Dental Pulpitis: What It Is, Symptoms, and How It Is Detected

The diagnosis of "pulpitis" is made when the pulp becomes inflamed — the inner tissue of the tooth containing the nerve and blood vessels. Below: what this tissue is, why infection gets into it, how inflammation of the dental nerve manifests, and by what methods the doctor confirms the diagnosis.

What pulpitis is and what the dental pulp is

Pulpitis is inflammation of the inner tissues of the tooth, that is, the pulp. The pulp is located inside the root canal and contains the nerve, blood vessels, and connective tissue cells, and from within it provides nourishment to the hard tissues of the tooth. Inflammation occurs when infection enters the pulp chamber. By course, pulpitis is divided into acute and chronic; in ICD-10 they fall within block K04 "Diseases of pulp and periapical tissues" — for example, K04.00 (initial, pulp hyperemia), K04.01 (acute), K04.03 (chronic).

Why pulpitis develops

Infection enters the pulp by two routes: intradentally, through the tooth crown, and retrogradely, through the opening at the root apex. Most often pulpitis becomes a complication of caries, including recurrent caries under a filling. Iatrogenic causes have been described: tooth preparation for prosthetic restorations, poor-quality filling materials, periodontal interventions, exposure to chemicals. Among physical factors are overheating of the pulp during preparation without cooling, opening of the tooth cavity, crown fracture with opening of the pulp chamber, as well as denticles and pulp stones, which are deposited in the pulp tissues, compress blood vessels, and impair microcirculation.

Symptoms of pulpitis: how inflammation of the dental nerve manifests

Acute pulpitis begins as focal serous inflammation, then purulent exudate appears, and the pain intensifies due to the accumulation of pus in the closed pulp chamber. The focal stage lasts about 2 days: the tooth is sensitive to thermal stimuli, mainly to cold, and the pain continues after the stimulus is removed — this is how pulpitis differs from caries. Tapping on the tooth is painless or only slightly painful, unlike periodontitis.

• throbbing pain and increased sensitivity to temperature;
• pain that does not pass immediately after removal of the stimulus;
• radiation along the branches of the trigeminal nerve, worsening of pain at night;
• in chronic purulent pulpitis — sensitivity to hot, while cold soothes.

In the diffuse form, the pain radiates along the branches of the trigeminal nerve and intensifies at night; in exacerbation of chronic pulpitis it is paroxysmal and spontaneous. Chronic fibrous pulpitis often runs asymptomatically; in the hypertrophic form, a fibrous polyp is visible in the carious cavity.

How pulpitis is detected and what is visible on X-ray

The doctor examines the teeth, gums, and mouth and taps on the tooth: this may be painful, and tight clenching of the mouth intensifies the pain. X-ray and other examinations help determine which tooth or teeth caused the problem.

Why pulpitis is dangerous and when to see a dentist

Without treatment, pulpitis leads not only to tooth loss: inflammation spreads to the tissues of the jaw, and with severely reduced immunity, sepsis is possible. Complications of advanced infection include spread to soft tissues, the jawbone, and other areas, up to brain abscess, heart inflammation, and pneumonia; swelling of the upper or lower jaw is a very serious sign. A dentist should be consulted for prolonged throbbing pain, for pain from hot and cold, for swelling of the gum above the tooth or the appearance of a blister on the gum resembling a pimple. The approach is chosen by the doctor: some techniques allow preserving the viability of the nerve and nourishing vessels rather than removing the pulp completely.

Pulpitis by itself is not a reason to call an ambulance; 103 or 112 — if, against the background of toothache, it is difficult to breathe, speak, or swallow, if the eye is swollen or painful, if vision problems suddenly appear, if there is severe swelling in the mouth, if it is difficult to open the mouth.

This material is for reference: it does not replace a dentist's consultation, and you make the decision on the approach together with the doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer