Question: What is irreversible pulpitis and what does it mean for my tooth?
Explanation: Irreversible pulpitis is inflammation of the dental pulp that has progressed beyond the point of recovery. The classic presentation is spontaneous pain, pain that lingers for more than 30 seconds after a cold stimulus is removed, and pain that wakes the patient at night. Heat may provoke intense pain relieved by cold. The pulp is still alive but dying. Because the pulp sits within rigid walls, the inflammatory swelling strangles its own blood supply. No medication reverses this. Treatment is root canal therapy or extraction.
Related Questions:
How is irreversible pulpitis different from reversible pulpitis?
Reversible pulpitis produces short, sharp pain that stops as soon as the stimulus is removed, and there is no spontaneous pain. Irreversible pulpitis produces lingering pain lasting beyond 30 seconds, spontaneous pain, and often night pain. The distinction determines whether the tooth can be saved by simply removing decay.
Can irreversible pulpitis heal if I take antibiotics?
No. The pulp’s blood supply enters through a tiny apical opening. Once inflammatory pressure exceeds perfusion pressure, the tissue infarcts. Antibiotics cannot reach it and cannot restore blood flow. Antibiotics have no role in treating irreversible pulpitis without spreading infection.
Why does heat hurt more than cold with irreversible pulpitis?
In a necrosing pulp, gases from tissue breakdown expand with heat, raising intrapulpal pressure sharply. Cold contracts them, temporarily relieving pressure. Patients sometimes arrive holding a cup of iced water. This reversal of the normal response is diagnostically significant.
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