Irreversible Pulpitis- Symptoms, Diagnosis and Treatment | Endodontic Lecture | Dental Notes
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Definition
Irreversible pulpitis is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic in nature with the pulp becoming incapable of healing.Types
Causes/Etiology
| CAUSES/ETIOLOGY |
|---|
| Most common is Dental Caries |
| Chemical, Mechanical and Thermal injuries to pulp |
| Untreated reversible pulpitis |
Symptoms
| SYMPTOMS |
|---|
| Pain is caused by sudden change in temperature specially cold, sweet or acidic food items and pressure from food entrapped in tooth cavity |
| Pain remains even after the removal of stimulus. |
| Pain can be spontaneous which can be Sharp, Piercing, Intermittent or Continuous in nature |
| Pain exacerbated by lying down or on bending due to increase in intra-pulpal pressure |
| Referred Pain to adjacent teeth or jaw. (Pain referred to temple or sinus in upper posterior teeth and ear in lower posterior teeth) |
| In later stages pain is severe, boring and throbbing in nature. Pain caused by hot stimulus and relieved by cold. |
| Apical periodontitis may develop in later stages |
Histopathology
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| HISTOPATHOLOGY |
|---|
| Vascular Dilation and Edema |
| Granular Cell Infiltration |
| Odontoblasts are destroyed |
| Formation of minute abscess |
| In later stages, pulp undergo liquefaction and necrosis |
Diagnosis
- Check for Deep Cavity exposing pulp
- Secondary Caries under restoration.
- Check for interproximal caries, depth and extent of caries.
- Normal periapical area but sometimes widening of PDL space can be noticed in later stages.
- Sometimes tender on percussion can be noticed due to increase in intra-pulpal pressure.
- Thermal Test- Pulp response to thermal changes. Hot stimulus increases pain due to increase in intra-pulpal pressure. Cold relieves the pain.
- Electric Test- Less current is required in initial stages.
Treatment
- Complete removal of pulp i.e Pulpectomy or Root Canal Treatment.
Prognosis
- Prognosis is favorable if complete removal of pulp is performed.
Differential Diagnosis of Reversible and Irreversible Pulpitis
A summary of Reversible and Irreversible Pulpitis.
Features | Reversible Pulpitis | Symptomatic Irreversible Pulpitis | Asymptomatic Irreversible Pulpitis |
Pain Type | Sharp and Momentary pain and ceases after stimulus removal | Intense, continuous and Prolong pain even after stimulus removal | Asymptomatic |
Stimulus | External Stimuli like heat, cold and sweet | - Spontaneous in nature. - Heat acts as stimulant - Dead or injured pulpal tissue acts as secondary stimulus | Often asymptomatic |
Pain at Night/Postural | No | Yes | No |
Pain Localization | Only with applied cold stimulus or PDL inflammation | Only with applied heat stimulus or PDL inflammation | Asympromatic
|
Referred Pain | Usually Not Found | Common Finding | Not |
History | -Recent Dental procedure -Cervical Erosion/Abrasion | -Deep caries -Trauma -Extensive Restoration | -Deep caries -Trauma -Extensive Restoration |
Percussion/Occlusion | If due to occlusion, Percussion test is positive. otherwise normal. | If PDL involved, Percussion test is positive. otherwise normal. | - |
Pulp Tests -EPT -Cold -Heat | Normal Response Exaggerated response Normal to elevated | Normal to elevated Pain relieved by cold Acute pain | Asymptomatic |
Color Change | No | Yes | Yes |
Radiograph | Caries and Defective Restoration | Caries, Defective Restoration and PDL Enlargement | Caries, Defective Restoration and PDL Enlargement |
Treatment | Removal of Decay, Pulp Protection and Occlusal Adjustment | Root Canal Treatment | Root Canal Treatment |
