Top stories
- Pulpitis — inflammation of the pulp: the soft tissue inside the tooth containing blood vessels and nerves, triggered by deep caries or trauma.
- Pain from hot and cold: at first short, then lasts longer, appears at night and without cause.
- Urgent appointment is needed for: unbearable pain, swelling of the face or cheek, raised body temperature.
- Examination includes: visual examination and probing, thermal test, percussion, dental radiography, electroodontodiagnostics.
- Treated by a dentist: removes the affected tissues, fills the canals, restores the tooth with a filling or crown.
What is pulpitis
Pulpitis is inflammation of the inner soft tissue of the tooth, where the nerves and vessels run. Below is an explanation of what exactly happens inside the tooth, which circumstances trigger the inflammation and who is affected by it more often.
What happens in the body
The inner soft tissue of the tooth, where the nerves and vessels are located, is called the pulp and occupies the cavity inside the crown and roots. While the hard tissues are intact, it is reliably separated from the bacteria that constantly live in the oral cavity. When caries destroys the enamel and dentine, this protection thins and at some point stops working. Bacteria penetrate into the pulp, and the tissue responds to their appearance with inflammation. The vessels dilate, the liquid part of the blood leaks into the surrounding tissues, and oedema occurs. The oedema presses on the nerve endings from the inside, because the tooth cavity is bounded by hard walls and has nowhere to expand. Hence the pain of varying intensity, which worsens with loading on the tooth, with hot or cold. If the inflammation is not stopped, the tissue gradually breaks down, and the process spreads beyond the tooth.
What causes it to develop
- Deep caries: destruction of the hard tissues reaches the inner chamber of the tooth and opens the way for bacteria to the pulp, and this is the main mechanism that triggers inflammation.
- Tooth trauma: a blow or a chip damages the enamel and dentine, the integrity of the walls is disrupted, and the infection gets inside even without visible destruction.
- Poor-quality treatment or a fallen-out filling: under an old filling a focus of destruction remains, it develops unnoticed, and a fallen-out filling immediately opens the tooth cavity.
- Frequent gum inflammation: a constant focus next to the root creates conditions under which the infection gradually spreads towards the pulp.
- Overcooling or overheating of the tooth: sharp temperature changes weaken the tissue and make it more vulnerable to the bacteria already present.
- Practical conclusion: any of these situations should be taken as a reason to show the tooth to a doctor before the process goes deeper.
Who encounters this more often
People with neglected caries and those who put off a visit to the dentist for a long time encounter inflammation of the pulp more often. Destruction of the hard tissues proceeds gradually and often without noticeable pain, so the moment of transition to the deep stage is easy to miss. Those who already have fillings are also at risk: over time they wear out, and a new focus of destruction may develop under them. The general condition of the oral cavity also matters — with frequent gum inflammation the infection stays next to the roots constantly. Trauma also contributes: a blow, a chip or the habit of biting hard objects damage the walls of the tooth and open the way for bacteria. Diet with an abundance of sweets also has an effect, because it supports the growth of bacteria on the surface of the teeth. The practical conclusion is simple: if a filling has been in place for a long time and there are no complaints, this does not mean that everything is fine under it, and it is worth checking it during a routine examination.
What symptoms can occur?
Pulpitis manifests as pain of varying intensity, and the nature of the sensations helps to recognise it. It is important to understand which signs require a visit to the dentist without delay.
How it is noticed at the very beginning
At the beginning, pulpitis often makes itself known through brief pain from hot or cold, which quickly passes after the irritant is removed. A person drinks a cup of hot tea and feels a sharp twinge, but soon forgets about it. Many attribute such sensations to fatigue, exposure to cold or accidental sensitivity and do not attach importance to them. Gradually the pain becomes stronger, lasts longer and may appear without any visible cause. Night-time attacks interfere with sleep, and the tooth itself begins to ache even at rest. Over time, the unpleasant sensations spread to neighbouring areas, and it becomes difficult for the person to understand which tooth exactly hurts. If a brief reaction to temperature repeats for several days in a row, this is a reason to see a dentist without waiting for the pain to worsen.
Signs that occur most often
- Pain from hot or cold: a sharp reaction to temperature lasts longer than usual and gradually intensifies, making it difficult to eat and drink.
- Spontaneous pain: attacks occur without an external cause, especially at night, and may radiate to neighbouring areas.
- Pain when biting: pressure on the tooth causes unpleasant sensations, which makes the person try to chew on the other side.
- A feeling that the tooth has become higher: it seems as though it has moved out of the row, and closing the jaws causes discomfort.
- Swelling of the gum or cheek: swelling next to the painful tooth is visible from the outside and indicates that it is no longer possible to wait.
When to seek help urgently
Examinations and tests
Examination for pulpitis is based on a clinical examination and clarifying methods that help assess the condition of the pulp and the surrounding tissues of the tooth. Below is a breakdown of what exactly the doctor does at the appointment and what results this gives.
How the examination begins
The examination begins with an inspection of the oral cavity and probing, during which the doctor assesses the condition of the hard tissues and the tooth's response. During the examination, the specialist pays attention to the depth of the carious cavity and the condition of the edges of the defect. Then a thermal test is carried out: the tooth is checked for its reaction to cold and hot, noting the nature and duration of the sensations that arise. After this, percussion is performed — tapping on the tooth, which helps to understand whether the surrounding tissues are involved in the process. If the examination data are insufficient, the doctor may order an X-ray to clarify the condition of the pulp and the tissues around the root. If necessary, electroodontodiagnostics is carried out to assess the excitability of the pulp and the depth of its damage. All these steps together give the doctor a basis for further decisions, so one should not put off a visit when complaints appear.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries from previous visits: they help the doctor see how the condition of the tooth has changed over time and avoid repeating steps already taken.
- Images taken earlier: comparing old and new data shows the dynamics of the process and clarifies which areas require attention now.
- A description of your own sensations: it is important to recall in advance when the pain appeared, what causes it and how long it lasts after the stimulus.
- Information about past illnesses: it is needed so that the doctor takes the general condition into account when choosing further actions and assessing the results.
- A list of questions for the doctor: points written down in advance help you not to forget anything in the conversation and to get clear answers about your situation.
Which doctor should I see?
Pulpitis is treated by a dentist, and it is to them that patients are referred when inflammation of the pulp is suspected. Understanding what happens at the appointment and what the treatment involves helps you plan the visit calmly.
Which specialist manages this condition
Pulpitis is treated by a dentist, so you need to book an appointment with this specialist, not with a physician or another general practitioner. The doctor examines the tooth, assesses the condition of the pulp and determines whether it can be kept viable. If there is no specialist dentist nearby, you should contact a dental department or a dental office at a polyclinic. The doctor removes the affected tooth tissues and decides whether devitalisation or extirpation of the pulp is needed. Then they treat the root canals and fill them to close off access for inflammation. The procedure ends with the placement of a filling or a crown if the tooth wall is severely damaged. After treatment, the doctor schedules follow-up to make sure the process has not returned. If the visit is delayed, the inflammation may spread to the surrounding tissues and complicate treatment.
What the treatment involves
- Removal of affected tooth tissues: the doctor removes the destroyed areas to gain access to the pulp and assess the extent of inflammation.
- Devitalisation or extirpation of the pulp: the pulp is either deprived of viability or removed completely if it can no longer be preserved.
- Filling of the root canals: the canals are filled with material to seal the cavity and leave no room for recurrent inflammation.
- Placement of a filling or crown: the tooth is restored on the outside, returning its shape and its ability to take part in chewing.
- Follow-up after treatment: the doctor checks how the tooth copes with the load and whether there are signs of the inflammation returning.
What depends on the patient themselves
The result of pulpitis treatment largely depends on how regularly the patient comes for check-ups after the intervention. The dentist can preserve a viable pulp with the help of medicated liners, but this requires careful attention to the timing of visits. If a person misses the scheduled check-ups, they do not notice how recurrent inflammation begins under the filling. After the canals are filled, the tooth may not cause any trouble, and this often dulls vigilance. Meanwhile, the load on the restored tooth is distributed differently, and this is noticeable in the sensations when chewing. The patient should tell the doctor about any pain, swelling or discomfort rather than wait for them to pass on their own. Regular check-ups help to see changes in time and adjust the follow-up.
What helps prevent an exacerbation?
This section is about what depends on the person themselves: daily habits, attention to the condition of the oral cavity and regular check-ups at the dentist. Timely treatment of caries and hygiene reduce the risk of exacerbation of pulpitis.
What is changed in habits
Brushing teeth twice a day is a basic habit that directly affects the condition of the enamel and dentine. A brush removes soft plaque from accessible surfaces, but the spaces between the teeth remain inaccessible to it. Dental floss cleans these areas, where food debris and bacteria most often accumulate. Limiting sweets and fizzy drinks reduces the environment in which the destruction of hard tissues proceeds faster. Timely treatment of caries stops the process before it reaches the pulp. If a carious cavity is not filled in time, inflammation can spread deeper and cause an exacerbation. Discuss with your doctor which of these habits you already have and which are worth adding.
What is worth keeping under control
- Oral hygiene: brushing twice a day and dental floss are the foundation that reduces the risk of inflammation of the pulp.
- Sweets and fizzy drinks: limiting them reduces the environment in which the destruction of tissues proceeds faster.
- The condition of previously treated teeth: fillings change over time, and a process may develop underneath them.
- Timely treatment of caries: the earlier the cavity is filled, the lower the likelihood that inflammation will reach the pulp.
- Preventive check-ups: a regular visit to the dentist helps to notice a problem at an early stage.
How often to see a doctor
A regular check-up at the dentist is needed even when the teeth do not hurt and you feel well. Many changes in the hard tissues and under fillings develop unnoticed and do not make themselves known until an exacerbation. The doctor examines the surface of the teeth, checks the condition of previously treated areas and assesses whether there are signs of inflammation. Preventive check-ups help to identify problems at an early stage, when the intervention is simpler and smaller in scope. If caries is detected in time, its treatment stops the process before it affects the pulp. If unpleasant sensations from hot, cold or sweet appear, the visit should not be postponed. Ask your doctor about the interval of check-ups suitable for you and stick to it.
What is worth remembering
Pulpitis is a condition in which inflammation affects the inner tissues of the tooth, and recognising it on your own without an examination can be difficult. Below are the conclusions that help you make a balanced decision and not harm yourself.
Key conclusions
Pulpitis does not go away on its own, because the inflammation inside the tooth has no conditions for reverse development. The pain may subside for a while, but this does not mean that the process has stopped. Enduring it and waiting for it to get better is the most common mistake, which leads to tooth loss. Putting off a visit to the doctor is also dangerous because the inflammation can spread beyond the tooth. Then changes in the surrounding tissues are added to pulpitis, and treatment becomes more difficult. The decision on what to do is made only by the dentist after an examination and an X-ray. No home measures replace a professional assessment of the condition. If pulpitis is detected in time, the chances of saving the tooth are noticeably higher.
