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Toothache - It Could be PulpitisThere are lots of different reasons why you might feel pain coming from your tooth.  One of the more common reasons is called pulpitis.  Pulpitis is an inflammation of the dental pulp.  Dental pulp is the portion of your tooth that has blood vessels and nerves in it.  It is the core of your tooth that nourishes the hard parts of the tooth.  If you want to see a diagram of the anatomy of a tooth, click here.

Normally when parts of our body get hurt, they get red.  This is a process called inflammation.  Our body sends blood and defense cells to the site of injury so that our body can begin the healing process.  This works great on most parts of the body.  However, sometimes it's not so good when it happens inside our teeth.

When the dental pulp gets irritated, our body responds by sending extra blood and defense cells to the pulp.  When inflammation occurs on any other part of our body, there is room for expansion.  For example, if we hurt our finger, our finger gets a red and puffy as it starts to heal.  When we irritate our teeth and the pulp gets inflamed, the pulp doesn't have anywhere to go — the pulp is surrounded by a very strong and hard tooth.

This increase in pressure can push on the nerves that run inside the dental pulp.  Since the nerves in the pulp are only capable of sending the signal of pain our brains, we feel pain.  The inflammation also makes our teeth more sensitive.  Things that normally wouldn't hurt a tooth all of the sudden start to cause pain.  For example, breathing in cold air, drinking hot drinks or chewing food can cause pain. 

This is pulpitis, an inflammation of the dental pulp. There are two types of pulpitis, irreversible and reversible.  I describe each one below.

Reversible Pulpitis

Reversible pulpitis is simply a mild inflammation of the dental pulp.  It can be caused by anything that irritates the pulp.  Some common causes of reversible pulpitis are:

  • Cavities that haven't reached the nerve yet.
  • Erosion of the tooth that reaches the dentin
  • Drilling done by a dentist when doing a filling or crown preparation on the tooth
  • A fracture of the enamel layer of the tooth which can expose the dentin
  • Getting your teeth cleaned (scraped!) by a dental hygienist, especially when they clean the roots if you have periodontal disease.

The symptoms of reversible pulpitis can range from nothing at all to a sharp pain when they are stimulated by things that otherwise wouldn't cause pain to your teeth.

When you eat ice cream, and the cold causes a sharp pain in a tooth that quickly goes away when you swallow the ice cream, chances are that you have reversible pulpitis.  Unlike in irreversible pulpitis, the pain usually goes away a few seconds after the stimulus is removed.

Luckily, reversible pulpitis gets its name due to the fact that it is reversible – it can go away if the cause of it is taken away.  For example, if you brush, floss and use a restoring mouthwash, you could re-mineralize the cavity that is just beginning and heal it.  If this was causing your reversible pulpitis, then the reversible pulpitis will go away.

All you have to do to cure reversible pulpitis is to find the cause of the inflammation, and get rid of it.

Irreversible Pulpitis

Irreversible pulpitis is a severe inflammation of the dental pulp.  Irreversible pulpitis is often occurs after reversible pulpitis when the cause of the pulpitis has not been removed.  So, irreversible pulpitis can be caused by everything that causes reversible pulpitis and the following:

  • When a dentist needs to remove lots of dentin due to big cavities and gets really close to the pulp.
  • When the blood flow to the pulp gets decreased or removed.  This could be caused by orthodontic treatment, such as braces, that makes the tooth move so fast that the blood vessels can't keep up and the pulp's blood supply gets cut off.  It could also be caused by trauma that severs the blood vessels and slowly kills the pulp.
  • Very deep cavities that go through the enamel and all the way through the enamel right into the pulp.  The bacteria then cause inflammation in the pulp.  The more the body tries to fight off the bacteria, the higher the pressure gets inside the tooth until the pressure may strangle the blood vessels and cause the pulp to die.

The symptoms of irreversible pulpitis can range from no symptoms at all to an excruciating spontaneous pain.  The tooth can be very sensitive to the slightest temperature change, such as breathing in room-temperature air.  The pain usually lingers as well.  For example, if you're eating ice cream and the pain stays for longer than five to ten seconds after you've swallowed the ice cream, it could be a sign of irreversible pulpitis.

Back in February 2007, I had a bad case of irreversible pulpitis.  I had a deep cavity that the dentist filled, but it was so deep that a little bit of bacteria had made it into the pulp.  At first, my tooth was slightly sensitive to cold.  It would hurt in the morning when I would drink orange juice.  After a few weeks, it got so bad that I woke up in the middle of the night with a throbbing pain in my mouth.  A few days later, I went to an endodontist and had a root canal performed.

Once you have irreversible pulpitis, there's no cure.  The only way to fix it is to have a root canal treatment performed (wehre the dentist or endodontist removes the dead pulp and fills it up with a rubber material) or to have the tooth extracted.