.0

§ etiologyEtiology

  • 01Deep caries
  • 02Cracked/fractured tooth
  • 03Dental procedures
  • 04Trauma
  • 05Attrition/erosion

§ epidemiologyEpidemiology

Extremely common; leading cause of dental pain worldwide.

§ pathogenesisPathogenesis

Bacterial invasion → inflammatory mediators → increased pulpal pressure in rigid chamber → pain and potential necrosis.

§ clinicalClinical Features

  • 01Reversible: sharp, transient pain to cold/sweet, relieved on stimulus removal
  • 02Irreversible: spontaneous, lingering pain, nocturnal exacerbation, poorly localised

§ differentialDifferential Diagnosis

  • 01Dentine hypersensitivity
  • 02Cracked tooth syndrome
  • 03Periapical periodontitis
  • 04Referred pain (sinusitis, TMD)

§ investigationsInvestigations

  • 01Thermal testing (cold)
  • 02Electric pulp test
  • 03Percussion test
  • 04Periapical radiograph

§ classificationClassification

  • 01Reversible pulpitis
  • 02Irreversible pulpitis — symptomatic/asymptomatic
  • 03Pulp necrosis

§ treatmentTreatment

  • 01Reversible: remove irritant, sedative restoration
  • 02Irreversible: root canal therapy or extraction
  • 03Pulpotomy in young permanent teeth (MTA)

§ complicationsComplications

  • 01Pulp necrosis
  • 02Periapical abscess
  • 03Cellulitis
  • 04Space infection

§ prognosisPrognosis

Reversible pulpitis: excellent. Irreversible: good with RCT.

§ examKey Examination Points

  • 01Cold test: lingering >10s = irreversible
  • 02EPT negative = necrosis
  • 03Percussion tenderness = periapical involvement

§ revisionQuick Revision Summary

  • 01Reversible = transient; Irreversible = lingering/spontaneous
  • 02Increased pulpal pressure causes pain
  • 03MTA pulpotomy for immature apex

§ vivaBDS Viva Questions

  • 01How do you differentiate reversible from irreversible pulpitis?
  • 02What is the pathophysiology of pulpal pain?
  • 03When is pulpotomy indicated?

§ mcqsMCQs — Assessment (3)

Question 1

Lingering pain to cold for >10 seconds indicates:

Question 2

First-line treatment for irreversible pulpitis:

Question 3

EPT negative with periapical radiolucency suggests:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Histopathology References

Reference #4L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #2L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #3L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. AAE Consensus Conference 2009
  2. Hargreaves KM. Cohen's Pathways of the Pulp, 12e

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.