1-22. ACUTE PULPITIS
Acute inflammatory changes in the pulp are often caused by bacteria that have
gained access to the exposed pulp. These changes may cause an initial inflammation
or a flare-up of a chronic inflammation. The active growth of the organisms in the
environment of the pulp produces rapid destructive changes. These changes are
accompanied by symptoms which can be correspondingly severe. Clinically, severe
pulsating pain is caused by the rapid buildup of pressure within the tooth. Release of
pressure by opening into the pulp chamber brings almost immediate relief. If the
condition is severe enough, it may be accompanied by fever, headache, and malaise.
As the inflammation progresses, it gradually may involve the entire pulp. Inflammation
can spread to the periapical tissues and cause the tooth to loosen and be sensitive to
externally applied pressure. It may pass beyond the periapical tissues to involve the
surrounding bone and perforate the periosteum and overlying tissues to drain either into
the mouth or through the skin.
1-23. CHRONIC PULPITIS
Chronic pulpitis may be the result of persistent mild to moderate irritation of the
pulp or it may follow a period of acute pulpitis. Chronic pulpitis may either resolve itself
or continue with slow destruction of the entire pulp, involving also the periapical tissues.
Chronic pulpitis may also develop into an acute infection in the presence of virulent
organisms that have reached the pulp from the mouth. Chronic pulpitis is usually
characterized by intermittent periods of mild to moderate pain or no pain at all. These
intermittent periods are associated with periods of increased activity and buildup of
pressure in the pulp chamber and root canals.
1-24. PULP ABSCESS
Localized areas of infection, such as an abscess with pus, may develop within
the pulp tissue. Abscesses may be found in teeth in which restorations have been
placed or in teeth having no detectable lesion. They can produce severe, intermittent
pain that may increase when the patient lies down. This sharp pain may respond to the
application of cold, tapering off to a dull pulsation. The affected tooth is sometimes
difficult to identify because of the occasional absence of caries or other identifiable
causes. Lack of involvement of the periapical tissues also makes it difficult to identify
the affected tooth. The tooth may not differ from the other teeth in its sensitivity to
percussion or other externally applied pressure.