When a tooth begins to hurt, it often signals inflammation within its innermost structure, a condition known as pulpitis. The dental pulp is the living core of the tooth, housed deep inside the hard layers of enamel and dentin. It contains the nerves, blood vessels, and connective tissue that sustain the tooth’s vitality. When this tissue becomes irritated or infected, the resulting inflammation causes significant discomfort and requires prompt dental intervention.
What is Dental Pulp and Why Does it Hurt?
The dental pulp serves multiple functions, including providing nutrients and moisture to the surrounding tooth structure and forming the protective dentin layer. The pulp contains the sensory nerves that register temperature, pressure, and pain, which is why inflammation here causes such intense sensations. When the pulp swells due to inflammation, the rigid walls of the tooth structure prevent the tissue from expanding, which increases pressure on the nerve endings. This pressure is the direct cause of the pain associated with pulpitis.
The inflammation is typically triggered when bacteria, usually from deep tooth decay or a cavity, penetrate the outer protective layers of the tooth and reach the pulp chamber. Other common causes include physical trauma, such as a severe crack or fracture that exposes the pulp, or repetitive stress from teeth grinding. Symptoms often include a sharp sensitivity to hot or cold stimuli, a spontaneous throbbing ache, or pain when biting down or chewing.
Understanding the Severity: Two Types of Pulp Inflammation
Dentists classify pulp inflammation into two main categories, which determines the necessary treatment pathway. The first is reversible pulpitis, a mild and transient inflammation where the pulp can heal fully if the irritant is removed. With this condition, the pain is brief, typically lasting only a few seconds after the stimulus, such as a sip of cold water, is withdrawn.
The second, more severe classification is irreversible pulpitis, which indicates that the damage to the pulp is extensive and permanent. The pulp tissue is dying or has become necrotic and cannot recover, even if the source of irritation is eliminated. The distinguishing sign of irreversible pulpitis is pain that is spontaneous, lingering long after a hot or cold stimulus is removed, or a constant, deep throbbing ache that may even wake a person from sleep. This distinction between a short-lived reaction and a persistent, severe ache is a diagnostic tool for the dentist.
How Dentists Treat Inflamed Pulp
For reversible pulpitis, the goal is to preserve the pulp and eliminate the cause of the irritation. This typically involves removing the decay and sealing the tooth with a filling or, in cases of extensive surface damage, a dental crown. Once the bacteria are sealed out and the pulp is protected, the mild inflammation subsides, and the tooth returns to a healthy state.
If the diagnosis is irreversible pulpitis, the inflamed and infected tissue must be removed, as the pulp is no longer capable of healing. The most common procedure for this is root canal therapy, a specialized procedure that saves the tooth structure itself.
Root Canal Therapy
During a root canal, the dentist or an endodontist creates a small opening in the crown of the tooth to access the pulp chamber. Using very small instruments, the infected pulp is completely removed from the chamber and the root canals.
After the infected pulp is cleared, the internal space is thoroughly cleaned, disinfected with antibacterial solutions, and shaped. The empty canals are then filled and sealed with an inert, rubber-like material called gutta-percha, along with an adhesive cement, which prevents any future bacterial re-entry.
A temporary filling is placed to close the access opening, and the tooth is later restored by the general dentist. Restoration usually involves a permanent filling or a crown to protect the tooth structure from fracturing. In cases where the tooth structure is too severely compromised, or the infection is too widespread, the only remaining option may be to extract the entire tooth.
Steps to Prevent Pulp Inflammation
Preventing pulpitis focuses on maintaining a healthy oral environment and protecting the teeth from damage. Daily oral hygiene is the most effective defense, including brushing twice a day and flossing daily to remove plaque and bacteria before they can cause decay. Regular dental check-ups and professional cleanings are important, as they allow the dentist to detect and treat small cavities while they are still far from the pulp.
Taking protective measures against physical damage can also reduce the risk of inflammation. For individuals who play contact sports, wearing a protective mouthguard helps prevent trauma that could crack a tooth or damage the pulp. Similarly, people who grind their teeth at night may benefit from wearing a night guard to reduce the stress and wear on the tooth enamel.