Pulpitis: Difference between revisions

Latest revision as of 22:00, 2 December 2021

Background

Dental Numbering

Classic dental numbering.

Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
Children (non-permanent) teeth identified by letters
Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom

Diagram of the tooth displaying the enamel, dentin, and pulp

Also known as a "dental carries"

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

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

Evaluation

X-ray showing well-defined radiolucency of mesial and distal roots of symptomatic first lower left molar consistent with irreversible pulpitis and associated apical periodontitis.

Workup=

Consider pain X-rays
- Not typically performed in the ED; may be performed upon referral

Diagnosis

Clinical diagnosis

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

References

Authors:

@@ Line 1: / Line 1: @@
-#Two types:
+==Background==
-##Reversible Pulpitis
+{{Dental numbers}}
-###Duration of pain is short (seconds)
+[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]]
-###Associated with noxious stimuli (cold or heat)
+*Also known as a "dental carries"
-##Irreversible Pulpitis
-###Duration of pain is long (hours) and intense
+==Clinical Features==
-###Associated with noxious stimuli or may occur spontaneously
+*Reversible Pulpitis
-###Tx = root canal or extraction
+**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==
+{{Template:Dental Problems DDX}}
+==Evaluation==
+[[File:PMC3548354 JCD-16-83-g001.png|thumb|X-ray showing well-defined radiolucency of mesial and distal roots of symptomatic first lower left molar consistent with irreversible pulpitis and associated apical periodontitis.]]
+===Workup====
+*Consider pain X-rays
+**Not typically performed in the ED; may be performed upon referral
+===Diagnosis===
+*Clinical diagnosis
+==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]]
+==References==
+<References/>
 [[Category:ENT]]
+[[Category:ID]]
-== Source ==
-*ER Atlas
-*Tintinalli
-*UpToDate