Pulpitis - how to recognize and how to treat?

What is inflammation of the tooth pulp?

Pulpitis is an inflammation of the dental pulp — the soft tissue inside the tooth that contains nerves and blood vessels. The pulp is responsible for the nutrition of the tooth and its sensitivity to stimuli (e.g., heat, cold, and pain). Pulpitis can be very painful and requires dental treatment. Two types of pulpitis can be distinguished:

Reversible pulpitis

Mild, early stage. The pulp is irritated, but its permanent damage has not yet occurred. Symptoms are sensitivity to cold and sweet, which quickly passes when the stimulus is removed. Its treatment consists in removing the cause (e.g., caries) and securing the tooth with a filling.

Irreversible pulpitis

Advanced stage of inflammation, in which the pulp is permanently damaged. Symptoms are severe, throbbing pain (often at night), spontaneous pain (without stimulus), and prolonged sensitivity to heat. In the vast majority of cases, root canal treatment (endodontic) or tooth removal is necessary.

If dental pulpitis is suspected, a quick visit to the dentist is important – if left untreated, it can lead to pulp necrosis, abscess and even the spread of infection to the bone.

Causes of inflammation of the tooth pulp

Here are the main causes of pulpitis of the tooth along with a description:

1) Deep caries — this is the most common cause. Caries bacteria destroy enamel and dentin until they reach the pulp, causing it to become infected and inflamed.

2) Mechanical trauma to the tooth – a strong blow, fracture or crack of the tooth can damage the pulp without the involvement of caries. The pulp then reacts with inflammation to a sudden disturbance of its structure and blood supply.

3) Leaky or deep fillings — a filling that does not adhere closely to the tooth can allow bacteria and toxins to pass into the tooth. If the filling is very close to the pulp, it can also mechanically irritate it.

4) Complications after dental procedures — frequent or intensive treatment of the same tooth (e.g., multiple borings) can lead to overheating of the dentin and damage to the pulp. Even if infection does not occur, sterile inflammation may develop.

5) Cracks and microtraumas of the tooth – even small, invisible-to-the-naked-eye enamel cracks can allow bacteria to access the pulp, leading to its inflammation over time.

6) Tooth friction (bruxism) — prolonged, severe grinding of teeth can cause overstrain and microtrauma to the internal tissues of the tooth, including the pulp, which can trigger inflammation.

7) Age — with age, the pulp naturally constricts (shrinks), which can reduce its resistance to injury and infection. Older people are also more likely to develop secondary caries and complications after previous dental treatment.

8) Genetic factors — some people have a genetic tendency to have a weaker enamel or dentin structure, which increases the risk of tooth decay and easier penetration of bacteria into the pulp. There may also be congenital differences in the structure of the pulp, affecting its susceptibility to inflammation.

All these factors have a common denominator — they cause direct or indirect damage to the pulp, which responds with inflammation. Depending on the severity and duration, inflammation can be reversible or lead to permanent damage and the need for root canal treatment.

Symptoms of pulpitis of the tooth

Symptoms of pulpitis of the tooth depend on the degree of inflammation but are usually quite characteristic.

1) Toothache — this is the most typical symptom. At first, it can be short and triggered by stimuli (e.g., cold, sweets). As the inflammation progresses, the pain becomes severe, throbbing, and even spontaneous – it appears for no apparent reason.

2) Prolonged sensitivity to temperature — the tooth can react with pain to cold or hot drinks, with the pain not going away immediately after removal of the stimulus. With irreversible inflammation, heat pain is more common.

3) Night pain — often intensifies in the evening or at night when we lie down. This is the result of an increase in pressure in the pulp in the supine position.

4) Radiating pain — sometimes it is difficult to tell exactly which tooth hurts. Pain can radiate to the jaw, ear, temples or adjacent teeth.

5) Increased discomfort when biting — with advanced inflammation, the tooth may be tender when pressed or bitten, although this symptom is more common with inflammation of the periapical tissues.

6) No response to pain treatment — In advanced conditions, the usual painkillers may stop working or only provide relief for a short time.

How to know if you have pulpitis?

It is impossible to unequivocally confirm pulpitis at home, but if you notice the above symptoms – especially pain that does not go away – this is a signal not to wait and go to a specialist. The dentist can confirm the inflammation of the tooth pulp by performing a so-called poop test, that is, gently tapping the tooth — if it is tender, this may indicate inflammation of the tissues around the apex of the root (often accompanied by advanced pulpitis). The final result will give a radiological examination (X-ray). The photo shows whether the inflammation has spread to surrounding tissues, whether the pulp has become necrotic, or whether inflammation has formed in the bone around the root. Electrodiagnostics are also sometimes used to check if the nerves in the tooth are still functioning.

How to treat inflammation of the pulp of the tooth?

Treatment of pulpitis of the tooth depends on the degree of inflammation. If it is an early, reversible inflammation, the dentist can remove the caries, secure the tooth with a suitable filling and apply preparations to relieve irritation of the pulp, which allows it to remain viable. In the case of irreversible inflammation, when the pulp is already permanently damaged or has died, root canal (endodontic) treatment is necessary, which consists in removing the altered pulp, cleaning and filling the root canals. In extreme cases, when the tooth is not amenable to treatment, its removal may be required. In any case, a quick diagnosis and the intervention of the dentist are crucial to avoid further complications such as abscess or inflammation of the bone.

What drugs for pulpitis of the tooth?

The pain associated with pulpitis of the tooth can be very severe, so painkillers and anti-inflammatory drugs are often resorted to. However, it is important to remember that no medication will cure the cause of the pain — they can only alleviate the symptoms by the time you visit the dentist. Medications that can provide relief include Ibuprofen (eg Ibuprom, Nurofen) or acetylsalicylic acid (eg Aspirin, which has a similar effect to ibuprofen. Paracetamol (e.g., Apap, Panadol) can also help. It is mainly analgesic and antipyretic, does not have strong anti-inflammatory properties, but can be a good alternative for people who cannot take non-steroidal anti-inflammatory drugs (NSAIDs).

Does an antibiotic help with pulpitis?

Antibiotics assigned by the doctor do not help immediately for pain and do not help with pulpitis itself. They, on the other hand, fight a bacterial infection with an abscess or swelling, which are the causes of pain.

Pulpitis of the tooth: how to relieve pain?

To relieve the pain caused by pulpitis of the tooth in home conditions, several ways can be used that bring temporary relief. Cold compresses applied to the cheek from the side of the aching tooth can help, which reduces swelling and relieves pain. Hot drinks and meals should be avoided, as well as chewing on the side of the affected tooth. It is also good to rinse the mouth with a cool infusion of sage, chamomile or saline solution – this has a slight anti-inflammatory and antibacterial effect. However, you should not put garlic, aspirin or alcohol directly into the tooth – they can irritate the pulp even more. Remember that home remedies can bring temporary relief, but they will not replace treatment – the sooner you go to the dentist, the greater the chance of saving the tooth.

Complications after inflammation of the pulp of the tooth

If left untreated, pulpitis of the tooth can lead to serious complications that go beyond the tooth itself.

Martica pulpitis — the most common consequence is pulp necrosis, which is the death of the nerve, which results in a stop of pain but does not mean a cure at all — the bacteria continue to develop in the dead tissue.

Inflammation of the periapical tissues — untreated pulp necrosis can lead to periapical tissue inflammation, which is inflammation around the root of the tooth.

Abscess of the tooth — going further along this trail can lead to the formation of an abscess, which is a reservoir of pus around the root, often causing severe pain, swelling and fever.

Purulent fistula — Another complication is the outflow of pus to the outside (e.g., through the gum), sometimes visible as a bubble or lump.

Periapical cyst — chronic inflammation leading to the formation of a fluid-filled cavity in the bone.

Osteomyelitis — The infection can spread to the bone, involving the jaw or lower jaw bone.

Maxillary sinusitis — in the case of the upper teeth, especially the molars, the infection can move to the sinuses.

Difficulty opening the mouth (jaw clenching) — when the infection involves the masticatory muscles.

Sepsis (sepsis) — a very rare but deadly complication when bacteria enter the bloodstream.

Therefore, timely treatment of pulpitis is crucial for the health of not only the teeth but the whole organism.

How long can you walk with pulpitis?

With pulpitis of the tooth, you should not walk for a long time – in practice, even a few days of delay can aggravate the situation. In the case of reversible inflammation (mild irritation of the pulp), a quick reaction can save the tooth without root canal treatment. In contrast, irreversible pulpitis progresses very quickly — within a few days or weeks, pulp necrosis, abscess development and infection of the tissues around the tooth can occur.

Often the pain initially intensifies and then... suddenly subsides – this is not a sign of improvement but a symptom that the nerve has died and the infection has “subsided” but continues to develop. Therefore, it is not worth waiting or trying to wait out the pain – it is best to go to the dentist immediately after the onset of symptoms, before there are complications that are more difficult and expensive to treat.