Irreversible Pulpitis

Tooth pain is usually a sign of a cavity and the tooth may erode if left untreated, and bacteria may enter into the tooth, which will lead to inflammation. In most cases, the inner part of the tooth—pulp—will become inflamed and leads to a condition called pulpitis.

What Is Pulpitis?

A tooth consists of three different parts: the enamel, the dentin and the pulp. The pulp is where the blood vessels, nerves and cells of the tooth are housed. When the tooth pulp becomes inflamed, the condition is called pulpitis and there are two types of this condition: reversible pulpitis and irreversible pulpitis.

Reversible pulpitis: a mild inflammation of the pulp of the tooth. When treated, the inflammation will subside and the tooth will return to normal. However, if left untreated, the inflammation will worsen and cause irreversible damaged to the tooth.

Irreversible pulpitis: with this condition, there is usually severe inflammation in the pulp of the tooth from which it is unlikely to recover. The pulp of the tooth will swell and it can become so swollen that the blood supply to the area is cut off. When this happens, the tooth is more likely to die and it will need to be treated with a root canal or be extracted.

What Causes Irreversible Pulpitis?

Trauma or Decay of the Tooth

This condition is usually caused by either trauma or decay of the tooth. Trauma to the tooth that causes this condition may be the result of an injury to the tooth resulting from a dental procedure, such as a filling that is close to the nerve or bad crown preparations on a tooth that no longer has a root present.

A fractured or cracked tooth caused from biting down on something hard or a blow to the tooth that moves the nerve within the socket can also result in pulpitis. In addition, if the tooth moves too quickly through the bone, usually from trauma like an injury, the blood supply of the tooth can be cut off.

Natural Tooth Decay

Another cause of irreversible pulpitis is natural tooth decay. If the decay goes too deep, such as into the dentine or to the nerve, the pulp can become severely inflamed and become damaged. Extreme sensitivity to hot, cold or sweets may also result in this condition.

The dentine of the tooth, which is the layer beneath the enamel, is porous because it has tubes running through it. As it gets closer to the nerve, the tubes become wider and will allow more bacteria to enter the pulp of the tooth. This causes more inflammation and increases the chances of this condition.

Symptoms of Irreversible Pulpitis

The primary symptom of irreversible pulpitis is pain. Pain is usually stimulated when hot, cold or sweet foods or drinks are consumed or get packed into a cavity. When stimulated, the pain is rather sharp and it is usually described as a shooting or piercing pain. Even when the stimuli are no longer present, the pain can continue for up to an hour.

The pain can spread to adjacent teeth or it can run along the jaw, up into the ear and temple. The pain can also be exacerbated by bending over or lying down. Sometimes, it can be so bad that it wakes the sufferer up at night or keeps him or her from being able to sleep.

How Is Irreversible Pulpitis Diagnosed?

To confirm that his condition of the tooth is present, a dentist can diagnose it by:

Visual Inspection

When a dentist is examining a patient's teeth after a complaint of pain, he or she may see a deep cavity involving the pulp of the tooth. The dentist may also spot secondary caries, a tooth disease, when doing a restoration to the tooth and confirm it with a probe. If the dentist deeply probes the tooth into the pulp, both the source of pain and bleeding can be spotted.


After taking images of the patient's teeth, usually x-rays, the dentist may be able to see the pulp of the tooth, caries under a filling or a deep cavity. The periapical, which is the area around the root of the tooth, may appear normal, but there may be some widening of the periodontal ligaments.


A pus-like fluid secreting from the pulp increases the pressure within the tooth and causes it to be tender when it is touched or gently tapped.

Vitality Tests

A dentist may use cold stimuli to test the tooth, as it will cause pain if the disease is present. If cold also helps to relieve the pain, instead of heat, which can intensify the pain, then the dentist can diagnose the condition.

How Is Irreversible Pulpitis Treated?

The main treatment for irreversible pulpitis is to perform an endodontic treatment, or a root canal, to help relieve the symptoms and inflammation. An Endodontist will take an image of the tooth to evaluate the root and the bones of for signs of disease.

If infection is present, it can be treated during the root canal. However, in some cases, a course of antibiotics may need to be used to help clear the infection before the root canal can be performed. If a root canal cannot be done, then the tooth may need to be pulled, or extracted.

How to Prevent Pulpitis

The best way to prevent pulpitis is to have good oral hygiene. By brushing your teeth, flossing and going to the dentist for regular checkups, you can prevent most tooth problems. It is recommended that you brush your teeth at least 2-3 times a day with a fluoride toothpaste and brush each tooth individually, on both the inside and the outside of the tooth.

Along with brushing, dental floss should be used to remove stuck food particles between your teeth. In addition, rinsing with a fluoride mouthwash will also help to prevent cavities and tooth decay that can lead to diseases like pulpitis.

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