What is Pulpitis?

Pulpitis if you dissect the word refers to “Pulp” (tissue inside the tooth) and “Itis” (Inflammation), so it mean Inflammation of the pulp. The Dental pulp is a delicate connective tissue consisting of blood vessels, nerves and lymphatics. Dental pulp reacts to any bacterial infiltration or any other physical or chemical stimuli by showing inflammatory response leading to Pulpitis and thus presenting as Toothache or Odontalgia.

Pulpitis is Classified into types based on the treatment protocol and the time from which the lesion has started. Acute and Chronic, the other classification is based on treatment – Reversible and Irreversible Pulpitis. Root Canal Treatment is advised in cases with Irreversible pulpitis.

Why is Toothache the most severe pain?

Toothache is considered to be the most painful among any pain in the human body because of the Pulpal tissue being surrounded by hard Dentin walls or Tooth structure, this prevents any swelling to escape leading to excruciating pain during the hyperemic phases of inflammation.

Types of Pulpitis:

Pulpitis is differentiated into different types based on multiple factors like cause or etiology, progress of lesion, age of lesion, spread of lesion etc.

  1. Anachoretic Pulpitis
  2. Acute Pulpitis
  3. Chronic Pulpitis
  4. Partial or Subtotal Pulpitis
  5. Partial or Focal Pulpitis
  6. Total or Generalized Pulpitis
  7. Open Pulpitis or Pulpitis Aperta
  8. Closed Pulpitis or Pulpitis clausa
  9. Focal Reversible Pulpitis or Pulp hyperemia
  10. Chronic Hyperplastic Pulpitis or Pulp Polyp

Anachoretic Pulpitis: It is the type of pulpitis when the pulpal inflammation is seen due to the bacteria entering into the blood stream through a Chemical or Mechanical injury to the pulp. In general Anachoresis is seen when substance like bacteria, pigments, dyes, metallic substances, foreign proteins and other foreign particles enter the blood stream infecting the pulp tissue.

Acute Pulpitis: Acute inflammation of the pulp following focal reversible pulpitis is termed as Acute pulpitis, it is the initial phase of Pulpitis where pain is felt when the carious lesion or any defective restoration is present. Severe pain is seen while taking Hot or Cold substances with the pain persisting even after the hot or cold substance has been removed.

Chronic Pulpitis: It usually follows up or is seen after Acute Pulpitis is dormant or without symptoms. The pain and symptoms in Chronic Pupitis are much less in comparison to Acute Pulpitis. In Chronic Pulpitis the pain in Dull ache and intermittent without high response to thermal or mechanical changes in comparison to Acute type.

Partial or Subtotal Pulpitis: When the Inflammation is confined to a portion of the pulp which is usually the Coronal portion mainly involving one of the Pulp horns, it is termed as partial pulpitis. It is also called as Focal pulpitis. In this type of pulpitis, we can consider Pulpotomy with the help of MTA to help preserve and repair the pulp tissue.

Total or Generalized Pulpitis: In cases where the whole of pulp – Coronal and Apical portions of all roots has been involved.

Open Pulpitis: The cases of pulpitis where the inflammed pulp tissue is in direct communication with the oral environment due to a large carious lesion or fracture of tooth exposing the pulp.

Closed Pulpitis or Pulpitis Clausa: In conditions where the pulpal tissue is not in connection with the Oral cavity .

Focal Reversible Pulpitis or Pulp Hyperemia: It is the earliest form of pulpitis, symptoms of which are seen during pulpal or Dentinal irritation. The pulpitis is mainly associated to the irritated Dentinal tubules without affecting the pulpal tissue much. Sensitivity to cold or hot can be felt, pain is felt on applying cold or ice on the surface and pain subsides as soon as the stimulus is removed. It exhibits lower pain threshold, with stimulation seen at a lower current levels when tested with an electric pulp tester.

Chronic Hyperplastic Pulpitis: It is usually seen as  progression of a chronic lesion or in a chronic stage of acute pulpitis if left untreated. The pulpal tissue due to constant Suppuration leads to proliferation or the pulpal tissue, which tends to extend out of the carious defect of the tooth as a pink – red globule mass. It is usually seen in children or young adults as they possess high tissue resistance and reactivity leading to increased response to proliferative lesions.