There are two forms of pulpitis: reversible and irreversible. Reversible pulpitis refers to instances where the inflammation is mild and the tooth pulp remains healthy enough to save. Irreversible pulpitis occurs when inflammation and other symptoms, such as pain, are severe, and the pulp cannot be saved.

According to a 2016 systematic review , the most common cause of pulpitis is when bacteria irritate the dental pulp through an area of tooth decay, including dental caries. Other causes of pulpal inflammation include: trauma or injury to a tooth. grinding or clenching the teeth.

Treatment of Pulpitis

1. Drilling and filling for reversible pulpitis.
2. Root canal and crown or extraction for irreversible pulpitis.
3. Antibiotics (eg, amoxicillin or clindamycin) for infection that cannot be resolved with local measures.

Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.

Pulpitis Symptoms Sensitivity to sweet foods or drinks. Sensitivity to cold that lasts only a few seconds. Sharp pain. Tooth doesn’t hurt when it’s tapped.

Antibiotics may decrease pain due to facial swelling from acute apical abscesses that are indeed due to bacterial infections but they are definitely not indicated for tooth pain relief due to an irreversible pulpitis.

Amoxicillin is usually the first choice for tooth infection treatment. Clavulanate is a drug that makes amoxicillin even more effective when the two are combined. So, if it appears that your tooth infection is more serious, your dentist may prescribe amoxicillin with clavulanate instead of plain amoxicillin.

Pulpitis occurs when the inner pulp portion of the tooth, which is made up of blood vessels and nerves, becomes inflamed. The inflammation is usually reversible, but there are times when the inflammation isn’t reversible, and the pulp can’t heal itself.

Antibiotics are not recommended in the treatment of irreversible pulpitis! There is insufficient scientific research to ascertain whether the use of antibiotics is helpful, studies show that antibiotics do not have any significant effect of reducing the pain from a toothache.

Prescribing Antibiotics for Irreversible Pulpitis

• Immediately prescribe antibiotics and schedule root canal treatment later.
• Immediately prescribe analgesics and schedule root canal treatment later.
• Immediately prescribe both antibiotics and analgesics and schedule root canal treatment later.

But in most cases when adults have a toothache and access to dental treatment, antibiotics may actually do more harm than good, Lockhart said. “While evidence on the benefits of antibiotics for toothaches is limited, it does show that antibiotics can harm patients,” Lockhart said by email.

Teeth with symptomatic irreversible pulpitis may be difficult to diagnose because the inffammation has not yet reached the periapical tissues, thus resulting in no pain or discomfort to percussion. In such cases, dental history and thermal testing are the primary tools for assessing pulpal status.

Both types of pulpitis cause pain, though the pain caused by reversible pulpitis may be milder and occur only while eating. The pain associated with irreversible pulpitis may be more severe and occur throughout the day and night.

Cold spray applied to a Q-tip and then held on a tooth for 5-10 seconds. Assuming pain is produced by this cold stimulation, if the pain lingers for more than 10 seconds after the Q-tip is removed this is considered evidence of irreversible pulpitis.

It usually is reversible and it goes away on it’s own. However, if pulpitis pain is severe and doesn’t go away you should consult a doctor. Pulpitis after filling happens from time to time and most doctors can consult you on that.

Signs You Have Cavities (Tooth Decay Symptoms) In the case of a deeper cavity that has reached the pulp or nerve canals, you may notice a bad taste in your mouth. Severe spontaneous pain, pain to pressure, pain that wakes you up at night and pain to hot are often signs of an infected nerve.

7.4 What is the difference between reversible vs irreversible pulpitis?…Pulpitis symptoms and signs.