Pulpitis is one of the common oral diseases that can severely affect oral health if not treated promptly. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 25% of adults aged 20-64 have dental caries. If not intervened in time, dental caries can progress to pulpitis, causing pain and the risk of tooth loss.
So, what is pulpitis? What causes this condition? How can it be recognized and prevented? Let’s find out in detail with My Auris in the article below.
What is pulpitis?
Pulpitis is an inflammatory condition that occurs in the dental pulp, the soft tissue located deep inside the tooth. The dental pulp plays a crucial role in nourishing and maintaining the life of the tooth, including connective tissues, nerves, and blood vessels. When the dental pulp becomes inflamed, bacteria can penetrate through cavities or cracks on the tooth surface, causing severe pain and seriously affecting oral health.
To better understand pulpitis, we need to grasp the structure of a tooth. A tooth is composed of three main layers:
- Enamel: The outermost, hard layer, protecting the tooth from external impacts.
- Dentin: The layer beneath the enamel, less hard, containing dentinal tubules connected to the dental pulp.
- Dental pulp: The innermost layer, containing connective tissues, nerves, and blood vessels, responsible for nourishing and sensing the tooth.
According to the American Dental Association (ADA), the dental pulp is an important component with an essential role in the life of the tooth.
What are the signs to recognize pulpitis?
Pulpitis is a condition of damage to the pulp tissue inside the tooth, causing severe tooth pain and many other uncomfortable symptoms. Early recognition of pulpitis signs helps patients seek timely treatment, avoiding dangerous complications such as pulp necrosis.
In the initial stage, pulpitis can be reversible if treated correctly. Common symptoms include:
Temporary tooth sensitivity: When eating sweets or drinking cold water, a sharp sensation appears but quickly disappears.
No pain during dentist’s examination: If the dentist gently taps the tooth with an instrument and it doesn’t cause pain, pulpitis may not be severe.
No reaction to temperature: The tooth is not irritated when exposed to excessively hot or cold food.
If left untreated, pulpitis can become severe and irreversible. At this point, the patient may experience:
Prolonged toothache: The pain can be dull or severe, especially when eating or at night.
Prolonged sensitivity to temperature: A sharp sensation when eating sweets, hot or cold food lasting more than 30 seconds.
Pain when pressure is applied: Pain when chewing or when the dentist gently taps the tooth.
Gum swelling around the tooth: Inflammation, redness, or swelling may appear in the affected tooth area.
Bad breath, mild fever: Bad breath due to bacterial growth, accompanied by mild fever in some cases of infection.
If pulpitis persists and is not treated, the dental pulp can become necrotic, leading to a loss of temperature sensation but still causing pain when pressure is applied. This condition can lead to a tooth abscess, jawbone inflammation, or widespread infection.
5 Causes of Pulpitis
The dental pulp is the crucial central part, containing nerves and blood vessels that nourish the tooth. Pulpitis occurs when the protective enamel layer is damaged, allowing bacteria to penetrate. Here are the main causes of this condition:
Periodontitis
Periodontitis is a common disease affecting the gums and jawbone. If not treated promptly, infection from the gums can spread down to the tooth root, allowing bacteria to enter the dental pulp through the apical foramen, causing severe inflammation.
Tooth decay – The primary culprit behind pulpitis
When bacteria in the oral cavity break down food, they produce acids that erode tooth enamel and form cavities. If not treated promptly, tooth decay can spread to the dentin and dental pulp, causing severe pain and infection. Improper brushing habits or excessive consumption of sugary foods are common causes of tooth decay.
Cracked tooth
Cracks in teeth can appear due to trauma, chewing overly hard foods, or teeth grinding habits. When a tooth is cracked, the dental pulp is at risk of exposure, allowing bacteria to penetrate and cause inflammation. Small cracks, in particular, may not be easily noticeable but still pose a potential risk of pulpitis.
Enamel erosion
Enamel erosion can occur due to brushing too hard, using hard-bristled toothbrushes, or teeth grinding during sleep. When enamel is worn down, the underlying dentin layer becomes exposed, making the tooth more sensitive and susceptible to pulpitis if bacteria attack.
Dental procedures
Interventions such as fillings, dental crowns, or improperly performed dental treatments can lead to pulpitis. If filling materials are not placed correctly or leak, bacteria can easily penetrate and damage the tooth root. Choosing a reputable dental clinic with experienced dentists is essential to avoid this complication.
Factors that increase the risk of pulpitis
Pulpitis is a serious inflammatory condition inside the tooth, often caused by bacteria entering the pulp through damage or tooth decay. Below are the risk factors for pulpitis that you need to be aware of:
Weakened immune system: People with weakened immune systems, especially diabetic patients, are more susceptible to infections, including dental pulp infections. When blood sugar levels are not well controlled, bacteria have a greater chance to thrive, increasing the risk of tooth decay and pulpitis.
Dental trauma from sports: Strong impacts during sports or accidents can cause cracked or chipped teeth, creating an entry point for bacteria into the pulp. To protect your teeth, wear a mouthguard when playing high-contact sports.
Diet high in sugar and refined carbohydrates: A diet rich in sugar and refined carbohydrates promotes the formation of dental plaque, creating a favorable environment for bacteria to grow. This leads to enamel destruction, dentin attack, and can cause pulpitis. Limiting high-sugar foods and increasing consumption of green vegetables and calcium-rich foods helps strengthen teeth.
Poor oral hygiene: Not brushing correctly, not using dental floss, or skipping regular dental check-ups will increase the risk of tooth decay and pulp inflammation.
Classification of pulpitis by severity
Pulpitis is a condition of pulp tissue damage due to infection or external factors such as tooth decay or tooth cracks. Based on its extent and progression, pulpitis is divided into two main groups:
Classification of pulpitis by extent of damage
Reversible pulpitis
This is an early stage of the disease, when the pulp tissue is only temporarily irritated. The patient may feel transient pain when exposed to hot, cold food, or excessively high-temperature drinks. However, this sensation will disappear when the stimulating agent is no longer present. Common causes include tooth decay or minor tooth cracks. If detected early and treated promptly by a dentist, this condition can be managed without extensive intervention.
Irreversible pulpitis
At this stage, the pulp tissue has been severely damaged and cannot recover. Prolonged inflamed dental pulp will lead to necrosis, causing severe pain. The patient may experience:
Pain lasting more than 30 seconds when exposed to hot or cold food.
Spontaneous pain, which may radiate to the ear, jaw, or temple.
Increased pain when lying down or at night.
When the infection spreads, the area around the tooth may become swollen.
In many cases, the infection has not spread to the apex of the tooth, making diagnosis difficult. If left untreated, irreversible pulpitis can lead to tooth loss or dangerous complications.
Classification of pulpitis by stage
Acute pulpitis
This stage is characterized by severe, prolonged pain even without the influence of food. The patient feels discomfort when chewing, especially when food falls into the inflamed area. If pulpitis progresses to suppurative pulpitis, the pain symptoms will become more severe, seriously affecting daily life and quality of life.
Chronic pulpitis
Unlike acute pulpitis, chronic pulpitis progresses more slowly. The pain can last for hours, but in some cases, the patient only feels mild pain when chewing. Because the symptoms are not too severe, many people tend to be complacent, allowing the disease to progress silently to a more severe stage.
Is pulpitis dangerous?
Pulpitis not only causes severe pain, but if not treated promptly, it can lead to serious tooth infections, affecting the jawbone and important organs in the body.
When pulpitis progresses, bacteria can penetrate deep into the tooth, causing:
Dental abscess: Formation of a pus pocket around the tooth root, causing severe pain.
Periapical inflammation, periapical abscess – Damage to the bone around the tooth root, causing the tooth to loosen.
Cellulitis: Spread of infection to the soft tissues of the cheek, chin, neck, causing swollen neck glands and high fever.
Osteomyelitis: Infection spreading into the jawbone, causing severe bone loss.
If bacteria from the tooth spread, they can cause a series of dangerous complications:
From upper jaw teeth:
- Purulent sinusitis, meningitis, even brain abscess due to bacteria traveling through the bloodstream.
- Orbital cellulitis, causing swelling and affecting vision.
- Cavernous sinus thrombosis, a life-threatening infection.
From lower jaw teeth:
- Ludwig’s angina: Airway obstruction due to severe swelling in the neck region.
- Parapharyngeal abscess, mediastinitis, which can cause shortness of breath and be life-threatening.
- Pericarditis, pleurisy, leading to severe impairment of heart and lung function.
- Jugular vein phlebitis, leading to the risk of sepsis.
Methods for diagnosing pulpitis
Pulpitis is a serious condition that, if not detected promptly, can lead to pulp necrosis and affect oral health. To diagnose pulpitis, dentists will perform a series of tooth sensitivity tests to determine the extent of pulp tissue damage.
Electric Pulp Test
This method helps assess the activity of the dental pulp by using low-intensity electrical impulses. If the pulp is alive, the patient will feel a stimulus. Conversely, if the pulp tissue has necrotized, the tooth will not react to the electrical impulse. This is an important method for determining the extent of pulp damage.
Hot/Cold Test
The dentist will apply hot or cold substances directly to the tooth to check the pulp’s reaction. If the pulpitis is irreversible, the patient will feel a lingering sensitivity for more than 30 seconds. In cases where the pulp tissue has died, the tooth will no longer have any sensation.
Percussion test to check reaction
The doctor will use a dental instrument to gently tap the tooth to assess the pain response. If pain occurs, especially when tapping the apical area, the patient may be experiencing irreversible pulpitis.
Dental X-ray
This is an important method to assess the extent of infection spread. Dental X-rays help determine whether the dental pulp is severely damaged and rule out other oral diseases.
Can pulpitis heal on its own? The truth you need to know
No, it cannot! Pulpitis is not capable of self-healing and requires timely medical intervention. If not treated correctly, the tooth infection can spread, forming an apical abscess and causing many dangerous complications such as tooth abscess, periapical periodontitis, or even permanent tooth loss.
Why can’t pulpitis heal on its own?
Pulp structure: The dental pulp is a soft tissue rich in nerves and blood vessels. When inflamed, bacteria cause severe damage that cannot spontaneously regenerate like other tissues in the body.
Disease progression: Pulpitis often develops through several stages. If not treated promptly, the dental pulp necroses, leading to widespread infection, weakening the jawbone, and affecting overall health.
High risk of complications: Bacteria in the tooth can travel through the bloodstream, causing sinusitis, cellulitis, and even affecting the cardiovascular system if not controlled early.
Effective methods for treating pulpitis
Pulpitis is an inflammatory condition of the pulp tissue inside the root canal, causing pain and potentially leading to serious complications if not treated promptly. Depending on the extent of the damage, the dentist will propose appropriate treatment methods.
When pulpitis is in a mild, reversible stage, the dentist will remove the cause of the disease – usually tooth decay – and perform a filling to protect the pulp tissue.
For irreversible pulpitis, more specialized treatment methods will be applied:
Root canal treatment (pulp removal)
When the pulp tissue is severely damaged but the tooth can still be preserved, the dentist will perform root canal treatment, including:
Removal of the inflamed pulp tissue
Cleaning and disinfecting the root canal
Filling the root canal to prevent bacterial re-entry
Aesthetic restoration with a dental crown to protect the tooth structure
After treatment, patients need to revisit for check-ups to ensure good tooth recovery.
Tooth extraction
If pulpitis has spread widely, making it impossible to save the tooth, the dentist may recommend tooth extraction. After extraction, the patient can choose from restorative options such as:
Dental implant: Replacing the missing tooth with an implant post integrated into the jawbone, helping to restore chewing function and aesthetics.
Dental bridge: Using a fixed dental crown attached to two adjacent teeth to fill the gap.
Using supportive treatment medication
Although antibiotics cannot cure pulpitis, they can help control the infection in cases where immediate intervention is not possible. Additionally, the doctor may prescribe pain relievers or non-steroidal anti-inflammatory drugs (NSAIDs) to help the patient feel more comfortable while awaiting treatment.
How to relieve pulpitis pain at home: Temporary solutions
Pulpitis is a serious condition that can cause severe pain, affecting daily activities. While waiting for a dental appointment, you can apply some home remedies for pulpitis to temporarily relieve toothache.
Use over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce inflammation and pain effectively. Acetaminophen (paracetamol) is an alternative if you cannot take NSAIDs.
Topical dental anesthetics: Gels or solutions containing benzocaine or lidocaine can be applied directly to the inflamed tooth and gums to numb the pain. Do not use for children under 2 years old or individuals with a history of allergy to these active ingredients.
Cold compress for tooth: Wrap an ice pack in a thin cloth and apply it to the cheek near the aching tooth for 15-20 minutes. This helps constrict blood vessels, reduce swelling, and temporarily soothe the pain.
Saltwater rinse: Dissolve a teaspoon of salt in warm water, rinse your mouth 2-3 times a day to clean bacteria and reduce inflammation.
Clove oil as a natural pain relief solution: Soak a few drops of clove oil on a cotton swab and dab it on the aching tooth. Eugenol, an active ingredient in cloves, has pain-relieving effects similar to anesthetics.
Garlic for toothache: Crush a clove of garlic and apply it to the aching tooth or inflamed gum. Allicin in garlic has anti-inflammatory properties, helping to reduce pain effectively.
Banana leaves for toothache: Crush young banana leaves, extract the juice, soak a cotton pad with it, and place it on the aching tooth for about 3 minutes. Banana leaves contain active compounds that help reduce inflammation and soothe pain.
Green tea rinse: Rinse your mouth with green tea 2-3 times a day to fight bacteria and support healthier gums and teeth.
Effective ways to prevent pulpitis
Pulpitis is an inflammatory condition that occurs inside the tooth, affecting the nerves and blood vessels in the root canal. If not treated promptly, the disease can cause severe pain, dental abscess, or permanent tooth loss. Therefore, preventing pulpitis is extremely important to protect oral health.
Brush your teeth at least twice a day with fluoride toothpaste to remove plaque and bacteria. Use dental floss daily to clean food stuck between teeth, reducing the risk of tooth decay leading to pulpitis.
Have a dental check-up every 6 months to detect early problems such as tooth decay, enamel erosion, or gingivitis that can progress to pulpitis. Regular scaling helps remove bacteria and limit the risk of infection.
If you have a habit of grinding your teeth at night, use a nightguard to prevent enamel erosion, helping to protect the dental pulp.
Limit biting hard foods such as ice cubes or hard candies as they can crack or chip teeth, creating an entry point for bacteria into the dental pulp. Reduce consumption of sugary foods and hot, cold drinks, as they can irritate teeth and increase the risk of tooth decay.
Limit foods high in carbohydrates, and instead, supplement with calcium- and vitamin D-rich foods for strong teeth.
Although there are many temporary ways to relieve pulpitis pain, self-treating at home can worsen the condition. Therefore, as soon as symptoms appear, you should visit a dentist for an accurate diagnosis and appropriate treatment plan.
