Reversible Pulpitis

Reversible Pulpitis
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Figure 1: Basic tooth anatomy. The pulp consists of blood vessels, nerves, and many types of cells. Nerve
tissue in teeth helps to warn us when there are bacterial invaders (tooth decay), cracks and chips, which can
allow microorganisms access to our body's circulatory system. Blood vessels in teeth bring nourishment to
the living cells inside the teeth. For example, "odontoblast" cells living in the pulp continuously produce
dentin throughout the life of the tooth. Dentin is a calcified substance that can "patch holes" created by
microscopic cracks, and build a dividing wall to slow the advance of bacteria found in tooth cavities.
Pulpitis is a general term for inflammation of the tooth "pulp", which consists of the
blood vessels, nerve tissue, and living cells that occupy the hollow interior of teeth
(Figure 1). Pulpitis is characterized by tooth sensitivity that arises from excess blood
flow (hyperemia) to the tooth. In some cases, the patient will complain of tenderness in
the neck, under the jaw, or under the chin, where lymph nodes are located. Lymph
nodes typically enlarge and become tender when there is infection nearby.
Pulpitis can be caused by any adverse event experienced by the tooth, including decay
(caries), traumatic injury (a sharp blow to the tooth), heavy biting forces, or drilling on
the tooth during dental procedures. Exposure to solutions which dehydrate or
demineralize the tooth can cause it. These may include tooth bleach, acids found in
food and beverages, and even certain multi-care toothpastes.
Pulpitis is generally divided into two types: Irreversible and Reversible. Irreversible
pulpitis is generally characterized by prolonged sensitivity to cold and/or heat, and
sometimes to sweets. It is often accompanied by a continuous low-grade ache, which is
aggravated by these stimuli. Swelling may be present. The tooth's ability to sense a
mild electrical stimulus may be reduced. With irreversible pulpitis, the nerve tissue is
considered vital (i.e. alive), but not viable (i.e. it won't remain alive, due to presence of
irreversible inflammatory agents in the tooth).
Reversible pulpitis is generally characterized by sharp sensitivity to cold, sometimes to
sweets and sometimes to biting. Usually heat doesn't bother the tooth as much. There
is generally no low-grade ache, and the painful response to stimuli is not as prolonged.
Swelling is generally not present. Normally, the tooth can still detect a mild electrical
stimulus. Inside the pulp, the inflammation is not as pronounced as with irreversible
pulpitis, and less damage to the pulp tissues (if any) has occurred.
If a tooth has recently undergone dental procedures (fillings, crowns, etc.), it may be
sensitive for a period of time afterward. This is known as post-operative sensitivity,
essentially a diagnosis of pulpitis. Depending on the nature of the dental procedure,
the age and immune status of the patient, the tooth may get better, or the pulpitis may
become irreversible. In some cases, the tooth pulp may become necrotic (i.e. may die).
A dentist is the only one who can diagnose your tooth, and may be able to give you an
idea of the likelihood of developing pulpitis before any dental procedures are performed.
Keep in mind that teeth are normally living, and that dental procedures on the teeth are
surgical procedures, which commonly produce an inflammatory response of some
degree. Most often the response is minor; however, if the procedure is involved,
irreversible pulpitis may occur.
Teeth have at least two types of nerve tissue inside of them: Myelinated and Unmyelinated. These may be thought of as "insulated" and "un-insulated" wires. The
Myelinated nerves are like insulated wires, and carry sharp pain stimuli to the brain
much faster than un-myelinated nerves. Un-myelinated nerves transmit continuous lowgrade pain (dull aches). When both types of nerve are affected, there is a good chance
the pulpitis is irreversible.

Reversible Pulpitis

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