Pulpitis – Types, Causes, Symptoms & Treatment

What is Pulpitis?

Pulpitis occurs when the pulp, or the tissue in the center of a tooth, becomes inflamed. The dental pulp is a bundle of connective tissue that sits below dentin. It contains the teeth’s sensory nerves and blood vessels.¹

Depending on the extent of the pulp inflammation, pulpitis can either be reversible or irreversible.²

Reversible Pulpitis

People with reversible pulpitis have mild inflammation of the dental pulp. A dental filling can usually successfully resolve this problem. 

Irreversible Pulpitis

People with irreversible pulpitis have inflammation of the dental pulp chamber. At this point, the pulp damage is irreversible and root canal treatment is needed. If irreversible pulpitis is left untreated, it can cause necrosis, or tissue death, of the pulp and lead to an infection. 

Treatment Options for Pulpitis

The best treatment option for pulpitis depends on whether it is reversible or irreversible.

Treatments and prognosis for reversible pulpitis

To treat reversible pulpitis, a dentist will often:

• Remove the cause, such as cavities or leaking restoration materials (crowns, fillings, sealants, etc.)
• Restore or cover damaged parts of teeth by placing sealers or crowns in regions with exposed dentin
• Schedule regular check-ups to ensure symptoms are not worsening
• Advise you to schedule an appointment if symptoms worsen

Many people who receive treatment for reversible pulpitis can save their damaged tooth. One 2021 study examined people with reversible pulpitis caused by tooth cracks. 72% of the people who received splinting and 94% who had a crown placed still had a healthy pulp 4 years after treatment.⁴

Treatments and prognosis for irreversible pulpitis

Most people with irreversible pulpitis undergo a root canal treatment or tooth extraction.

A dentist removes the damaged tooth pulp during a root canal. If a root canal is successful, you may be able to save your tooth. The tooth will still receive nourishment from the surrounding blood vessels and tissues even without a viable pulp.

If a root canal is not possible given the extent of the problem, your tooth may be extracted.⁵ How long it takes to recover from a tooth extraction depends on how complex the surgery was. 

Most people recover and can return to regular activities 48 to 72 hours after having an extraction. But it often takes the jawbone several weeks to fully heal. If you get a dental implant after extraction, it will probably take a few months to fully complete treatment.

Symptoms of Pulpitis

The symptoms you experience with pulpitis depend on whether you have reversible or irreversible pulpitis.

Reversible pulpitis tends to cause temporary tooth pain when you expose teeth to cold or sweet foods or beverages. This tooth pain tends to go away 1 to 2 seconds after exposure stops.³

Pain from irreversible pulpitis is typically intense and can:

• Occur spontaneously or randomly
• Linger for a few minutes after exposure to hott or cold
• Cause pain in other parts of the mouth, which makes it hard to tell where the pain originates (referred pain) 
• Inflame the tissues surrounding the impacted tooth

If irreversible pulpitis progresses to necrosis, pain to hot or cold will not be present, but chewing pain will be. Necrosis may also cause your tooth to feel higher than normal when you bite. 

What Causes Pulpitis?

Common causes of pulpitis include:

• Dental caries (cavities) or tooth decay
• Tooth injury 
• Having multiple fillings or invasive dental procedures like crowns 
• Grinding or clenching the teeth

Pulpitis often begins as reversible pulpitis and progresses to irreversible pulpitis. 

When to See a Dentist for Pulpitis

Cases of reversible and irreversible pulpitis both require professional dental care.

Talk to a dentist if you experience:

• New or worsening tooth sensitivity or tooth pain 
• Inflamed, tender, or bleeding gums
• Severe pain while biting or chewing
• Pimples or sores on gums
• Cracked or chipped teeth
• Darkening of the gums 
• Teeth that look discolored or diseased

How is Pulpitis Diagnosed?

To diagnose pulpitis, a dentist will ask questions about your symptom, take dental X-rays, and examine your teeth. During their examination, they may perform a sensitivity test, where they expose teeth to triggers like heat, cold, or pressure.

A dentist may check to see if your tooth’s dental pulp is still alive using an electric pulp tester. If you feel a small electrical charge when the dentist uses the pulp tester, the pulp is still alive. Your pulp is likely dead If you don’t feel anything.

Dental X-rays can help determine if the inflammation has spread beyond the pulp. Dental X-rays can also help rule out other conditions.  

Can You Prevent Pulpitis?

There are several things you can do to help prevent pulpitis.

Tips include:

• Practice good oral hygiene
• Visit the dentist regularly
• Limit consumption of sugary or sweet foods and drinks
• Limit consumption of acidic foods and drinks
• Avoid grinding or clenching the teeth, or other similar habits 
• Wear a mouthguard to protect the teeth against nighttime grinding

Pulpitis Complications 

Potential complications associated with pulpitis include:

• Periodontitis —  gum infections
• Dental or periapical abscess — bacterial nerve-related infections
• Cellulitis — bacterial infections that have progressed to the head or neck
• Osteomyelitis — inflammation and pain in the jawbones

More rarely, infections or inflammation from pulpitis can spread and cause:

• Sinusitis — infection and swelling in the lining of the nose
• Meningitis — infection and swelling in the membranes surrounding the spinal cord and brain
• Brain abscesses — infections in brain matter
• Orbital cellulitis — infections and swelling in the muscles and fat around the eye
• Cavernous sinus thrombosis — blood clots in part of the sinuses

Summary

Pulpitis occurs when a tooth’s dental pulp, a bundle of connective tissue in the tooth’s center, becomes inflamed and pain occurs. It tends to cause pain when teeth are exposed to hot, cold. or sweet things. It often occurs due to damaged teeth, tooth decay, or defective dental work.

Talk with a dentist about tooth sensitivity that causes spontaneous pain or lingers after exposure to triggers. People with reversible pulpitis may be able to save their teeth with proper dental care. If you have irreversible pulpitis, you will likely need to undergo a root canal treatment or have the tooth extracted.