Commonly, the appearance of dental pulpitis is associated exclusively with caries, but the truth is that there are other factors that can cause this condition.
The pulp is one of the components of the complex structure of our teeth and its integrity can be threatened by severe trauma or advanced caries.
In this article we will tell you exactly what pulpitis is and what are the appropriate treatments in these cases.
Where is the dental pulp located?
The dental pieces are attached to the jawbone through the periodontium, and in its structure we can distinguish a visible and an invisible part.
The dental pulp is located inside the crown, and is the part commonly known as the nerve.
It is important to know how to differentiate the parts of the teeth in order to know their anatomy and correctly identify what pathologies or complications each one may present.
A tooth is made up of the following parts:
The dental crown is the part of the dentition that is visible when we speak or smile.
Its shape determines the function, as well as the name of each piece and thanks to them we can carry out the functions of chewing and grinding food.
The edge of the gum is the junction of the dental pieces with the mucosa.
It is in this area where tartar and food debris tend to accumulate which, if not removed properly, can lead to periodontal diseases – gingivitis or periodontitis.
The dental root is inserted in the alveolar bone and its function is to support the tooth.
Depending on the tooth in question, it may have one root – canines and incisors – or several – molars and premolars.
The internal structure of the tooth
But in addition to this structure, the tooth is made up of different internal parts:
The enamel covers the dental crown and its mission is to protect the dentin from the action of pathogenic agents.
In spite of being the hardest layer of the human body, it can suffer some wear due to poor oral hygiene or abrasive agents.
As a result, dental caries can occur.
The dental pulp is inside the tooth.
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PARTS OF A TOOTH
Dentin is located underneath the enamel and is responsible for mitigating the shocks and pressures on the tooth, e.g. from chewing forces.
Dentin therefore prevents the development of tooth sensitivity.
It consists of a large number of tubules that connect it directly to the dental pulp – or nerve.
Together with the enamel, dentin surrounds the pulp chamber, where the pulp is located.
It is a soft connective tissue composed of nerves and blood vessels.
Finally, the cementum is part of the periodontium and is a thin layer whose function is to cover the surface of the dental root.
Now, we have understood the structure of the tooth and the place of the pulp in it, but… what is its mission?
Functions of the dental pulp
As it contains nerve fibers, the purpose of the dental pulp is to send a sensory signal in the event of damage to the tooth.
Not only that, but it fulfills an essential function during tooth development: it is the part responsible for nourishing the tooth and forming dentin.
Once the tooth has completed its development, as well as the stages of dentition, the action of the pulp is no longer necessary for it to remain stable.
What is pulpitis and how many types are there?
We speak of pulpitis when the nerve is inflamed due to different external factors.
Depending on the damage to the pulp, the condition can be reversible or irreversible, and its symptoms can vary from slight dental sensitivity to the loss of the tooth due to the death of the nerve.
Reversible dental pulpitis
Reversible dental pulpitis is a slight temporary inflammation of the nerve.
As a general rule, this swelling is caused by pH changes in the tooth, the ingestion of excessively acidic or sugary foods, or foods that are too hot or too cold.
Likewise, dental whitening generally causes a certain sensitivity in the tooth, but this is temporary and only lasts for the month that the treatment lasts.
On these occasions in which the patient presents reversible pulpitis, the discomfort subsides once the stimulus that provokes it has disappeared.
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Irreversible dental pulpitis
On the contrary, in cases of more advanced pulpitis, the discomfort persists for a period of time once the stimulus that generates it has disappeared.
It is then when we are dealing with an irreversible case, because the inflammation of the nerve is so severe that it is not possible to return it to its healthy state.
Pulpitis has different phases
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IRREVERSIBLE DENTAL PULPITIS
This condition is suffered by people who receive a continuous impact on a tooth.
If a patient suffers from bruxism, it means that he/she keeps a prolonged pressure on his/her dental piece.
It is very possible that after a while, if not remedied, they may develop irreversible pulpitis.
The same happens as a consequence of a strong traumatism.
Signs may take time to appear, the main sign being the darkening of the tooth.
When irreversible dental pulpitis is not treated in time, either because of carelessness or because it is asymptomatic, the nerve becomes necrotic and the stability of the tooth may be threatened.
Death of the nerve: pulp necrosis
If a tooth presents acute inflammation that has not been treated in time or has suffered a strong blow that has caused the blood supply to stop, the nerve ends up dying.
This is when we speak of pulp necrosis, a condition that can be diagnosed through an x-ray.
Another common sign in people with necrosis is the appearance of a small lump or fistula in the gum.
Pulp necrosis is divided into two types:
Aseptic or coagulation necrosis.
This is a pathology caused by ischemia, i.e. a blockage or decrease in blood circulation.
Coagulation necrosis is asymptomatic and especially frequent in children, who are more prone to receiving heavy blows to their teeth.
However, it does not always have to result in the death of the nerve, as it is possible for the tooth to remain in an intermediate state known as calcification.
Septic or gangrenous necrosis
On the other hand, if the tooth presents a bacterial colonization that has produced severe inflammation, we will be dealing with a case of septic or gangrenous necrosis.
Patients suffering from gangrene usually feel acute and intense pain.
When the tooth structure is compromised and the nerve is exposed, dental pulpitis is generated.
What can cause damage to the dental pulp?
On some occasions, certain conditions or the action of pathogenic agents can damage the dental structure, exposing the dental pulp.
Two of the most common causes are caries and advanced periodontal disease (pyorrhea).
Although the genetic factor may have a certain degree of influence in the appearance of these ailments, the truth is that both have a common cause: poor oral hygiene.
But in addition, as we have already mentioned, there are other diverse reasons for dental pulpitis:
Dental erosion, often caused by bruxism.
Dental abrasion, due to the repetitive action of elements that are harmful to the enamel on the surface of the teeth.
The appearance of a fissure or fracture in the dental piece due to a strong traumatism.
Dental treatments that have not been carried out rigorously, such as, for example, a filling or a reconstruction that has not been carried out successfully.
X-ray of a denture
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X-RAY OF A DENTURE
And not only this. As the conclusions of a trial published in the European Journal of Odontostomatology show, the age of the person also has a direct relationship with dental pulpitis.
The age and habits of 66 individuals were studied. As a result, the study states that the younger group presented a higher volume of cases of reversible dental pulpitis.
On the contrary, those with more age had problems directly related to the root of the tooth.
According to this trial, it is possible that the younger population should visit the dental clinic more frequently to slow down the progression of the disease.
What is the treatment for dental pulpitis?
As we have explained, pulpitis presents different phases, and depending on the state of oral health of the person, the dental professional will choose to approach the problem in one way or another.
Thus, in cases of reversible pulpitis, the treatment lies in eliminating the cause that generates the discomfort, generally translated into dental sensitivity.
In the case of caries, the solution is to carry out a filling.
In fact, total caries excavation is the method most often chosen by dentists in the case of reversible pulpitis.
The aim of a study carried out by researchers from the Section of Endodontics at the University of Seville was to determine the approach taken by professionals to these patients.
A total of 125 dentists volunteered to carry out the report and it was concluded that more than 80% of dentists eliminated the caries completely.
The reason for opting for one treatment or another was the good clinical outcome (83%).
As for the factors directly related to the patient that determined a particular action against reversible pulpitis, it was the oral health in 84% and the age of the person in 70%.
However, the ideal solution to address a case of irreversible pulpitis is endodontics or root canal treatment.
Thanks to this intervention it is possible to eliminate the vasculonervous bundle inside the pulp chamber.
Dentists choose to keep in the mouth a tooth that, if not properly treated, would have to be extracted.
Pulpitis in baby teeth
In the event that the patient with pulpitis still has baby teeth, the procedure to end the pathology is to perform a pulpectomy.
Like endodontics, this intervention completely cleans the inside of the tooth, but the difference lies in the fact that it is only performed on children who are of a growing age.
Although pulpectomy is an effective treatment, it can be very invasive for the tooth.
That is why, in certain cases of irreversible pulpitis, other techniques can be used, such as coronal pulpotomy, generally applied when the damage to the tooth does not reach the root.
This is corroborated by a report prepared by various dental institutions in Ireland and the United Kingdom.
The results of the only comparative clinical trial showed that pulpotomy has comparable success to root canal treatment at 12, 24 and 60 months follow-up.
The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12-month follow-up.
Saving necrotic teeth
Endodontics is also capable of slowing necrosis, and depending on which tooth is affected, unirradicular, biradicular or polyradicular root canal treatment will be necessary.
However, the discoloration caused by the disease is not solved by the endodontic procedure.
Necrosis darkens the tooth.
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PULP NECROSIS
To recover the original shade of the tooth and the esthetics of the smile, the patient should undergo internal bleaching of the endodontically treated tooth.
This procedure can be complemented with dental veneers to obtain even more natural-looking results.
Don’t let it pass you by: see your dentist
In case of very advanced pulpitis, you run the risk of losing the tooth, so early detection of the disease makes all the difference.
Infection of the pulp can spread to other areas of the mouth, such as the gums.
It should not be forgotten that the state of the oral cavity affects the rest of the organism, and the gums are closely related to cardiovascular alterations.
The most appropriate way to avoid the development of pulpitis is prevention.
Maintaining good hygiene routines and regular visits to the dentist will ensure the good condition of your teeth and gums.
If you have any doubts regarding any of the conditions related to dental pulp or you would like to make an appointment with us, we invite you to contact us through our website.
You will be interested in ” What is pericoronaritis?
Bibliographic references
At DrAW Dental Clinic we are guided by editorial guidelines that ensure the veracity of all the information we publish. If you want to know more about how we ensure that our content is updated and properly supported, we encourage you to read our editorial commitment.
Díaz Almenara, Eugenia Mª, (2019). Are alcohol and age associated with suffering from pulpitis or apical periodontitis (http://www.redoe.com/ver.php?id=297).
Crespo-Gallardo, I., Martín-González, J., Jiménez-Sánchez, M.C., Cabanillas-Balsera, D., Sánchez-Domínguez, B., Segura-Egea, J.J. (2018). Dentist’s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. (https://www.ncbi.nlm.nih.gov/pubmed/30697380).
Cushley, S., Duncan. H.F., Lappin, M.J., Tomson, P.L., Lundy, F.T., Cooper, P., Clark, M., El Karim IA. (2019). Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. Journal of Dentistry. Jun. 20. pii: S0300-5712 (19) 30129-0. (https://www.ncbi.nlm.nih.gov/pubmed/31229496).
