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Causes of Pulpitis
- Caries that penetrate though the tooth enamel, the dentin, and into the pulp
- Repeated dental procedures or tooth trauma
Regardless of the cause of pulpitis the inflammation can be associated with a bacterial infection. As in the case of a carie that penetrates the pulp cavity the tooth is no longer sealed to infectious pathogens, where as when the blood supply is cut off to the pulp, bacteria have an opportunity to over take the pulp.
When the pulp becomes inflamed pressure begins to build up in the pulp cavity exerting pressure on the nerve of the tooth and the surrounding tissues. Pressure from inflammation can cause mild to extreme pain, depending upon the severity of the inflammation. Often, pulpitis can create so much pressure on the tooth nerve the individual will have trouble locating the source of the pain, confusing it with neighbouring teeth. Inflammation in the tooth provides a difficult environment for reducing the inflammation in the pulp cavity. Unlike other parts of the body where pressure can dissipate through the surrounding soft tissues and where lymph can reach, the pulp cavity is very different. The dentin surrounding the pulp is hard and does not give under the pressure of the inflammation so the pressure has very little chance of dissipating before pulp necrosis occurs. The pulp cavity inherently provides the body with an immune system response challenge, which makes it very unlikely that the bacterial infection can be eliminated. The pain will usually stop once the pulp has died, however the infection can spread to the ancillary anatomy.
Differential Diagnosis of Pulpitis
|Cardiovascular||No underlying causes|
|Chemical / poisoning||No underlying causes|
|Dermatologic||No underlying causes|
|Drug Side Effect||No underlying causes|
|Ear Nose Throat||No underlying causes|
|Endocrine||No underlying causes|
|Environmental||No underlying causes|
|Gastroenterologic||No underlying causes|
|Genetic||No underlying causes|
|Hematologic||No underlying causes|
|Iatrogenic||No underlying causes|
|Infectious Disease||No underlying causes|
|Musculoskeletal / Ortho||No underlying causes|
|Neurologic||No underlying causes|
|Nutritional / Metabolic||No underlying causes|
|Oncologic||No underlying causes|
|Opthalmologic||No underlying causes|
|Overdose / Toxicity||No underlying causes|
|Psychiatric||No underlying causes|
|Pulmonary||No underlying causes|
|Renal / Electrolyte||No underlying causes|
|Rheum / Immune / Allergy||No underlying causes|
|Trauma||No underlying causes|
|Miscellaneous||No underlying causes|
Once the pulp has become inflamed the tooth can be diagnostically divided into two categories.
- reversible pulpitis
- irreversible pulpitis
Once the irritant is removed the pulp remains vital and is not unduely affected by the changes.
The pulp is irreversibly damaged and necrosis will follow. Pain may not subside after removal of the irritant. Pain may be sharp or dull and throbbing. If there is any drainage then severity of pain is reduced
The tooth may be endodontically treated where by the pulp is removed and replaced by gutta percha. An alternative is extraction of the tooth. This may be required if there is insufficient coronal tissue remaining for restoration once root canal therapy has been completed.