Pulpitis is an inflammatory condition which affects the living tissue of the tooth (the pulp, nerve). There are many reasons for its occurrence – untreated caries, trauma and fracture of tooth crown, advanced abrasion of the teeth, thermal damage from drilling for crowns, etc.

Most often pulpitis arise from untreated caries. Over time the caries progresses to the dentine and reaches the pulp, at this point the two layers of the tooth are overcome – the enamel and dentine, the bacteria begin to freely enter from the oral cavity into the cavity of the tooth which leads to inflammation of the nerve, which is irreversible and extremely painful.

Pulpitis after untreated caries

Pulpitis affects primary and permanent teeth. Pulpitis can be acute and chronic, serous and purulent. The leading symptom is pain.

In acute pulpitis pain is strong, either induced or more frequently spontaneous. It is stronger at night and comes in bouts. It can be pulsed, amplified by warm and soothing by cold (when there is purulent inflammation).

In most cases, the pain is not localized to a tooth. It spreads from a tooth in the lower jaw to a tooth in the upper jaw and vice versa, but on the same side. With teeth from the upper jaw the pain is directed to the temple while with teeth from the lower jaw – the ear. In some cases, the pain goes away (when taking pain killers) but the tooth is not cured. If an acute pulpitis is left untreated it can become chronic pulpitis or periapical periodontitis (granuloma).

The pain with chronic pulpitis is less pronounced. It appears after eating because the nerve of the tooth is already in direct contact with the oral cavity and the food and saliva reach and provoke it. Usually the tooth is open, with a large hole or a broken filling. Under the influence of irritants (hot, cold) or suction, the patient’s tooth pain remains for a long time. In young people a lightly sensitive soft tissue (polyp) is located at the hole of the tooth. This is granulomatous tissue (nerve) which has grown out of the pulp and it bleeds when touched. Depending on the type of pulpitis, the degree of destruction of the tooth, patient’s age and general condition, a method of treatment is selected.

In children’s primary teeth acute pulpitis occur in an earlier age (3-6 years old). They appear with severe pain while eating or at night. The child refuses to eat and drink liquids. Chronic pulpitis are more common in school age. Pain is less pronounced, and the child avoids chewing on the troublesome side.

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