Introduction
Pulpitis of the tooth is an inflammation of the dental pulp or an inflammation of the dental nerve. In most cases the cause is an untreated, deep-seated caries close to the pulp. The bacteria penetrate the tooth and a defensive reaction of the tooth follows, which results in an inflammation of the dental nerve.
In addition to deep-seated caries, there are other possible causes for the development of pulpitis. These include trauma, deep gum pockets or tooth fractures. A distinction is made between reversible and irreversible pulpitis.
Causes
The main cause for the development of pulpitis is an untreated caries close to the pulp. Toxins from caries close to the pulp (Caries profunda) and bacteria are transported to the pulp. This initially reacts with hyperemia, i.e. increased blood circulation.
This serves the purpose of creating more defence cells at the affected areas to fight the bacteria. The hyperemia then turns into an inflammation of the dental nerve. It leads to strong sensitivity to heat and cold and further to sensitivity to knocking and pressure.
In addition to caries profunda, there are other possible causes for the development of pulpitis. These include infectious causes, diseases of the maxillary sinus, acute inflammation around the root tip or in the area of neighboring teeth, therapeutic causes or hematogenic causes. Often the cause of a pulpitis is also a descending periodontitis. This means that the periodontal apparatus, the periodontium, is damaged or inflamed. Through deep gum pockets the inflammation can penetrate to the area of the tooth pulp from the outside.
Associated symptoms
In addition to the pain due to cold or warm stimuli, as well as the knocking and throbbing pain, accompanying symptoms often occur. Often it can hurt very strongly when biting into the mouth. Another symptom can be a ‘thick cheek‘.
This is caused by water retention in the inflamed tissue. This results in a so-called oedema. Furthermore, fever, tiredness and fatigue can be accompanying symptoms of pulpitis.
When the bacteria reach the bloodstream, the body reacts with a defensive reaction that results in fever and fatigue. Headaches can also be a sign of pulpitis in conjunction with the above-mentioned symptoms. However, the nature of the accompanying symptoms is very individual and cannot be generalized.
According to new studies, a pain-inducing knock test (percussion test) is considered a sure sign of an existing pulpitis. Pain or sensitivity to cold or warm stimuli are the main symptoms of an existing pulpitis. This can happen in any everyday situation.
The pain is described as stabbing and pulling and often lasts longer than caries. They are also often described as permanently throbbing. In acute pulpitis, the pain is very intense and can occur in continuous intervals.
Often the pain can also increase when lying down in acute pulpitis. However, a pulpitis can also occur almost without pain. In this case it would be chronic.
The pain is less severe than in the acute case. Due to the increased pressure on the dental nerve, the patient often cannot differentiate from which tooth the rarely occurring pain originates. The name of the disease pulpitis indicates an inflammation by the ending -itis.
This inflammation can have many different causes. In most cases, deep-seated caries is the cause of the pulpitis. The bacteria in the caries produce toxins, so-called endotoxins, which penetrate into the pulp.
The tooth reacts with a defensive reaction and as a result an inflammation develops. Sometimes the inflammation is accompanied by swelling or redness of the gums. This depends on the spread of the inflammation. It can also happen that the inflamed tissue could not be completely removed during the treatment. In this case, a new inflammation forms which must be treated again.
