Pulpitis

Clinical Features

• Reversible Pulpitis
  • Duration of pain is short (seconds)
  • Associated with noxious stimuli (usually cold or heat, can also be elicited by sweat and sour)
• Irreversible Pulpitis
  • Duration of pain is long (hours) and intense
  • Associated with noxious stimuli or may occur spontaneously

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

• Clinical evaluation
• X-Ray images
• Dental referral

Management

• Short term management with local anesthetics
• Antibiotics controversial for dental pain alone without evidence of infection
• Antibiotic choices: Penicillin VK or Clindamycin
• Definitive therapy with root canal or extraction (for irreversible pulpitis)

Disposition

• Discharge with dental follow-up

See Also

• Dental Problems