Pulpitis: When the living part of your tooth becomes inflamed

Inside the innermost part of each tooth, is an area called the pulp. The pulp contains the blood, supply, and nerves for the tooth.

So when the pulp, becomes inflamed you develop a condition known as pulpitis, explains Dr Caroline Njeri Theuri, a pediatric dentist at Vimak Dental Centre. She also describes the pulp is the third part of a tooth, the first being the enamel followed by dentin.

“By the time someone has pulpitis, it means that a cavity has moved from the enamel, into the dentin and into the pulp, inflaming it,” she explains, adding that it can occur in one or more teeth.

Dr Njeri explains that one of the major causes of dental caries are foods, also known as the substrate, including sugary foods.

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Dental caries occur when bacteria from the substrate gets on the teeth then produces acid, which corrodes the tooth causing a cavity. “Once pulpitis stays longer, a dental abscess forms and then a pulp polyp,’’ she says.

A dental abscess is a collection of pus that forms inside the tooth, which develops into a pulp polyp, also known as Chronic Hyperplastic Pulpitis, a growing inflammation of the dental pulp that usually forms after long standing infection.

Dr Njeri says pulpitis forms in both milk teeth, which is primary teeth in children, and in adults. She explains that the most common signs of pulpitis are inflammation and pain on the gum of the affected tooth, difficulty in eating due to the inflammation of pulp, an abscess, increased sensitivity and sometimes, tooth discoloration. “In Kenya, dental caries stand at about 40 per cent to 70 per cent of cases, where one in four to seven people has a cavity,’’ she offers.

Reversible and irreversible pulpitis

She further explains that pulpitis can be reversible or 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. “In reversible pulpitis, you can do a filling for treatment, while in irreversible pulpitis, you can’t do anything, other than do a root canal treatment or a tooth extraction,’’ she says.

First, an X-ray is done to identify the extent and size of the cavity to allow for proper treatment.

She explains that in adults, pulpitis is treated through root canal on the permanent teeth, and in children, a procedure called pulpotomy or pulpectomy is done. Pulpotomy, also known as a mini root canal, is where the coronal part, also known as the crown of the pulp is removed. The crown is the visible part above the gum line. In a pulpectomy procedure, the dentist removes the pulp from the damaged teeth completely from the crown to the roots. After the damaged pulp is removed, the tooth is cleaned, disinfected, filled, and covered, Dr Njeri says.

More teeth can be affected

The process is similar to that of a root canal.

 If pulpitis is left untreated, pain increases, the patient will be unable to chew and develop halitosis (bad breath) due to food packing inside the cavity.

Surprisingly, Dr Njeri says that pulpitis also affects the opposite side of the tooth. “For example, if you get a pulp polyp or pulpitis on the lower tooth and the tooth breaks and its left like a root, the upper tooth tends to grow longer into the space of the one that is missing, because teeth function in twos,” she shares.

The process is known as supra eruption, where a missing tooth or delayed replacement of lost teeth leads to extrusion of the opposing teeth into the edentulous space. “Dealing with a decay in the early stages is cheaper than a root canal treatment,” she said.

Pulpitis can be avoided by brushing of teeth at least twice a day, after meals, use of fluoridated toothpaste, avoiding sugary foods and flossing as part of oral hygiene. “Pulpitis is preventable andtreatable, nobody should suffer from it,” she says in conclusion.