Pulpitis

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

Acute alveolar osteitis (dry socket)
Acute necrotizing ulcerative gingivitis (trench mouth)
Dental abscess
- Periapical abscess
- Periodontal abscess
Ludwig's angina
Pulpitis (dental caries)
Pericoronitis
Peritonsillar abscess (PTA)
Retropharyngeal abscess
Vincent's angina - tonsillitis and pharyngitis

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

References

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