Pulpitis

Pulpitis
ICD-10	K04.0
ICD-9	522.0
DiseasesDB	29367
MeSH	D011671

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Pulpitis is an inflammation of the dental pulp.

Causes of Pulpitis

• Caries that penetrate though the tooth enamel, the dentin, and into the pulp
• Repeated dental procedures or tooth trauma

Regardless of the cause of pulpitis the inflammation can be associated with a bacterial infection. As in the case of a carie that penetrates the pulp cavity the tooth is no longer sealed to infectious pathogens, where as when the blood supply is cut off to the pulp, bacteria have an opportunity to over take the pulp.

When the pulp becomes inflamed pressure begins to build up in the pulp cavity exerting pressure on the nerve of the tooth and the surrounding tissues. Pressure from inflammation can cause mild to extreme pain, depending upon the severity of the inflammation. Often, pulpitis can create so much pressure on the tooth nerve the individual will have trouble locating the source of the pain, confusing it with neighbouring teeth. Inflammation in the tooth provides a difficult environment for reducing the inflammation in the pulp cavity. Unlike other parts of the body where pressure can dissipate through the surrounding soft tissues and where lymph can reach, the pulp cavity is very different. The dentin surrounding the pulp is hard and does not give under the pressure of the inflammation so the pressure has very little chance of dissipating before pulp necrosis occurs. The pulp cavity inherently provides the body with an immune system response challenge, which makes it very unlikely that the bacterial infection can be eliminated. The pain will usually stop once the pulp has died, however the infection can spread to the ancillary anatomy.

Differential Diagnosis of Pulpitis

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Trauma	No underlying causes
Miscellaneous	No underlying causes

Treatment

Once the pulp has become inflamed the tooth can be diagnostically divided into two categories.

• reversible pulpitis
• irreversible pulpitis

Reversible pulpitis

Once the irritant is removed the pulp remains vital and is not unduely affected by the changes.

Irreversible pulpitis

The pulp is irreversibly damaged and necrosis will follow. Pain may not subside after removal of the irritant. Pain may be sharp or dull and throbbing. If there is any drainage then severity of pain is reduced

The tooth may be endodontically treated where by the pulp is removed and replaced by gutta percha. An alternative is extraction of the tooth. This may be required if there is insufficient coronal tissue remaining for restoration once root canal therapy has been completed.

Template:Oral pathology
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