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With a reversible pulpitis, sleep is usually not affected and no analgesics are necessary. Usually, no atypical change is evident on the radiograph. [4] Pulp vitality tests are positive and it is possible to preserve a healthy vital pulp. Irreversible pulpitis, in contrast, is characterised by a constant severe pain that arises without provocation.
Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. [1] It is often the result of many cases of dental trauma, caries and irreversible pulpitis.
Pulpitis is established when the pulp chamber is compromised by bacterial infection. Irreversible pulpitis is diagnosed when the pulp is inflamed and infected beyond healing. Removal of the aetiological agent does not permit healing, and a root canal is often indicated. Irreversible pulpitis follows reversible pulpitis absent early intervention.
It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial ...
However, a lingering pain which continues despite the removal of the stimulus is indicative of irreversible pulpitis. No response — lack of response to sensitivity testing suggests that the nerve supply to the tooth has been diminished, as in the case of pulpal necrosis or in previously root treated canals.
Irreversible pulpitis progresses to pulp necrosis, wherein the nerves are non-functional, and a pain-free period following the severe pain of irreversible pulpitis may be experienced. However, it is common for irreversible pulpitis to progress to apical periodontitis, including an acute apical abscess, without treatment.
A history of toothache with sensitivity to hot and cold suggests previous pulpitis, and indicates that a periapical abscess is more likely. If the tooth gives normal results on pulp sensibility testing, is free of dental caries and has no large restorations; it is more likely to be a periodontal abscess.
This allows the endodontist to choose the most appropriate treatment option, allowing preservation and longevity of the tooth and surrounding tissues. Treatment options for an irreversibly inflamed pulp (irreversible pulpitis) include either extraction of the tooth or removal of the pulp. Partial pulp amputation (pulpotomy) is the treatment of ...