Introduction

Imagine that on a warm summer day you decided to treat yourself to an ice lolly. As per plan, you bought it and gave it a go. As soon as you started to savour it, you felt a sharp pain in one or more of your teeth. Yes, that might be a sign of pulpitis, and if this sign comes up repeatedly, you might be advised to consult a dentist as soon as possible. Pulpitis in general is an inflammatory condition of the pulp of a tooth that might have a range of causal pathways, such as trauma, new caries, an existing carious lesion, etc. 

Pulpitis could be of two types based on disease progression: reversible and irreversible pulpitis. As the name suggests, the disease progression in reversible pulpitis could be arrested, but the same condition takes an irreversible turn when it is left untreated for a long time. The following article will help the identification and possible mitigation strategies of reversible pulpitis. 

Understanding dental pulp

A typical tooth has two major parts: the crown and the root, or roots in the case of posterior teeth like premolars and molars. These parts form the basic morphology of the tooth. If we further delve deep into the structure of a tooth, we may find that the crown has two layers from outside to inside and a hollow centre. The two layers are enamel and dentin. Similarly, the root has two layers as well: the cementum and dentin and a hollow core.¹

However, the core is not hollow at all in real life but is filled with soft tissue that contains the blood vessels, a gel-like matrix filled with cells, and the nerves. This soft tissue that makes a tooth vital is called the pulp. The inflammation of this tissue is simply called pulpitis. Since inflammation is restricted, the term reversible has been added to the condition, which indicates that the disease progression can be reversed with timely intervention.¹

Causes of reversible pulpitis

There are several pathways that may lead to the causation of reversible pulpitis. Such as:

• Shallow dental caries: Dental caries is a progressive degenerative disorder of hard dental structures facilitated by a group of harm-causing bacteria. In cases of caries, the hard tooth structures are exposed to the acids produced by the bacteria as a result of the metabolism of sugar. The hard structures contain mostly inorganic substances that get dissolved and eventually reach the pulp. As a response to the harmful substances, the pulp gets inflamed^2,3
• Trauma: Such accidents may lead to cracks that lead to inflammation. Trauma could be caused by the grinding of teeth or improper brushing^2,3
• Diet: Prolonged consumption of acidic substances has been proven to expose the dentin of the tooth that contains nerve endings and may lead to inflammation of the pulp. Pulp exposure is not always mandatory for pulpitis to happen. A response to anomalous stimuli can also be considered a causal factor in pulpitis^2,3
• Due to a faulty dental restoration or an alteration of the natural tooth structure by a clinician^2,3

Symptoms of reversible pulpitis

Symptoms are vague in the case of reversible pulpitis and only felt when properly stimulated. It does not lead to other symptoms such as fever, headache, or irreversible pulpitis.

The only symptoms are:

• Sharp pain while consuming something cold or sweet³ 
• Sometimes blowing cold air into your mouth may lead to pain³
• Mild to moderate pain is generally present while chewing, but it disappears after the stimulus is removed³

The nature of the pain distinguishes between the irreversible and reversible types of pulpitis. While pain is sharp and stabbing in nature in reversible pulpitis and no specific time of pain is present, dull, boring, continuous pain is generally reported in the case of irreversible pulpitis. In the case of reversible pulpitis, the duration of pain is generally minimal, and the pain subsides after the removal of the harmful stimuli. This may lead the patient to not opt for treatment, but it can also lead to further complications.³

Diagnosis of reversible pulpitis

The diagnosis of reversible pulpitis is a two-stage process. In the first stage, proper history is recorded, supplemented by other tests such as the cold test, percussion or tapping, and electric pulp testing. To confirm the diagnosis, a dental X-ray is recommended.

• History: Since no other distinguishing factor other than pain is present, a proper and exact history is of extreme value to establish a provisional diagnosis³
• Percussion or tapping: The affected tooth is gently taped with a metallic instrument by the clinician. In cases of irreversible pulpitis or periodontal pathology, pain with tapping is reported³
• The cold test is generally done by touching the tooth with an ice stick or any other cold object, and comparison is done with other teeth as well, which are not affected. In the case of a condition other than reversible pulpitis, the pain sensation lasts longer than expected. In the case of a dead pulp, no response is noted³
• Electric pulp testing: In this test, the clinician uses an electronic instrument called an electric pulp tester and sends an electrical pulse through the tooth. In cases of reversible pulpitis, the patient can sense the stimulation³

In the second phase of diagnosis, a radiograph is generally obtained, and radiographic features are assessed to rule out any other pathological condition. This step is particularly relevant to rule out a false diagnosis by the electric pulp tester. Since an electric pulp tester is a machine, false results are of concern and are observed in many circumstances.³

Complications

If left untreated, reversible pulpitis can progress to irreversible, since dental caries, is so far an irreversible process. Further down the line of sequela, an abscess may form, which is an infection of the surrounding bony structure. Pus may form and may destroy the cortical bone.

Cellulitis, which is an infection of the deeper layer of the tissue, may occur if reversible pulpitis is left untreated for a longer period of time. According to the Centre for Disease Control, cellulitis can be proven to be fatal if treatment is not initiated accordingly.^2,3,4

Risk factors for reversible pulpitis

Risk of tooth decay: some medical disorders, such as diabetes, may raise the risk of pulpitis as a result of poor dental hygiene. If oral hygiene care is not overseen, the danger to children and older people is elevated. Additional factors such as sugary diets, and activities including contact sports, and bruxism can also contribute to pulpitis.

Treatment options for reversible pulpitis

Treatment options are generally conservative in nature. Conservative treatments are those which retain the essential tooth structure. Some treatment modalities are:

• Using pit and fissure sealants in shallow cavities⁵
• Using restorative materials for further deep caries. The restorative material of choice is glass ionomer cement. Glass ionomer cement, or GIC, has an adhesive property with fluoride-releasing capabilities that helps to reverse the decay caused by bacteria. It has good biocompatibility as well⁵
• Desensitising agents are also recommended, which can block the unnatural nerve transmissions that may cause pain. Desensitising agents are available as toothpastes, gels, mouthwashes, etc⁵
• Dietary changes are also recommended for these patients if a debilitating diet pattern is found⁵
• In the case of tooth grinding, behavioural therapy is recommended. For children and young adults, removable appliances such as night guards are also available⁵
• Monitoring and follow-ups are highly recommended, as in rare cases, post-treatment flare-ups are possible⁵

While antibiotics aren't typically used to treat reversible pulpitis directly, they can help contain bacteria that might lead to abscess formation. When it comes to managing the discomfort associated with reversible pulpitis, over-the-counter pain medications like paracetamol or ibuprofen can be real lifesavers.

These medications work to alleviate the pain and inflammation that often accompany dental issues. Ibuprofen, in particular, has shown to be quite effective in providing relief for dental conditions. Remember, it's always best to consult with a healthcare professional or dentist before starting any medication regimen to ensure it's safe and appropriate for your specific situation.⁶ 

Prevention of reversible pulpitis

Good oral hygiene practice might help to prevent reversible pulpitis at an early stage.⁶

• Brushing and flossing your teeth two times a day
• Avoid food with added sugar or avoid having ultra-processed carbohydrates
• Routine dental check up
• Routine oral prophylaxis or cleaning from a professional
• Wearing a night guard in case of bruxism^6,7

Additionally, if you experience any tooth pain or sensitivity, be sure to notify your dentist immediately. Seek expert opinion before using anything that may complicate issues, such as clove oil, consumption of alcohol to avoid pain, or self-administration of local anaesthetics from unknown sources.

FAQs

How do I know if I have reversible pulpitis?

If you experience sharp pain while having cold or sweet food items, please consider consulting a dentist. This could be reversible pulpitis.

Is the treatment of reversible pulpitis painful?

No, absolutely not. Since the procedure is not invasive or minimally invasive, in most cases, you will not feel any pain while having a treatment. If you feel pain, please inform the dentist who is treating you. Treatment can then be done under local anaesthesia.

How long does it take to recover?

The good news is that as soon as the treatment ends, you might feel well. It might take a few days to get totally well, as a new restoration might make you feel uncomfortable at first.

Does reversible pulpitis hurt all the time?

No, only while having something cold or sweet. Cold weather may trigger this as well. If a tooth is always painful, then it might be something else, like an abscess or irreversible pulpitis.

Does reversible pulpitis subside itself?

Unfortunately no. Reversible pulpitis is a progressive condition if not treated. You might feel the symptoms have suddenly subsided, especially in cases of trauma, but that indicates something else, such as a pulp necrosis.

Summary

In conclusion, reversible pulpitis presents a crucial indication of dental distress that demands timely attention. Understanding its causes, symptoms, and diagnostic procedures is essential for prompt intervention.

Through conservative treatments and preventive measures, individuals can effectively manage reversible pulpitis, safeguarding their oral health and preventing further complications. Prioritising regular dental check-ups and proactive oral hygiene practices can significantly reduce the risk of reversible pulpitis and promote long-term dental well-being.