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Pulpitis

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Brief description of the condition

Inflamed dental pulp with signs and symptoms that vary depending on whether reversible or irreversible pulpitis.

Key signs and symptoms

  • Tooth pain - may either be intermittent and associated with stimuli or is longer lasting (up to several hours) and may keep the patient awake at night

Initial management

Recommend optimal analgesia (see Analgesia).

Do not prescribe antibiotics.25,32

Advise the patient to seek non-urgent dental care or, if analgesia is ineffective, to seek urgent dental care.

Subsequent care

Determine if reversible or irreversible pulpitis.

    • Reversible: Gives a positive or exaggerated response to sensibility test; tooth is not tender to percussion.
    • Irreversible: Pain may be difficult to localise to a single tooth, may last for several hours, may be dull and throbbing, may be worsened by heat, but may also be alleviated by cold. The pain can occur spontaneously, typically keeping the patient awake at night.

For reversible pulpitis:

  • If the pulp is not exposed, consider caries removal and restoration of the affected tooth or placing a temporary dressing and restoring later.26,33
  • If the pulp is exposed, consider pulpotomy or pulpectomy and restoration.26,33

For irreversible pulpitis, consider:

  • Providing endodontic therapy (pulpotomy for vital primary teeth; pulpotomy or pulpectomy/root canal therapy for permanent teeth).26,33 Note that in some cases, achieving anaesthesia is difficult and a corticosteroid-antibiotic paste may be used to reduce inflammation for extirpation at a later date.
  • Extracting the tooth.