This document discusses different types of pulpitis, inflammation of the dental pulp. It defines reversible pulpitis as a mild inflammation where the pulp can return to normal after stimulus removal. Irreversible pulpitis is a persistent inflammation where pain lasts for minutes to hours after stimulus removal. Pulp necrosis occurs when the pulp has died, either partially or totally. The document provides details on causes, symptoms, diagnosis, and treatment for each type of pulpitis.

2. PULPITIS
Dr. Syed Sarosh Hussain
House officer HUDH

3. Content
■ Introduction
■ Etiology
■ Classification
■ Diagnosis
■ Treatment

4. Introduction
■ Dental Pulp is a delicate connective tissue liberally interspersed with tiny blood
vessels, lymphatic, nerves and Undifferentiated connective tissue cells.
■ It reacts to bacterial infection or to other stimuli by an inflammatory response
known as Pulpitis.

5. Etiology
■ Dental Caries (most common)
■ Trauma
■ Cracked tooth syndrome
■ Thermal
■ Chemical

6. Classification
■ On the basis of severity of inflammation:-
1. Reversible Pulpitis
2. Irreversible Pulpitis
3. Pulp Necrosis

7. 1. Reversible Pulpitis
■ It is a mild to moderate Inflammatory condition of the pulp caused by noxious
stimuli in which the pulp is capable of returning to its normal state following
removal of stimuli.

8. Clinical features
■ Short sharp pain lasting for a moment.
■ Does not occur spontaneously and does not continue when the cause has been
removed.
■ Sensitivity to cold, hot or maybe air.
■ Symptoms resolve quickly after stimulus is removed.
■ Pain response to cold is immediate.
■ Pain response to hot initially delayed.
■ No radiographic changes evident.

9. Diagnosis
Patient symptoms and clinical test:-
■ Pain
■ Visual examination and History.
■ Radiograph
■ Percussion test.
■ Vitality test.

10. Treatment
■ The best treatment for Reversible Pulpitis is prevention.
■ Periodic care to prevent the development of caries, early insertion of a filling if a
cavity has developed.
■ Desentization of necks of teeth where gingival recession is marked.
■ Use of cavity varnish or cement base before insertion of filling and care in cavity
preparation and polishing are recommended to prevent pulpitis.

11. 2. Irreversible Pulpitis
■ It is persistent inflammatory condition of pulp either
Symptomatic or Asymptomatic caused by a noxious
stimulus.
■ The pain persists for several minutes to hours,
Lingering after removal of thermal stimulus.
■ Most common cause is bacterial involvement of pulp
through caries.
■ Any Clinical, Chemical, Thermal factor can also cause
Irreversible Pulpitis.

12. Clinical features
■ Intermittent or continuous or spontaneous pain.
■ Pain last several minutes to hour even after removal
of stimulus.
■ Localization of pain is difficult, may radiate.
■ Inflammation in PDL causes percussion sensitivity.
■ Radiograph may show slightly widened PDL.
■ Occasionally erosion of Lamina Dura.
■ Subdivided as Symptomatic and Asymptomatic
Pulpitis.

13. Diagnosis
Patient symptoms and clinical test:-
■ Pain
■ Visual examination and History.
■ Radiograph
■ Percussion test.
■ Vitality test.

14. Treatment
■ Treatment consists of complete removal of pulp or pulpectomy.
■ In posterior teeth, in which time is a factor, the removal of coronal pulp or
Pulpectomy should be performed in emergency procedure.
■ Surgical removal should be considered if tooth is not restorable.

15. 3. Pulp Necrosis
■ Death of the pulp.
■ Maybe partial or total depending on part or the entire pulp is involved.

16. Clinical features
■ Symptoms often similar to irreversible pulpitis.
■ Patient’s previous pain history.
■ Maybe spontaneous pain or complete absence
of pain.
■ May have little radiographic changes.
■ May have obvious radiographic pathology.
■ Discoloration of tooth is the first indication,
when pulp is dead.

17. Treatment
■ Complete removal of pulp (RCT).
■ Obturation of the root canal.