Irreversible Pulpitis- Symptoms, Diagnosis and Treatment

 

Definition

Irreversible pulpitis is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic in nature with the pulp becoming incapable of healing.

Types

There are two types of Irreversible Pulpitis

1) Asymptomatic Irreversible Pulpitis

2) Symptomatic Irreversible Pulpitis

Causes/Etiology

CAUSES/ETIOLOGY 
Most common is Dental Caries
Chemical, Mechanical and Thermal injuries to pulp
Untreated reversible pulpitis

Symptoms

SYMPTOMS
Pain is caused by sudden change in temperature specially cold, sweet or acidic food items and pressure from food entrapped in tooth cavity
Pain remains even after the removal of stimulus.
Pain can be spontaneous which can be Sharp, Piercing, Intermittent or Continuous in nature
Pain exacerbated by lying down or on bending due to increase in intra-pulpal pressure
Referred Pain to adjacent teeth or jaw. (Pain referred to temple or sinus in upper posterior teeth and ear in lower posterior teeth)
In later stages pain is severe, boring and throbbing in nature. Pain caused by hot stimulus and relieved by cold.
Apical periodontitis may develop in later stages

Histopathology

Pulp shows acute and chronic inflammatory changes such as-

HISTOPATHOLOGY
Vascular Dilation and Edema
Granular Cell Infiltration
Odontoblasts are destroyed
Formation of minute abscess
In later stages, pulp undergo liquefaction and necrosis

Diagnosis

Visual Examination and History
  • Check for Deep Cavity exposing pulp
  • Secondary Caries under restoration.
Radiographic Examination
  • Check for interproximal caries, depth and extent of caries.
  • Normal periapical area but sometimes widening of PDL space can be noticed in later stages.
Percussion
  • Sometimes tender on percussion can be noticed due to increase in intra-pulpal pressure.
Vitality Tests
  • Thermal Test- Pulp response to thermal changes. Hot stimulus increases pain due to increase in intra-pulpal pressure. Cold relieves the pain.
  • Electric Test- Less current is required in initial stages.

Treatment

  • Complete removal of pulp i.e Pulpectomy or Root Canal Treatment.

Prognosis

  • Prognosis is favorable if complete removal of pulp is performed.

Differential Diagnosis of Reversible and Irreversible Pulpitis

A summary of Reversible and Irreversible Pulpitis.

 Features

Reversible PulpitisSymptomatic Irreversible PulpitisAsymptomatic Irreversible Pulpitis

Pain Type

Sharp and Momentary pain and ceases after stimulus removal

Intense, continuous and Prolong pain even after stimulus removal

Asymptomatic

Stimulus

External Stimuli like heat, cold and sweet

- Spontaneous in nature.

- Heat acts as stimulant

- Dead or injured pulpal tissue acts as secondary stimulus 

Often asymptomatic

Pain at Night/Postural

No

Yes

No

Pain Localization

Only with applied cold stimulus or PDL inflammation

Only with applied heat stimulus or PDL inflammation

Asympromatic

 

Referred Pain

Usually Not Found

Common Finding

Not

History

-Recent Dental procedure

-Cervical Erosion/Abrasion

-Deep caries

-Trauma

-Extensive Restoration

-Deep caries

-Trauma

-Extensive Restoration

Percussion/Occlusion

If due to occlusion, Percussion test is positive. otherwise normal.

If PDL involved, Percussion test is positive. otherwise normal.

-

Pulp Tests

-EPT

-Cold


-Heat


Normal Response

Exaggerated response

Normal to elevated


Normal to elevated

Pain relieved by cold


Acute pain

Asymptomatic

Color Change

No

Yes

Yes

Radiograph

Caries and Defective Restoration

Caries, Defective Restoration and PDL Enlargement

Caries, Defective Restoration and PDL Enlargement

Treatment

Removal of Decay, Pulp Protection and Occlusal Adjustment

Root Canal Treatment

Root Canal Treatment 

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