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