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

§ 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:

References

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

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