repair, and even with removal of the irritant it will not heal.
The pulp will progressively degenerate,
causing necrosis and reactive destruction c
ost commonly the bacterial
involvement of pulp through dental caries, Chemical, mechanical or thermal injuries that cause inflammation of the pulp.
Untreated reversible pulpitis can lead to
irreversible pulpitis c
Y rapid onset of pain when any stimulus like
cold foods, or sweet food, pressure from packing of food into cavity, or pressure exerted by tongue, that results in congestion of the blood vessels of the pulp. The pain may be caused by sudden temperature changes, which is prolonged. prolonged episodes of pain even after the source of the pain is removed c
The pain may be sharp, shooting or
piercing in nature. The pain may be referred to adjacent teeth sometimes, and also to ear if lower teeth are involved, and to temple region if the upper teeth are involved. The pain caused by cold stimulation can be relieved by heat, and similarly, the pain caused by heat can be relieved by cold r
Ôisual ʹ Diagnosis through direct vision, showing a deep cavity involving the pulp, or any secondary caries under any restoration.
Radiograph ʹ It may show exposure of
the pulp, caries under any filling, and deep cavity.
The periapical area usually is normal,
with some widening of the periodontal ligament sometimes. r ! " Cold test Throbbing and lingering pain. lasting several Heat test minutes or hours EPT Response in normal limit
Test cavity #
Percussion + if periodontal ligament
becomes involved. obility $
palpation $
Generally not tender to percussion or palpation
c
!"
Radiologically there may be early signs of
periodontal ligament widening
when the periodontal ligament becomes
involved, the pain will be localised
Y widened periodontal ligament may be
seen radiographically in the later stages.
Complete removal of the pulp and total
cleaning and shaping of the root canal system are the treatment of choice for emergent irreversible pulpitis
In multirooted teeth, a pulpotomy
(removal of the coronal pulp or tissue from the widest canal) has been advocated for emergency treatment of irreversible pulpitis Y file should not be introduced into any canal unless a is anticipated.
Pain symptoms can persist or worsen
if inflamed pulp remains in the root canals.
Intracanal medicaments helped
control or prevent additional pain was very popular Complete removal of the pulp is the best treatment of irreversible pulpitis
Single-visit endodontic treatment for
teeth diagnosed with irreversible pulpitis is not contraindicated
Occlusal reduction is not indicated in
these cases without periapical involvement
etween visits, the canals should be
medicated with calcium hydroxide to prevent bacterial regrowth.
Occlusal reduction has been reported
to reduce postoperative pain.
Yntibiotics are not recommended for
irreversible pulpitis or acute apical periodontitis ëinally, teeth with irreversible pulpitis should not be left open between visits because bacterial contamination of the cleansed canal will occur