Pulpitis

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Background

Dental Numbering

Classic dental numbering.
  • Adult (permanent) teeth identified by numbers
    • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
  • Children (non-permanent) teeth identified by letters
  • Common landmarks:
    • 1: Right upper wisdom
    • 8 & 9: Upper incisors
    • 16: Left upper wisdom
    • 17: Left lower wisdom
    • 24 & 25: Lower incisors
    • 32: Right lower wisdom
Diagram of the tooth displaying the enamel, dentin, and pulp
  • Also known as a "dental carries"

Clinical Features

  • Reversible Pulpitis
    • Duration of pain is short (seconds)
    • Associated with noxious stimuli (usually cold or heat, can also be elicited by sweat and sour)
  • Irreversible Pulpitis
    • Duration of pain is long (hours) and intense
    • Associated with noxious stimuli or may occur spontaneously

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Evaluation

X-ray showing well-defined radiolucency of mesial and distal roots of symptomatic first lower left molar consistent with irreversible pulpitis and associated apical periodontitis.

Workup=

  • Consider pain X-rays
    • Not typically performed in the ED; may be performed upon referral

Diagnosis

  • Clinical diagnosis

Management

  • Short term management with local anesthetics
  • Antibiotics controversial for dental pain alone without evidence of infection
  • Antibiotic choices: Penicillin VK or clindamycin
  • Definitive therapy with root canal or extraction (for irreversible pulpitis)

Disposition

  • Discharge with dental follow-up

See Also

References