Pulpitis is an inflammation of the dental pulp. The dental pulp consists of connective tissues, blood vessels and nerves. The pulp is surrounded by enamel and dentine. When the integrity of the enamel and dentine is compromised, the pulp will be exposed to irritants. This provokes a response which you may feel as a toothache. Pulpitis may be

• Reversible – the pulp is able to heal if the irritation is removed such as by doing a filling in a tooth with decay.

• Irreversible – the pulp is unable to heal and requires pulp therapy or root canal treatment. 

A tooth with dental pulp inflammation or infection can present with one or more of the following symptoms:

• Prolonged sensitivity to hot or cold food / drinks

• Pain that is unprovoked • Pain that is spontaneous and throbbing

• Pain on biting • Pain which may interrupt sleep

• Pain which may be referred to head, temple or ear

• Discolouration of the tooth

• Tenderness of the overlying gums

• Abscess or swelling

Sometimes, there may be no symptoms at all. When the dental pulp inflammation or infection is left untreated, it can eventually cause severe pain, abscess (swelling) and loss of the supporting bone.

It is best to consult with your dentist if you have any of the symptoms mentioned for a more accurate diagnosis and treatment.

Abscess on upper right tooth

• Caries or tooth decay is the most common cause of dental pulp inflammation and infection.

Other pathways for bacterial invasion into the tooth structure and infection of the underlying dental pulp are through:

• Defective fillings or restorations

• Cracks in the tooth structure can serve as potential pathways for bacteria and noxious stimuli to irritate the dental pulp.

• Traumatic injuries to the face and mouth from sports or other accidents can cause teeth to fracture, loosen or even be knocked completely out of the socket (avulsion). Any damage of the tooth structure, surrounding gum or supporting bone will allow bacteria colonisation from saliva, leading to an inflamed dental pulp.

Trauma to upper front teeth

• Excessive wear of the hard outer layers (enamel and dentine) of the tooth due to parafunctional habits like grinding of teeth also make the dental pulp more vulnerable to bacterial or acidic attack.

Excesive wear on upper and lower teeth

You should see a dentist immediately if you experience a toothache. In the meantime, the following may ease the discomfort:

• Avoid hot or cold food

• Avoid biting on the involved tooth

• Take an over the counter painkiller such as paracetamol or ibuprofen

Diagnosis of the dental pulp status of your tooth is done by your dentist using clinical examination and investigations. Some of these investigations include:

• Pulp vitality tests, such as thermal tests or electric pulp tests. These are used to determine if the dental pulp is still alive.

• X-rays (radiographs) are used to determine the extent of tooth decay and surrounding bone inflammation caused by dental pulp infection.

Prevention Prevent tooth decay having a sensible diet and practising good oral hygiene:

• Limit snacking in between meals and consumption of refined carbohydrates e.g. sweets, cake, ice cream

• Brush your teeth with a fluoride tooth paste twice daily

• Floss at least once a day

Visit your dentist for regular check-ups so that decay or a defective filling can be detected and treated early before there is irreversible damage to the dental pulp.