1.

Pulpitis is a condition in which the pulp (nerve) of the tooth becomes inflamed,
causing pain and pressure in the tooth. There are varying degrees of pulpitis, from
mild to severe.

Etiology of pulpal diseases can be broadly classified into three groups:

1.Bacterial:
caries;
microleakage around a restoration;
periodontal pocket and abscess;
anachoresis.
2.Physical:
a.Mechanical:
trauma:
acute trauma like fracture or avulsion of tooth;
iatrogenic dental procedures:
pathologic wear like attrition, abrasion, etc.;
barodontalgia due to barometric changes.
b.Thermal:
heat generated by cutting procedures;
heat from restorative procedures;
heat generated from electrosurgical procedures;
frictional heat from polishing restorations.
3.Chemical:
acids from erosion;
use of chemicals like monomers, liners, bases, phosphoric acid, or use of cavity
desiccants like alcohol.
4.Idiopathic:
aging;
resorption: internal or external.
Grossmans Clinical Classification
a.Reversible papulosis:
Symptomatic (Acute).
Asymptomatic (Chronic).
b.Irreversible pulpitis:
Acute
Abnormally responsive to cold.
Abnormally responsive to heat.
Chronic
Asymptomatic with pulp exposure.
Hyperplastic pulpitis.
Internal resorption.
2.Pulp degeneration:
a.Calcific (Radiographic diagnosis).
b.Other ( Histopathological diagnosis).
3.Pulp necrosis:
a.Coagulation necrosis.
b.Lique faction necrosis.
Pulpitis classification (E. M. Gofung, 1928)
1. Acute pulpitis:
 a) Partial.
b) General.
c) Purulent.
2. Chronic pulpitis:
a) Fibrous (simple).
b)Hypertrophic.
c) Gangrenous.
American Association of Endodontists Classification*
Normal pulp
Reversible pulpitis
Symptomatic irreversible pulpitis
Asymptomatic irreversible pulpitis
Pulp necrosis
Previously treated
Previously initiated therapy

2. Chronic pulpitis

Mostly due to caries and other chronic degenerative conditions of the pulp with long
lasting stimulation, can occur with chronic inflammation of the pulp process. Chronic
pulpitis in the development process, such as an increase in polymorphonuclear
leukocytes, the release of lysosomal enzymes also increased, leaving exacerbate
inflammation, acute onset of symptoms can occur clinically. Chronic pulpitis
clinically divided into three categories: chronic pulpitis atresia, chronic open
pulpitis and chronic hyperplastic pulpitis. Also called chronic open pulpitis pulpitis
chronic ulcers. Chronic hyperplastic pulpitis pulp, also known as polyps.

3. Investigation
1. Obtain thorough dental history and inquire about recent restorations or trauma.
2. Inquire about previous history of pain on the offending tooth.
3. Ask the patient about:
Location of the offending tooth
When did the pain start?
How intense is the pain?
What causes the pain and what relieves it?
How long does the pain last?
Pain description (e.g., dull, sharp, throbbing)
4. Perform an intraoral examination to check for exposed dentin, caries, a deep or
defective restoration, or trauma.
5. Perform a percussion test to rule out acute apical periodontitis.
6. Perform a cold test using a refrigerant spray (e.g., Endo-Ice) or an ice stick. Test
the healthy control teeth first in order to better localize the offending tooth.
7. Perform a hot test using hot water in a syringe (e.g., Monojet) and rubber dam
isolation, a heated gutta percha stick or heat source (e.g., System B Heat
Source) to reproduce pain to hot. Healthy control teeth should be tested first.
Delayed and prolonged pain triggered by heat may indicate irreversible pulpitis.
8. Use radiographs to identify teeth with large restorations or caries that are not
clinically visible. Keep in mind that teeth with reversible or irreversible pulpitis
will not show periapical lesions radiographically, but may show thickening of the
 periodontal ligament (PDL), loss of lamina dura, and/or condensing osteitis.
Irreversible pulpitis may show widened PDL space.

Diagnosis
Based on clinical examination and testing, a diagnosis of reversible or irreversible
pulpitis is determined.
Reversible Pulpitis
Pain from cold test does not linger more than 30 s
No percussion sensitivity
No spontaneous pain
No heat sensitivity
Irreversible Pulpitis
Pain from cold test lingers more than 30 s
May get pain from heat test
May have spontaneous pain
May be percussion sensitive
Radiographically or clinically visible deep caries.

Treatment
Common Initial Treatments
Reversible pulpitis
1. Remove the irritant or repair tooth structure (caries, exposed dentin, defective
restoration).
2. Continue to monitor the patients symptoms.
3. Advise patient to return if symptoms persist or worsen.
Irreversible pulpitis
1. Pulpectomy of the offending tooth: complete removal of the pulp. If it is
determined that the case in question is too complex, promptly refer to an
endodontist.
2. If treatment is undertaken and the appointed treatment time permits, root canal
treatment can be completed in one visit.
Antibiotics are not recommended for irreversible pulpitis as they will not
alleviate the patients pain and should not be given in lieu of performing an
immediate pulpectomy.