What Is Pulpitis?

Pulpitis refers to inflammatory lesions that occur in the pulp tissue. Pulp is a loose connective tissue that mainly contains nerve blood vessels. It is located in the pulp cavity inside the tooth. Deep caries, wedge-shaped defects, and other dental hard tissue diseases, if not controlled and treated in a timely and effective manner, can cause pulpitis and become one of the most frequent and common diseases in the oral cavity.

Basic Information

English name: pulpitis
Visiting department: Stomatology
Common locations: Dental pulp

Common causes: The main cause is infection, and caries is the most common cause
Common symptoms: Acute patients have severe toothache, exacerbated at night, and temperature-stimulated pain
Contagious: no

Pulpitis classification

Acute pulpitis

Acute pulpitis can develop from dental pulp congestion, and can also come from acute exacerbations of chronic pulpitis. According to the development of inflammation, acute pulpitis can be divided into serous phase and suppurative phase.

(1) Acute serous pulpitis The scope of the lesion is limited to the crown pulp, which is localized serous pulpitis. When the lesion spread to the root pulp, it is all serous pulpitis.

(2) Acute suppurative pulpitis In the short serous period of pulpitis, exuded white blood cells continue to necrotize and liquefy, forming an abscess, which is acute purulent pulpitis.

2. Chronic pulpitis

Chronic pulpitis is most common clinically, with atypical symptoms, and some cases may not have spontaneous pain. If the exudate of acute inflammation is drained but the inflammation is not completely eliminated, it can also be converted into chronic inflammation. Conversely, if the body's resistance is reduced or local drainage is not smooth, chronic pulpitis will turn into acute pulpitis, that is, acute exacerbation of chronic pulpitis.

(1) The pulp of chronic atretic pulpitis has not been exposed, but deep caries, crown fillings, or other hard pulp tissues near the pulp can be detected. There is no visible pulp exposed after removing the necrotic material. hole. Chronic inflammation can last longer.

(2) Chronic ulcerative pulpitis The pulp tissue has been exposed and ulcers have formed on the surface. Because of the fear of pain, the patient has been abandoning the tooth for a long time, and even a large amount of soft dirt and tartar have accumulated.

(3) Chronic proliferative pulpitis mostly occurs in young people, and the pulp has been exposed, which causes a proliferative response due to mild and long-lasting stimuli. The red and "mushroom" shaped granulation tissue in the large and deep caries of the tooth is called dental pulp polyps, which is painless but easy to bleed. Generally, there is no spontaneous pain. Sometimes, when eating, you will feel toothache or bleeding when eating. You can often see tartar accumulation in the affected tooth and its adjacent teeth.

Etiology of pulpitis

The main cause of dental pulp inflammation is infection. Bacteria can invade and infect dental pulp when the hard tissue of the tooth is damaged for various reasons. Among them, dental caries is the most common cause of tooth hard tissue loss. Other reasons include dental defects caused by abnormal tooth development, accidental dental crown fracture, dental pulp exposure, and direct damage to dental pulp. In addition, in severe periodontal disease, the periodontal pocket reaches the root apex, and bacteria can also enter the pulp cavity from the apical foramen or some small branches of the root of the tooth to cause pulp inflammation.

Pathogenesis of pulpitis

Due to the different effects of pathogenic stimuli and the body's resistance, dental pulp has different pathological changes, which will clinically show a series of different symptoms and signs. After the pulp is stimulated, the initial pathological manifestations are vasodilation and blood filling. If the pathogenic stimulus is removed in time, this simple congestive state can be relieved and the pulp can return to its original state.

After dental pulp hyperemia lasts for a long time, it turns into acute pulp inflammation. If the bacteria that invade the dental pulp have low virulence and the body's resistance is strong, the inflammation of the dental pulp tissue is mostly a chronic process. If the exudate of acute inflammation is drained but the inflammation is not completely eliminated, it can also be converted into chronic inflammation. That is, chronic pulpitis, the most common type in clinical practice, clinical symptoms are not typical, and some cases may not have spontaneous pain. Conversely, if the body's resistance is reduced or local drainage is not smooth, chronic pulpitis will turn into acute pulpitis, that is, acute exacerbation of chronic pulpitis.

Because the pulp tissue is located in the hard and inelastic pulp wall of the four walls, its blood circulation can only pass through the small apical foramen, and lack of collateral circulation. Once the pulp has inflammation, the inflammation exudate is not easy to drain, and the pulp cavity The pressure increases quickly, causing severe pain.

Clinical manifestations of pulpitis

Acute pulpitis

The main symptom of acute pulpitis (including acute exacerbations of chronic pulpitis) is severe pain with typical clinical characteristics.

Sudden severe pain occurs without any external stimuli. The pain has a process of continuation and relief, so it has the characteristics of paroxysmal seizures or paroxysmal aggravation; secondly, nocturnal pain, patients often have difficulty falling asleep because of toothache; third Temperature stimulus will aggravate pain, which can cause pain or worsen the pain when eating hot and cold foods, and often dare not brush your teeth with cold water. In the later stage of pulpitis, it is also characterized by "hot pain and cold relief". Thermal stimulation can cause severe pain. At this time, patients often use gargle and cold water to temporarily relieve pain. When pain occurs, most patients cannot clearly indicate where the teeth are. , Pain often radiates to the upper and lower jaw teeth or head and face on the same side of the affected tooth.

2. Chronic pulpitis

(1) Chronic atretic pulpitis No obvious spontaneous pain or occasional dull pain. However, almost all patients have a long history of cold and heat stimulating pain.

(2) Chronic ulcerative pulpitis usually has no obvious spontaneous pain, but patients often complain of severe pain when food is embedded in the cavity of the affected tooth. Another typical symptom is severe pain when cold or heat irritates the affected teeth.

(3) Chronic proliferative pulpitis generally has no spontaneous pain, and sometimes patients may complain of tooth pain or bleeding during eating. Therefore, they do not dare to chew food on the affected side for a long time.

Differential diagnosis of pulpitis

It is not difficult to diagnose based on clinical manifestations and needs to be distinguished from the following diseases.

1. Deep caries, reversible pulpitis, chronic pulpitis

(1) Symptoms of pain can be hot and cold pain, but deep caries and reversible pulpitis have no history of spontaneous pain; chronic pulpitis may have a history of spontaneous pain.

(2) Cold test the tooth surface with a popsicle for temperature measurement. The response of the tooth with deep caries is the same as that of the control tooth. Only when the ice water enters the hole causes pain; the tooth with reversible pulpitis is cold when the tooth surface is measured. Transient sensitivity appears. Chronic pulpitis has a severe degree of pain response caused by temperature stimulation, which lasts for a long time, and sometimes mild palpitation can also occur.

2. Acute pulpitis and trigeminal neuralgia

The onset of trigeminal neuralgia usually has a pain "trigger point", and the patient induces pain every time he touches that point. Trigeminal neuralgia rarely occurs at night, and cold and hot temperature stimulation does not cause pain; typical pain of acute pulpitis can be found in affected teeth.

3. Acute pulpitis and gingival papillitis

Gingival papillitis may also occur spontaneously, but the nature of the pain is persistent tenderness. The response of the affected tooth to the temperature test may be transiently sensitive. Patients are more localizable to pain. During the examination, it was found that there was hyperemia and edema in the gingival papilla indicated by the patient, bleeding was detected, and tenderness was very obvious. There are traces of food impaction or history of food impaction between the adjacent teeth of the affected area. Hard tooth tissue damage and other diseases that can cause pulpitis are generally not investigated.

4. Acute pulpitis, acute maxillary sinusitis

With acute maxillary sinusitis, the posterior maxillary teeth on the affected side may exhibit pain symptoms similar to pulpitis. However, the pain that occurs during acute maxillary sinusitis is persistent tenderness. The maxillary bicuspis and molars on the affected side can be affected at the same time, causing pain in two or three teeth. The response of the affected teeth to the temperature test is the same as the control teeth. Re-examination of the anterior wall of the maxillary sinus may cause tenderness, and the patient may also have symptoms of upper respiratory tract infections such as headache, nasal congestion, and pus.

5. Chronic pulpitis and dry socket

Patients with dry socket have a recent history of tooth extraction. Examination revealed that the alveolar socket was empty, the bone surface was exposed, and an odor appeared. Adjacent teeth in extraction sockets may also have cold, heat irritation, and pain, but there is no clear indication of dental pulp disease.

Pulpitis Treatment

Due to the lack of sufficient collateral circulation, once the pulp is inflamed and cannot be eliminated by itself, the pulp must be removed to relieve symptoms, and the infection in the pulp cavity needs to be removed, and then the root canal is filled with biocompatible materials to prevent reinfection The most widely used method in clinical practice is root canal therapy. With timely and effective treatment, affected teeth can generally be preserved. However, if the treatment is not timely, the infection will spread further, causing inflammation around the apex, and eventually leading to the loss of dental organs.

Treatment method

(1) Reversible pulpitis To preserve the living pulp, there are direct pulp capping, indirect pulp capping, and pulpotomy.

(2) Irreversible pulpitis The purpose is to remove the pulp and save the affected teeth, such as root canal therapy.

2. Principles of treatment

Save the living pulp or save the affected teeth. Emergency treatment can open the pulp and decompress. After flushing with warm saline, place analgesics (such as camphor, syringol or toothache water) in the caries cavity to temporarily relieve pain. At the same time, Taking anti-inflammatory and analgesic drugs, 1 to 2 days after pain relief, depending on the specific conditions of the affected teeth: living pulpectomy; flat pulp surgery; dental pulp plastic or root canal treatment. Unretained teeth can be removed.

Pulpitis prevention

Oral hygiene

Insist on brushing your teeth in the morning or evening or after eating, rinsing your mouth after meals, and timely removing food residues and bacteria left in your mouth. The use of fluoride toothpaste has a certain effect on preventing dental caries.

Children's diet should be diversified. Eating hard and tough food appropriately can promote the growth and development of their jaws and teeth. Do not allow children to sleep with sugar cubes, as the acidification of sugar in their mouths can easily erode teeth and cause dental caries.

When the permanent teeth of 6 to 12 years old are eruption, the sulcus is closed in time, that is, the sulcus of the teeth is closed with a layer of resin material to prevent harmful substances such as food debris and bacteria from entering the teeth, thereby preventing dental caries.

2. Food impaction of teeth

Immediate treatment of misplaced wisdom teeth and food impaction teeth, and inappropriate dentures and braces in time.

3. Oral examination

Regular oral examination.

4. Treatment of dental caries

If the tooth cavity is shallow, it should be filled with appropriate materials after removing the damaged dentin to prevent further caries; deep tooth cavity caries should be appropriately treated according to the specific situation. For pulpitis or periapical periodontitis caused by dental caries, it is necessary to remove bacterial infections in the pulp cavity or around the roots of the teeth, and to maintain the teeth after root canal treatment. Remove the residual crowns and roots that have lost their therapeutic value in time and inlay them in time.