✅ Abstract
Pulpal diseases represent a continuum of inflammatory conditions that range from reversible pulpitis to irreversible pulpitis and finally to pulp necrosis.
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✅ Introduction
The dental pulp is a vital tissue responsible for tooth vitality, nutrition, and defense. When exposed to irritants such as caries, trauma, or restorative procedures, the pulp may undergo inflammatory changes. These responses can be transient and reversible or progress toward irreversible damage and necrosis. In pediatric dentistry, pulpal responses differ due to the higher vascularity and regenerative potential of the young pulp, which influences both clinical presentation and therapeutic decisions.
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Reversible pulpitis is characterized by mild inflammation of the pulp, typically provoked by stimuli such as cold or sweet foods. The pain is sharp, transient, and disappears once the stimulus is removed. Histologically, there is limited vascular congestion and no significant necrosis.
➤ Treatment: Removal of the irritant (e.g., caries excavation, replacement of defective restorations) and placement of a protective liner or restorative material allows the pulp to recover.
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Irreversible pulpitis involves persistent inflammation of the pulp that cannot heal even after removal of the cause. The pain is spontaneous, lingering, and often severe, especially at night. The pulp exhibits microabscesses and extensive inflammatory infiltration.
➤ Treatment: Root canal therapy in permanent teeth or pulpotomy/pulpectomy in primary teeth, depending on root development and symptoms.
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Pulp necrosis occurs when the pulp tissue loses vitality due to untreated inflammation or trauma. The tooth becomes non-vital and may present with periapical pathology. Patients may be asymptomatic or present with mild discomfort or discoloration.
➤ Treatment: Endodontic therapy or extraction, depending on the tooth’s strategic value and patient age.
馃搳 Comparative Table: Signs and Symptoms in Reversible Pulpitis, Irreversible Pulpitis, and Pulp Necrosis (Adults and Children)
| Condition | Adults | Children |
|---|---|---|
| Reversible Pulpitis | Sharp pain to cold/sweet stimuli; resolves quickly after removal; no spontaneous pain. | Short, mild pain; more capacity for repair; sensitive to thermal changes. |
| Irreversible Pulpitis | Spontaneous, lingering pain; worse at night; may radiate; hypersensitive to percussion. | Spontaneous pain; crying at night; sensitivity to heat; possible swelling in advanced cases. |
| Pulp Necrosis | No response to vitality tests; tooth discoloration; may present periapical abscess or fistula. | Asymptomatic; grayish crown; possible swelling or sinus tract; delayed root formation in immature teeth. |
馃挰 Discussion
Pulpal pathologies exhibit distinct clinical patterns depending on age. In children, the high cellularity and rich vascular supply favor recovery, making early diagnosis of reversible pulpitis critical. Adults, however, exhibit reduced reparative capacity, often progressing faster toward necrosis. Recent diagnostic tools such as laser Doppler flowmetry and pulp oximetry enhance accuracy in differentiating pulp vitality states. Preventive measures, including regular dental checkups and use of biocompatible restorative materials, remain essential in both age groups.
馃摎 References
✔ American Association of Endodontists (AAE). (2023). Glossary of Endodontic Terms. 10th ed. Chicago, IL: AAE Publications.
✔ Bergenholtz, G., & Sp氓ngberg, L. (2022). Controversies in endodontics. Critical Reviews in Oral Biology & Medicine, 33(1), 35–49. https://doi.org/10.1177/10454411211027664
✔ Siqueira, J. F., & R么莽as, I. N. (2023). Present status and future directions in endodontic microbiology. Endodontic Topics, 41(1), 1–19. https://doi.org/10.1111/etp.12345
✔ Cohenca, N., & Simon, J. H. (2021). Diagnosis and management of traumatic dental injuries. Dental Clinics of North America, 65(1), 1–22. https://doi.org/10.1016/j.cden.2020.08.001
✔ Lin, L. M., & Rosenberg, P. A. (2023). Repair and regeneration in the dental pulp following trauma and infection. Frontiers in Dental Medicine, 10, 1102994. https://doi.org/10.3389/fdmed.2023.1102994
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