Pulpitis is an inflammatory reaction of the vital pulp to bacterial, physical or thermal injury to it.
It’s clinical symptoms are subdivided as being Reversible or being Irreversible Pulpitis.
It is recognised by a patient describing symptoms to you or by clinical examination of the patient.
The difference between reversible and irreversible pulpitis is found by the patient’s history, examination and carrying out further tests.
There are four states of the pulp to be aware of. This is the normal pulp, reversible pulpitis, irreversible pulpitis and a necrotic pulp.
In reversible pulpitis, pain is described as mild to moderate and more especially with cold and sweet foods/ liquids; the pain will last no more than 1-minute after stimulus is removed. The pain is usually fairly well localised and the patient can tell you exactly which tooth that is.
In irreversible pulpitis, it is usually heat what causes the stimulation of pain. In fact patients will sometimes even say that a cold drink almost seems to relieve the pain. It is therefore not uncommon for a patient with a irreversible pulpitis to be sitting in your waiting room with a bottle of cold water.
The pain is much more intense and the patient will be resorting to taking analgesics.
Pain is much more diffused and even referred pain can be to the surrounding anatomical structures (ear) and even the opposing arch.
Sometimes the pain will even just occur spontaneously without heat and the patient will say that it is worse when lying down at night and they can be awoken up.
There is a no widening of the PDL but sometimes their tooth can be slightly positive to the percussion test indicating that part of the pulp has already become necrotic and the toxins have reached the periapical tissues.
In molars and premolars, different roots can be in a different pulpal state with 2 or more being present simultaneously.