Pulpitis

Definitions & Key takeaways

Pulpitis is an inflammation of the dental pulp, which is the soft tissue located inside the tooth that contains blood vessels, nerves, and connective tissue. It is mainly caused by a bacterial infection which itself is a secondary development of caries (tooth decay). Pulpitis can be reversible and easily cured, or, irreversible, leading to a dead tooth that can be kept in place to help with mechanical chewing or extracted completely. Symptoms of pulpitis can include tooth sensitivity to hot or cold temperatures, pain or discomfort when biting or chewing, and spontaneous pain.

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Introduction0:00–0:23

Pulpitis is inflammation of dental pulp, and it’s usually caused by bacterial infections. The dental pulp is the soft inner section of the tooth, that houses the nerves and blood vessels that nourish the tooth.
If the pulp gets inflamed, these nerves get activated, really intensively. Pulpitis usually starts with either an injury to the tooth, such as a fracture, or commonly from tooth decay which is when there’s erosion of the overlying enamel and dentin layers, opening up a direct route to the pulp.

Causes0:23–1:15

Bacteria can then access the dental pulp, and generate an infection. The most common bacteria include the mutans group streptococci, such as Streptococcus mutans and Streptococcus sobrinus.
The bacterial infection typically leads to an inflammatory response from the immune system. The inflammation causes tissue swelling.
But because the dental pulp is encased in a tough layer of dentin, there’s very little room for tissue to expand. That means that the tissues get squeezed and there’s a lot of pressure on the nerves.
Clinically, pulpitis can be divided into two types - reversible and irreversible. In reversible pulpitis, healthy pulp reacts to the presence of an irritant, for example, a deep carious lesion that isn’t actually within the dental pulp.

Pathology1:15–2:25

Now, irreversible pulpitis is more serious because the pulp is actually damaged. For example, there may be a bacterial infection within the dental pulp.
Usually, when there’s an active infection within such an enclosed space it is virtually impossible for the dental pulp to heal.
Over time, the pulp undergoes necrosis, creating a “dead tooth”. And over time, the bacterial infection can spread to surrounding tissues and bone.
In reversible pulpitis there’s typically transient pain, and sensitivity to things like cold, heat, or even sweetness in drinks and foods.
In irreversible pulpitis there can be severe pain, and sometimes that pain can be hard to localize to the exact tooth that’s affected.

Treatment2:25–3:08

In reversible pulpitis, it’s important to promptly remove the decay and then place a restoration to help stop the process, and allow the dental pulp to return to a healthy state.
It’s also important to seal the restored tooth, so that there’s not reinfection of the tooth. In irreversible pulpitis there are two main approaches for treatment.
First, there’s endodontic treatment which involves removing the diseased pulp, and filling it up with a filler material like a special cement.
In this approach, although the tooth is dead, it can continue serving its mechanical function of chewing. The second approach is extraction of the affected tooth.

Review3:08–3:28

All right, as a quick recap. Pulpitis is the inflammation of dental pulp, that’s most often caused by a bacterial infection.
Reversible pulpitis is easily cured, whereas irreversible pulpitis leads to a dead tooth which can be kept in place to help with mechanical chewing or extracted completely.