Pulpitis

It is one of the most frequent causes of toothache, which usually appears due to dental caries. Pain is the main symptom of pulpitis, whose intensity - from mild to moderate - is accentuated when the tooth is subjected to thermal (cold/heat), chemical (sweets and sugars) or mechanical (chewing) stimuli.

The treatment of pulpitis consists of minimizing the symptoms (pain) and eliminating the cause responsible for the inflammatory process. The treatment of pulpitis is relatively simple; however, when the inflammation is not carefully treated, the tooth may undergo a degenerative-necrotic process (lose its vitality). In such circumstances, pulpitis requires devitalization, partial removal of the pulp or extraction of the tooth.

What is pulpitis?

Pulpitis is a dental disease characterized by inflammation of the dental pulp.

Early intervention by the dentist with experience in the treatment of this disease of the oral cavity could halt the course of acute pulpitis, preventing the disease from becoming chronic and causing pulp necrosis as an unfortunate consequence.

The dental pulp is a soft tissue composed of arterioles, venules, nerves and special cells called odontoblasts, capable of producing dentin, one of the hard tissues that make up the tooth.

The starting point and main cause of pulpitis, a condition that can be very painful, is a microbial infection that usually comes from a caries lesion or a periodontal lesion affecting the apex of the tooth that extends to the dental pulp. Other causes of pulpitis can be dental fractures that expose the pulp to bacteria, but also chronic dental trauma such as, for example, those caused by bruxism (the habit of grinding the teeth while sleeping) or malocclusions that cause unbalanced chewing. Finally, excessive thermal stimuli, especially cold, can also initiate pulpitis, which in most cases will be temporary and reversible.

Causes

Pulpitis is often the immediate consequence of cariogenic damage. Caries is a process of tooth destruction that causes progressive demineralization of enamel and dentin. The microorganisms present in the oral cavity, hungry for sugars, produce acidic substances from the fermentation of carbohydrates, and it is these acidic products that perforate the enamel, reaching the dentin and damaging the pulp of the tooth to trigger pulpitis.

Symptoms of pulpitis

It is not uncommon for the symptoms of pulpitis to go unnoticed for a long time, therefore, it is advisable to have regular check-ups with the dentist in order to intervene in time.

The pain is usually difficult to localize and particularly intense, often accompanied by the sensation of a throbbing tooth, this being the most evident symptom of the pathology. Pulpitis pain increases during chewing, consumption of sugary foods and exposure to temperature changes.

Types of dental pulpitis: reversible and irreversible

Pulpitis, depending on the depth of the lesion and the level of inflammation, can manifest itself in two different ways: reversible pulpitis and irreversible pulpitis. In the first case, the inflammation is mild to moderate and the carious lesion is usually on the enamel or dentin surface. In this case, the sensation of pain is aggravated when the tooth is subjected to an external stimulus such as, for example, too cold or sugary food, but disappears instantly as soon as the stimulus is removed.

In this form of pulpitis, immediate intervention and appropriate treatment leads to complete recovery from the disease.

Irreversible pulpitis, on the other hand, occurs when the inflammation is severe, with a high risk of progressing to pulp necrosis. In these cases, it is common to see that the pathology is accompanied by periodontitis or abscesses. In this case, unlike the previous one, the pain does not cease once the stimulus is removed, but lasts for several minutes.

In some cases it can also occur spontaneously and the patient struggles to locate the tooth that causes pain, confusing the mandibular and maxillary arches. The toothache may extend to the ear, temple, face and neck in a deep and continuous manner. The supine position, which brings more blood to the affected area, makes the pain even more acute, making it difficult to sleep.

Treatment

A "shock" treatment is indispensable to prevent pulpitis from progressing to its irreversible form.

The treatment of pulpitis is based on:

• Analgesic medications to relieve pain.
• Dental treatments performed in the dental clinic to eliminate the cause of pulpitis.

First, pain can be controlled by the administration of analgesic drugs that can mask the symptoms and provide relief to the patient. While paracetamol and NSAIDs are usually sufficient to effectively relieve mild to moderate pain, codeine or other opioids are necessary in cases of severe and unbearable pain.

Along with pharmacological treatment, the dentist performs a medical treatment, which consists of a specific intervention to eliminate the cause of pulpitis. When pulp involvement is limited, pulpitis is treated by simply removing the caries. On the other hand, in the presence of severe inflammation and pulp necrosis, partial or total removal of the pulp of the tooth (devitalization or eventual extraction of the tooth) may be necessary.

Prevention of dental pulpitis

The best treatment for pulpitis is prevention. Since most pulpitis is a consequence of cariogenic processes, simpledietary precautions, combined with the correction of an unhealthy lifestyle, can prevent the occurrence of pulpitis.

To minimize the risk of pulpitis, it is necessary to take care of your teeth on a daily basis:

• Brush your teeth at least three times a day with appropriate toothpastes. Toothpastes containing fluoride are the best for preventing pulpitis because they strengthen tooth enamel.
• Brush teeth from the gum towards the tooth, never backwards.
• Limit the use of toothpastes formulated with abrasive whitening products, which can damage the enamel, thus favoring the appearance of caries and pulpitis.
• Floss at least once a day.
• Replace the toothbrush every 2-3 months.
• Use mouthwashes
• Limit consumption of sweets and sugary foods - such as jam, honey and chocolate - which can adhere to the enamel and favor the entry of bacteria.

Have regular check-ups at the dentist, at least once or twice a year. Routine visits can detect at the root any asymptomatic inflammatory process, including pulpitis, and remedy it before the damage becomes irreversible.