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or extracting the tooth. Pulpitis can occur when A tooth requires multiple invasive procedures Trauma disrupts the lymphatic and blood supply to the pulp Pulpitis is designated as
Infectious sequelae of pulpitis include apical
periodontitis Periodontitis
Periodontitis is a chronic inflammatory oral disease that progressively destroys the tooth-supporting apparatus. It usually manifests as a worsening of gingivitis and then, if untreated, with... read more Spread from mandibular teeth may cause
Ludwig angina
Submandibular Space Infection Submandibular space infection is acute cellulitis of the soft tissues below the mouth. Symptoms include pain, dysphagia, and potentially fatal airway obstruction. Diagnosis usually is clinical... read more
Symptoms and Signs of PulpitisIn reversible pulpitis, pain occurs when a stimulus (usually cold or sweet) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 seconds. In irreversible pulpitis, pain occurs spontaneously or lingers minutes after the stimulus (usually heat, less frequently cold) is removed. A patient may have difficulty locating the tooth from which the pain originates, even confusing the maxillary and mandibular arches (but not the left and right sides of the mouth). The pain may then cease for several days because of pulpal necrosis. When pulpal necrosis is complete, the pulp no longer responds to hot or cold but often responds to percussion. As infection develops and extends through the apical foramen, the tooth becomes exquisitely sensitive to pressure and percussion. A periapical (dentoalveolar) abscess elevates the tooth from its socket, and the tooth feels “high” when the patient bites down.
Diagnosis is based on the history and physical examination, which makes use of provoking stimuli (application of heat, cold, and/or percussion). Dentists may also use an electric pulp tester, which indicates whether the pulp is alive but not whether it is healthy. If the patient feels the small electrical charge delivered to the tooth, the pulp is alive. X-rays help determine whether inflammation has extended beyond the tooth apex and help exclude other conditions.
In reversible pulpitis, pulp vitality can be maintained if the tooth is treated, usually by caries removal, and then restored. In irreversible pulpitis, the pulpitis and its sequelae require endodontic (root canal) therapy or tooth extraction. In endodontic therapy, an opening is made in the tooth and the pulp is removed. The root canal system is thoroughly debrided, shaped, and then filled with gutta-percha. After root canal therapy, adequate healing is manifested clinically by resolution of symptoms and radiographically by bone filling in the radiolucent area at the root apex over a period of months. If patients have systemic signs of infection (eg, fever), an oral antibiotic is prescribed (amoxicillin 500 mg every 8 hours; for patients allergic to penicillin, clindamycin 150 mg or 300 mg every 6 hours). If symptoms persist or worsen, root canal therapy is usually repeated in case a root canal was missed, but alternative diagnoses (eg, temporomandibular disorder, occult tooth fracture, neurologic disorder) should be considered. Very rarely, subcutaneous or mediastinal emphysema develops after compressed air or a high-speed air turbine dental drill has been used during root canal therapy or extraction. These devices can force air into the tissues around the tooth socket that dissects along fascial planes. Acute onset of jaw and cervical swelling with characteristic crepitus of the swollen skin on palpation is diagnostic. Treatment usually is not required, although prophylactic antibiotics are sometimes given.
Click here for Patient Education Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Is pulp necrosis a diagnosis?Pulp Necrosis is a clinical diagnostic category indicating death of the dental pulp, necessitating root canal treatment. The pulp is non-responsive to pulp testing and is asymptomatic.
What is the most common symptom of pulp damage?Toothache and sensitivity are the main symptoms of pulpitis. The pain you feel usually varies depending on the stage of the inflammation. Symptoms of reversible pulpitis include: No pain when your dentist taps the tooth.
How is pulp necrosis diagnosed?How is pulp necrosis diagnosed?. Electric pulp testing: In this test, an instrument delivers a small electrical pulse to your tooth. ... . Heat or cold test: This involves touching your teeth with a hot or cold substance. ... . Tooth tapping: Your dentist will assess your response to gentle tapping on your tooth with an instrument.. What are the causes and symptoms of Pulpal damage?Symptoms of irreversible pulpitis include:. Intense pain.. Spontaneous pain.. Sensitivity to cold that lasts more than 30 seconds.. Sensitivity to heat.. Pain when the tooth is tapped.. Swelling around tooth and gums.. Fever.. Bad breath.. |