Pulpitis

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Pulpitis is the inflammation of dental pulp tissue.

Types

  • Reversible: pulpal inflammation which should resolve once the aetiology is removed (defective restoration or caries).
  • Irreversible pulpitis: pulpal inflammation which will not resolve once the aetiology is removed.

Causes

  • Infection
  • Trauma physical Irritation
  • Chemical irritation
  • Mixed microorganisms.

Signs and symptoms

  • Reversible pulpitis
    • Caries
    • Exposed dentin
    • Non-lingering pain to temperature (hot or cold) or osmotic changes
  • Irreversible pulpitis
    • Deep caries
    • Intense, lingering pain to temperature changes
    • Spontaneous pain
    • Diffuse or referred pain

Investigations

  • Intraoral examination to check for exposed dentin, caries, a deep or defective restoration, or trauma
  • Percussion test to rule out acute apical periodontitis
  • X-ray
  • Electric Pulp tester
  • Ethyl Chloride spray

Treatment objectives

  • Relieve pain
  • Treat inflammation
  • Exclude pulp from stimulus in reversible pulpitis
  • Extirpate pulp in irreversible pulpitis

Non-pharmacological treatment

  • Indirect & direct pulp capping
  • Conventional fillings – Amalgam and Composite filling
  • Root canal therapy
  • Extraction

Pharmacological treatment

Paracetamol oral

Adult:

500mg-1g every 6-8hours

Child:

6-12 years: 250-500mg every 6-8 hours

1-5 years: 120-250mg every 6-8 hours,

3 months-1 year: 60-120mg every 6-8 hours when required

OR

Ibuprofen oral

Adult:

200-400mg every 8 hours 

Child:

100-200mg every 8 hours

Antibiotics may only be used if there is indication of bacterial infection

Amoxicillin oral:

Adult:

500mg every 8 hours for 7days

Child:

6-12 years:  250mg every 8 hours for 7 days

1-5 years 125mg every 8 hours for 7 days,

<1 year: 62.5mg every 8 hours for 7days

OR

Metronidazole oral

Adult:

400mg every 8 hours for 7 days

Child:

100-200mg every 8 hours for 7days         

Referral

Dentist for definitive treatment

Prevention

  • Practice good oral hygiene
  • Regular and prompt dental check up
  • Prevent dental caries