Pulpitis is inflammation of the dental pulp that is most commonly caused by dental caries. Left untreated, pulpitis can lead to pulp necrosis, periapical periodontitis, and tooth loss. The document describes the causes, clinical features, classifications, and management of pulpitis. Pulpitis causes severe, sharp pain that is difficult to relieve with analgesics and requires endodontic treatment or extraction.

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PULPITIS
Dr. Sarang Suresh Hotchandani

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Pulpitis is Most Common Cause of;
Dental Pain
Loss of tooth in
younger age
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Causes of Pulpitis
 Dental Caries (Most Common)
 Trauma
 Cracked tooth syndrome
 Thermal
 Chemical
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If Pulpitis Not Treated this will happen!
Pulpitis
Pulp Necrosis
Periapical
Periodontitis
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Clinical Features of Pulpitis
 Patient unable to localize from which tooth
pain is originating.
 Because pulps of individual teeth are not sensed
precisely on Sensory Cortex.
 Sometimes pulpitis pain is referred;
 E.g. mandibular molars to ear.
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Clinical Features of Pulpitis
 There is no any pain on applying
pressure/palpation/percussion on tooth in
pulpitis.
 If pain is present on pressure it is always periapical
periodontitis; inflammation of PDL.
 But sometimes, when there is frank cavity in tooth, the
impacted food particles sometimes apply pressure
through soft & thin dentine.
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Clinical Classification of Pulpitis
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Acute Pulpitis
(Early Stage Acute Pulpitis)
 Tooth is hypersensitive
 Very cold/hot stimuli cause stabbing
pain, relieved by removing stimuli.
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Acute Pulpitis
(Late Stage Acute Pulpitis)
 Duration of pain increases & it is
persistent.
 Pain starts spontaneously often
when patient try to sleep.
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Pain of Pulpitis Occurs due to;
 Presence of inflammatory infiltrate in
closed pulp chamber on irritated nerve
endings.
 Pain producing substances from
damaged pulp.
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Characteristics of Acute Pulpitis Pain
 Sever
 Sharp
 Stabbing
 Can’t relieved by simple analgesics.
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Clinical Classification of Acute Pulpitis
Acute Pulpitis
Irreversible
Acute Pulpitis
Reversible
Acute Pulpitis
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Characteristics of Irreversible
Acute Pulpitis
 Constant sever pain even after
removal of stimuli.
 Treatment; Root Canal Therapy
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Outcome of untreated Acute Pulpitis!
 Chronic Pulpitis
 Pulp Necrosis
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Chronic Pulpitis
 Spontaneous attack of dull pain for
hours or more
 It may or may not be due to acute
pulpits.
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Acute Closed Pulpitis
(Histologic Findings)
 Pulp hyperemia
 Infiltration of inflammatory exudate
 Some areas of necrosis leading to micro
abscesses
 If left untreated for long time can lead to
Pulp Necrosis
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Chronic Closed Pulpitis
(Histologic Factors)
 Mononuclear macrophage cell infiltrate
 Vigorous connective tissue response
 Small areas of pulp necrosis
 Small areas of minute abscesses
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Factors Which Prevent Survival of Pulp
 Pulp is enclosed within rigid walls of pulp
chamber
 Only one small opening at apex for blood
supply to tooth
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19. Death of Pulp
Blood Supply Cut off to Tooth
Compression of Apical Vessels
Inflammation
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Open Pulpitis
(Pulp Polyp)
 Pulp grown through cavity opening.
 This may be due to large open
apices & good blood flow.
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Clinical Features of Open Pulpitis
(Pulp Polyp)
 Dusky red/ pinkish soft tissue nodule protruding in
to cavity opening.
 Painless
 Bleed on probing
 Tender to palpation
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Histological Features of Open Pulpitis
(Pulp Polyp)
 Few odontoblast present
 Pulp tissue is replaced by granulation tissue
 Proliferated mass of pulp polyp is covered by stratified
squamous epithelium
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Management of Pulpitis
 If cause is fracture/ cracked tooth, stabilize & seal the pulp temporarily.
 If cause is caries, pulp capping, caries removal.
 Pulpotomy in deciduous teeth
 Endodontic treatment
 Extraction
 Analgesic are ineffective against pulpitis pain
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THE END
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