Pulpitis is inflammation of the dental pulp, or tissue in the center of a tooth. The dental pulp comprises soft connective tissue, nerves, and the blood supply for the tooth.

Pulpitis causes pain, swelling, and sensitivity. A bacterial infection from a cavity is typically the cause.

This article will look at what it is, as well as the symptoms, causes, diagnosis, and treatment options.

a man with toothache because of pulpitisShare on Pinterest
A person with pulpitis may have throbbing pain.

Pulpitis is inflammation of the dental pulp. It is how a dentist might describe ‘toothache.’

The pulp inside a tooth consists of vascular tissues, blood supply, nerves, and connective tissue. When the pulp is inflamed, a person may experience pain from the tooth’s nerve.

Pulpitis can be reversible or irreversible.

Reversible pulpitis

In reversible pulpitis, there is typically mild inflammation in the pulp, and people have short-lived pain.

If a person is experiencing reversible pulpitis, a tooth may have a cavity, but it is not deep yet, and so there is an absence of bacteria in the pulp.

With the reversible form of pulpitis, eating something sweet or cold may cause pain, but this pain goes away once the stimulant is gone.

The tooth pulp is typically healthy and, with treatment, it is possible to save the tooth and for the nerve to heal.

Irreversible pulpitis

Irreversible pulpitis is one of the most frequent reasons for a person to seek emergency dental treatment.

Irreversible pulpitis occurs when bacteria spread to the nerve, and there is significant inflammation of the pulp.

Irreversible pulpitis typically causes intense pain that may be spontaneous, lingering, and radiating. Irreversible pulpitis pain may be so severe that it wakes a person up at night.

Someone with irreversible pulpitis may have difficulty pinpointing the exact location of the pain. However, 40% of teeth with irreversible pulpitis may also be painless.

Irreversible pulpitis can lead to an infection at the end of the tooth if the bacteria in the pulp cause the nerve to die. This is called pulp necrosis, or pulp death.

If necrosis occurs, a pocket of pus may form at the end of the tooth’s root, known as a periapical abscess, or dental abscess. It can cause severe pain, especially when biting.

Left untreated, the infection can spread to other parts of the body, including the brain.

Pulpitis causes:

  • pain, which may be sharp or throbbing
  • sensitivity to sweet, hot, or cold foods and beverages
  • inflammation

The severity of these symptoms depends on the type of pulpitis.

Reversible pulpitis typically causes mild symptoms, such as sensitivity and nonlingering pain to cold.

Irreversible pulpitis, on the other hand, may cause severe pain. With irreversible pulpitis, the pain lasts for a long time, even after the stimulant has gone.

Signs and symptoms of infection may also accompany irreversible pulpitis if the inflammation progresses, and may include:

  • a fever
  • an unpleasant taste in the mouth
  • bad breath (halitosis)
  • difficulty eating
  • swelling in the face or cheek
  • swollen lymph nodes

According to a 2016 systematic review, the most common cause of pulpitis is when bacteria irritate the dental pulp through an area of tooth decay, including dental caries.

Other causes of pulpal inflammation include:

  • trauma or injury to a tooth
  • grinding or clenching the teeth
  • repeated, invasive dental procedures

These irritants typically first cause reversible pulpitis. If the pulp continues to be inflamed, the pulpitis becomes irreversible, which may eventually lead to the pulp dying.

A dentist can diagnose pulpitis from a person’s symptoms, an examination of the teeth, and possibly X-rays.

In some cases, the dentist may perform other tests, such as:

  • A sensitivity test: The dentist will check to see if cold or hot stimuli cause pain and discomfort.
  • Tooth tap test: The dentist taps gently on the tooth with a lightweight instrument to check the level of inflammation.
  • Electric pulp test: The dentist may use a tool to deliver a small electrical charge to the pulp. If the person can feel the charge, the pulp is responding normally, and the pulpitis may be reversible.

These tests can help the dentist to determine the extent of the damage, and possibly save the pulp.

The treatment will depend on whether the pulpitis is reversible or irreversible.

Reversible pulpitis

If the pulpitis is reversible, the pain and discomfort should resolve once the person treats the underlying cause of the inflammation.

If damage to the tooth, such as with a cavity or a fracture, is causing the pulpitis, a dentist may repair the tooth to protect the pulp.

The pulp should heal and return to its normal, healthy state once a dentist has removed the source of the irritation.

Irreversible pulpitis

Irreversible pulpitis means that something has damaged the nerve beyond repair, and the inflammation in the pulp cannot be reversed.

The dentist will typically perform a root canal treatment to remove the dying pulp.

Alternatively, a dentist may remove the entire tooth, although this is not typically the first line of treatment if they can save the tooth.

A dentist will not recommend systemic antibiotics as a treatment for irreversible pulpitis. This is because antibiotics will not alleviate the pain and heal the nerve inside the tooth.

To prevent pulpitis, people can ensure that they practice good oral hygiene to remove unhealthy bacteria from their mouth and teeth.

To help maintain healthy teeth and gums, a person should:

  • see a dentist regularly
  • seek immediate attention for tooth pain or sensitivity
  • brush teeth twice daily
  • floss daily
  • limit or avoid sugary foods

Individuals who have bruxism, which occurs when a person grinds or clench their teeth in their sleep, may want to consider wearing a mouth guard at night.

If left untreated, pulpitis can lead to a periapical abscess, otherwise known as a dental abscess, which is a localized infection in the bone or soft tissues. A person may notice a pocket of pus beside their tooth.

Cellulitis may occur if the infection spreads to local tissue spaces and causes widespread swelling.

Symptoms may include:

  • swollen glands and lymph nodes
  • painful rash
  • fever
  • chills
  • difficulty swallowing
  • trismus, or difficulty opening the mouth

If a person develops cellulitis, they can take antibiotics to treat it.

If a person experiences any of the symptoms above, or sees changes in mental state and has difficulty breathing, they should seek emergency medical help.

Individuals should see their dentist at the first sign of pain, sensitivity, or inflammation in the mouth.

It is also important to see a dentist regularly for checkups and cleanings.

The outlook for pulpitis depends on the extent of the damage.

Reversible pulpitis may resolve with treatment of the cause or irritant.

Irreversible pulpitis requires a root canal treatment or removal of the tooth to resolve the pain and sensitivity.

Early intervention for pulpitis can improve the outlook. A dentist may be able to perform a simple treatment, such as a filling to heal the pulp before the condition becomes irreversible.