Pulpitis

Overview

What is pulpitis?

Pulp is the soft inner tissue of your teeth. It contains nerves, blood vessels and connective tissue. The pulp supplies blood and nutrients to the hard, outer layers of your teeth to keep them healthy.

Pulpitis is an inflammation of the pulp. It usually happens when there’s an irritation inside a tooth due to things such as grinding or a cavity.

What are the types of pulpitis?

There are two types of pulpitis. Dentists classify them based on the extent of the infection:

  • Reversible pulpitis: In this early stage, pulpitis is reversible if your dentist repairs the tooth and seals it with a filling.
  • Irreversible pulpitis: In this stage, the inflammation is more advanced and the tooth can’t recover. The pulp tissue will eventually die. This is pulp necrosis.

How common is pulpitis?

Pulpitis is very common. The U.S. Centers for Disease Control and Prevention (CDC) estimates about 1 in 4 adults between the ages of 20 and 64 have untreated cavities that can lead to pulpitis.

Symptoms and Causes

What are the symptoms of pulpitis?

Toothache and sensitivity are the main symptoms of pulpitis. The pain you feel usually varies depending on the stage of the inflammation.

Symptoms of reversible pulpitis include:

  • No pain when your dentist taps the tooth.
  • No sensitivity to heat.
  • Sensitivity to cold or sweets that goes away quickly. People often describe this as a sharp pain.

With irreversible pulpitis, you may experience:

  • Pain when your dentist taps the tooth.
  • Sensitivity to heat, cold or sweets that lasts more than a few seconds. This can be a throbbing, aching or sharp pain.

If pulp necrosis occurs and the nerve tissue dies, you may not have any sensitivity to heat, cold or sweets. But your tooth may still hurt when your dentist taps it.

What causes pulpitis?

The hard enamel of your tooth protects the pulp. If the enamel becomes damaged, it could lead to pulpitis. Tooth damage can occur from:

  • Cavities: Bacteria in your mouth produce acid that can eat away at your enamel and create holes.
  • Cracks: Small cracks can happen if you chew on hard foods or injure your tooth.
  • Dental procedures: Treatment of a tooth alone can cause pulpitis. If a tooth isn’t sealed correctly during a dental procedure, it can allow the filling to leak and cause pulpitis, too.
  • Worn enamel: Grinding your teeth or brushing aggressively can wear down your enamel and make the nerve more susceptible to inflammation.

Diagnosis and Tests

How is pulpitis diagnosed?

One of the main ways that dentists diagnose pulpitis is by assessing the sensitivity of your tooth. Types of sensitivity tests include:

  • Electric pulp testing: This test determines if your pulp is still alive or if the infection has progressed to pulp necrosis. Your dentist uses an instrument to deliver a small electrical pulse to the tooth. If your pulp is alive, you’ll feel the stimulation. If the pulp tissue is dead, you won’t feel the electrical pulse.
  • Heat or cold test: Your dentist will touch your teeth with a hot or cold substance. In irreversible pulpitis, sensitivity lasts for longer than a few seconds. If the pulp tissue is dead, you won’t feel any sensitivity.
  • Tooth tapping: This involves a gentle tapping on your tooth. Pain with tapping is a sign of irreversible pulpitis.

Your dentist will also take dental X-rays to look for defects in the tooth and signs of infection.

Management and Treatment

How is pulpitis treated?

For reversible pulpitis, your dentist will try to remove the cause. Often, this involves the removal of the decay and sealing the tooth with a normal filling.

Irreversible pulpitis requires more intensive treatment to remove the pulp tissue. Treatment options include:

  • Root canal: You usually go to an endodontist (a dentist who specializes in treating pulp infections) for a root canal. They remove the infected pulp and clean out the root. Next, they fill the empty root canal and seal the tooth. You’ll return to your dentist a few weeks later for a crown to cap your tooth.
  • Tooth removal: Some people opt for tooth extraction. Your dentist will discuss your options for replacing the tooth, including a dental implant or dental bridge.

Antibiotics aren’t a treatment for pulpitis, but they may help prevent the problem from progressing into an infection if there’s a delay in your treatment.

What are the possible complications of pulpitis?

Left untreated, pulpitis can spread, leading to infection or an abscess. This can cause:

  • Pain.
  • Fever.
  • Swollen neck glands.

If the area does become infected, it can also spread to your jawbone (osteomyelitis) and the soft tissues in your head, neck and chest. If not treated, these infections can be life-threatening.

Prevention

How can I prevent pulpitis?

Good oral hygiene is the best way to prevent pulpitis. This consists of:

  • Brushing your teeth two times a day.
  • Flossing every day.
  • Seeing your dentist for routine cleanings and checkups.
  • Wearing a night guard if you grind your teeth at night.

Also, make sure to let your dentist know right away if you’re having any tooth pain or sensitivity.

Outlook / Prognosis

What is the outlook for pulpitis?

Pulpitis is highly treatable but can become problematic if it continues and causes an infection. In the past, people frequently died from tooth infections that spread. But today, advancements in antibiotic therapy, imaging technology and surgical treatments have greatly improved the prognosis of these infections.

Living With

When should I see my dentist?

Talk to a dentist if you have any tooth pain or notice any new sensitivity to hot, cold or sweet foods or beverages. With early treatment, you’ll spend less time in a dentist’s chair and be less likely to develop a more serious condition.

A note from Cleveland Clinic

Pulpitis is an inflammation of the pulp, the soft inner tissue of your teeth. Pulpitis is reversible if you identify it early. Your dentist will treat the cause and expect the symptoms to resolve. The main sign that the pulpitis has progressed to irreversible pulpitis is a lingering sensitivity to heat or cold. In this case, you’ll need a root canal or tooth extraction. Let your dentist know right away if you develop any new sensitivities in your teeth. With daily brushing and flossing and routine visits to the dentist, you can keep your teeth healthy and prevent pulpitis.

Last reviewed by a Cleveland Clinic medical professional on 07/18/2022.

References

  • American Association of Endodontists. Endodontic Diagnosis. (http://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/endodonticdiagnosisfall2013.pdf) Accessed 7/18/2022.
  • Centers for Disease Control and Prevention. Dental Caries Among Adults and Older Adults. (https://www.cdc.gov/oralhealth/publications/OHSR-2019-dental-carries-adults.html) Accessed 7/18/2022.
  • Dentaly.org. What is Pulpitis? Your Complete Guide to Symptoms and Treatment. (https://www.dentaly.org/us/pulpitis/) Accessed 7/18/2022.
  • Erazo D, Whetstone DR. Dental Infections. (https://www.statpearls.com/ArticleLibrary/viewarticle/20354) [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 7/18/2022.
  • Patient. Tooth Decay. (https://patient.info/oral-dental-care/toothache/tooth-decay) Accessed 7/18/2022.

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