A pulp with reversible pulpitis has mild inflammation
and it is capable of healing once the irritating stimulus
has been removed. Pain is only felt when a stimulus
(usually cold or sweet foods but sometimes heat) is
applied to the tooth, and the pain ceases within a few
seconds or immediately upon removal of the stimulus.
The pain is short and sharp in nature but not
spontaneous. There are no significant radiographic
changes evident in the periapical region, and the only
radiographic findings of note may be the cause of the
problem, such as caries, a deep restoration, etc. Usually
more extreme temperatures are required to induce the
pain rather than mild changes (e.g., ice cream rather
than tap water).
If there is pain to biting pressure as well as the above
symptoms, then this may indicate a crack in the tooth
(Fig 2) or restoration. While reversible pulpitis is usually
acute,
it may also be an acute exacerbation of a chronic
condition. Here the terms “acute” and “chronic” are
not used as histological terms but are based on the
clinical symptoms: that is, acute means painful and
chronic means no pain or only mild discomfort.
Conservative pulp therapy in conjunction with the
removal of the cause and the pathway of the irritation
will result in resolution of the pulp inflammation and
the return of the pulp to a clinically normal state.
A diagnosis of reversible pulpitis should always be
considered as a “provisional diagnosis” since it is
impossible to be completely certain about any
individual pulp’s ability to recover. This will depend on
many factors – such as previous problems, previous
inflammation, the degree of fibrosis, the true status of
the pulp, etc. – and these are generally impossible to
assess clinically. Hence once the diagnosis of reversible
pulpitis has been provisionally made, the tooth can be
managed in a conservative manner (as above) and then
arrangements must be made to review the status of the
pulp to determine whether it has actually returned to a
clinically normal state. If it has, then it should be free
of symptoms, have no signs of pulp or periapical
diseases and should respond normally to pulp sensibility
tests. The pulp status should be reviewed after several
weeks (assuming there are no postoperative symptoms)
although a three-month interval is generally considered
to be more reliable as healing may take some time or
necrosis (if it occurs) may take some time to become
evident. At the review appointment, the provisional
diagnosis can be confirmed as reversible pulpitis if the
pulp has returned to a clinically normal state. However,
if symptoms have persisted or if pulp necrosis has
occurred, then the original provisional diagnosis will
need to be altered to that of “irreversible pulpitis”
and it is capable of healing once the irritating stimulus
has been removed. Pain is only felt when a stimulus
(usually cold or sweet foods but sometimes heat) is
applied to the tooth, and the pain ceases within a few
seconds or immediately upon removal of the stimulus.
The pain is short and sharp in nature but not
spontaneous. There are no significant radiographic
changes evident in the periapical region, and the only
radiographic findings of note may be the cause of the
problem, such as caries, a deep restoration, etc. Usually
more extreme temperatures are required to induce the
pain rather than mild changes (e.g., ice cream rather
than tap water).
If there is pain to biting pressure as well as the above
symptoms, then this may indicate a crack in the tooth
(Fig 2) or restoration. While reversible pulpitis is usually
acute,
condition. Here the terms “acute” and “chronic” are
not used as histological terms but are based on the
clinical symptoms: that is, acute means painful and
chronic means no pain or only mild discomfort.
Conservative pulp therapy in conjunction with the
removal of the cause and the pathway of the irritation
will result in resolution of the pulp inflammation and
the return of the pulp to a clinically normal state.
A diagnosis of reversible pulpitis should always be
considered as a “provisional diagnosis” since it is
impossible to be completely certain about any
individual pulp’s ability to recover. This will depend on
many factors – such as previous problems, previous
inflammation, the degree of fibrosis, the true status of
the pulp, etc. – and these are generally impossible to
assess clinically. Hence once the diagnosis of reversible
pulpitis has been provisionally made, the tooth can be
managed in a conservative manner (as above) and then
arrangements must be made to review the status of the
pulp to determine whether it has actually returned to a
clinically normal state. If it has, then it should be free
of symptoms, have no signs of pulp or periapical
diseases and should respond normally to pulp sensibility
tests. The pulp status should be reviewed after several
weeks (assuming there are no postoperative symptoms)
although a three-month interval is generally considered
to be more reliable as healing may take some time or
necrosis (if it occurs) may take some time to become
evident. At the review appointment, the provisional
diagnosis can be confirmed as reversible pulpitis if the
pulp has returned to a clinically normal state. However,
if symptoms have persisted or if pulp necrosis has
occurred, then the original provisional diagnosis will
need to be altered to that of “irreversible pulpitis”