SYMPTOMATIC IRREVERSIBLE

PULPITIS

Reported by

O.R.GANESH

Definition

The pulp has been damaged beyondrepair, and even with removal of the irritant it will not heal.

The pulp will progressively degenerate, causing necrosis and reactive destruction

Symptomatic irreversible pulpitis

Causes of Irreversible Pulpitis

Most 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

Symptoms of Irreversible Pulpitis

A 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

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

Symptoms of Irreversible Pulpitis

Visual – Diagnosis through direct vision, showing a deep cavity involving the pulp, or any secondary caries under any restoration.

Radiograph – 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.

Diagnosis

Diagnostic test Offending toothCold test Throbbing and lingering

pain. lasting several minutes or hoursHeat test

EPT Response in normal limit

Test cavity +

Percussion + if periodontal ligament becomes involved.

Mobility _

palpation _

Generally not tender to percussion or palpation

Radiograph appearance

Radiologically there may be early signs ofperiodontal ligament widening

when the periodontal ligament becomes involved, the pain will be localised

A widened periodontal ligament may be seen radiographically in the later stages.

Symptomatic irreversible pulpitis

TREATMENT

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

A file should not be introduced into any canal unless a pulpectomy 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

Treatment of Irreversible Pulpitis with Acute Apical Periodontitis

Between visits, the canals should be medicated with calcium hydroxide to prevent bacterial regrowth.

Occlusal reduction has been reported to reduce postoperative pain.

Antibiotics are not recommended for irreversible pulpitis or acute apical periodontitis

Finally, teeth with irreversible pulpitis should not be left open between visits because bacterial contamination of the cleansed canal will occur

REFERENCE

Textbook of endodontology - gunnar bergenholtzClinical endodontics - leif tronstad,Pathways of the pulp – stephen cohen 9th ed.Endodontics - john i. ingle, dds, msd