There are two types of pulpitis: reversible and irreversible. In reversible pulpitis the nerve and the pulp can yet be saved and brought back to sound condition. Produced by bad contact with the opposing tooth or by a new filling that is irritatingly close to the pulp or by a deep unfilled cavity, reversible pulpitis may degenerate into irreversible pulpitis. When the pulp is abscessed and dying and cannot be resurrected, the pulpitis is irreversible. A painful response is elicited when the tooth is tapped with an instrument or a finger.

The Danger: If not treated the tooth will become abscessed and removal might be necessary.

Symptoms: The tooth becomes sensitive to cold, the pain lasting a few minutes and then disappearing. In advanced stages, pain will appear without any cause and last for a much longer time, occurring more frequently when the patient is in a horizontal position. There may be swelling of the face.

The tooth will now be sensitive to hot substances as well. The toothache is sharp, stabbing, or throbbing; the pain is difficult to pinpoint, often manifesting itself in a different place, sometimes even in the opposing jaw.

Treatment: In reversible pulpitis the dentist will apply a suitable germicide and seal off the exposed pulp, thus preventing further invasion from salivary bacteria. In irreversible pulpitis, he will begin root canal work or send the patient to an endodontist. The pulp will be removed and the canals sterilized and filled.

Prevention: Care should be taken that a cavity does not develop too far without treatment. On some occasions an overenthusiastic dentist might drill too near the pulp, thus destroying it.

Outlook: Removal of the pulp in root canal work does not mean that the tooth is dead; it is still attached to the bone, very much alive, and can do a useful job for a long time, providing that the root canal treatment is well done.

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