Pulpitis: Difference between revisions
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==Background== | ==Background== | ||
{{Dental numbers}} | |||
[[File:Enamel.png|thumb|Diagram of the tooth displaying the enamel, dentin, and pulp]] | |||
*Also known as a "dental carries" | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 14: | Line 16: | ||
==Evaluation== | ==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== | ==Management== | ||
*Short term management with local anesthetics | *Short term management with local anesthetics | ||
*Antibiotics controversial for dental pain alone without evidence of infection | *[[Antibiotics]] controversial for dental pain alone without evidence of infection | ||
*Antibiotic choices: Penicillin VK or | *Antibiotic choices: [[Penicillin VK]] or [[clindamycin]] | ||
*Definitive therapy with root canal or extraction (for irreversible pulpitis) | *Definitive therapy with root canal or extraction (for irreversible pulpitis) | ||
Latest revision as of 22:00, 2 December 2021
Background
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
- 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
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