Acute pulpitis

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Acute pulpitis is a condition in which bacterial infection or irritant inflammation develops in the dental pulp (nerves and blood vessels) inside the tooth due to dental caries (tooth decay), trauma, or other causes. Because the pulp chamber is an enclosed structure, the increase in pressure caused by inflammation leads to severe pain. As the inflammation progresses, pulp necrosis may occur, and the inflammation may spread around the root tip (apical periodontitis and abscess).
• Main causes: Severe dental caries, tooth cracks, trauma (external force), repeated dental treatment, excessive grinding, and more.
• Main symptoms:
  • Severe and persistent toothache (spontaneous pain), worsening at night
  • Sensitivity to cold water, hot water, or sweet foods (especially when the response persists for a long time, which may indicate irreversible pulpitis)
  • Difficulty localizing the pain, with referred pain to the ear, head, jaw, and other areas
  • Pain when the tooth is tapped (when inflammation around the root tip is present)
  • Swelling, fever, and tenderness in the area (when the inflammation has spread)

Treatment Methods and Precautions

• Emergency treatment (pain control):
  • Attempt to relieve pain with a nonsteroidal anti-inflammatory drug (e.g., ibuprofen) alone or combined with acetaminophen.
  • For severe pain, relieve pressure through emergency root canal treatment (emergency pulpotomy or partial removal of the pulp).
• Definitive treatment:
  • Irreversible (acute) pulpitis: Root canal therapy (nerve treatment) — removal of inflamed and infected tissue, disinfection of the root canals, and filling.
  • If the tooth is irreversibly damaged and cannot be preserved: extraction.
  • In some cases (especially in children or under specific conditions), vital pulp therapy (partial or complete pulpectomy) may be considered.
• Antibiotic use:
  • Use antibiotics only when there is a systemic risk from the infection, such as systemic symptoms (fever), localized spread (swelling, difficulty swallowing or breathing, etc.), or in immunocompromised patients.
  • In general, the primary treatment is root canal therapy, and antibiotics play an adjunctive role.
• Additional treatment:
  • If drainage is necessary, perform incision and drainage or drainage through the root canal.
  • When planning orthodontic or prosthetic treatment, prosthetic restoration (crown, inlay, etc.) is needed after root canal therapy.
• Precautions (including self-care):
  • Even if the pain is severe, do not rely only on painkillers for a prolonged period; seek dental care promptly.
  • If antibiotics are prescribed, take the full course as directed and do not stop them on your own.
  • Be sure to inform the dentist before treatment about any special circumstances, such as bleeding disorders, use of anticoagulants, or pregnancy.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/information to prepare:
  • List of medications currently being taken (antithrombotic agents, anticoagulants, antibiotics, allergy medications, etc.)
  • History of medication and food allergies (especially allergies to penicillin and similar drugs)
  • Bring any recent dental imaging (X-ray) results, if available
  • When the pain began, factors that worsen or relieve it (cold or hot foods, nighttime, etc.), and pain intensity (a pain diary or pain score)
  • Whether there have recently been systemic symptoms such as fever, facial or jaw swelling, difficulty swallowing, or difficulty breathing
  • Pregnancy status and chronic conditions (diabetes, immunocompromised status, etc.)
• Things to do before the visit:
  • If possible, organize information about the circumstances when the pain occurred (photos or brief notes)
  • Record recently taken painkillers and antibiotics
• Example questions (to prepare in advance for the doctor):
  • "What treatment can be provided right away to reduce the pain quickly?"
  • "I am currently taking medication such as an anticoagulant. Does it affect root canal treatment?"

Examples of General Questions to Ask the Doctor

• What are the side effects of this medication?
• What is the prognosis of this treatment (root canal therapy/extraction)? Can the tooth be preserved?
• How will the pain be managed? What should I do in an emergency?
• Are antibiotics necessary? If so, which medication should I take and for how long?
• What should I be careful about in daily life (meals, oral hygiene, and exercise)?

Examples of Condition-Specific Questions

• Can this tooth be preserved with root canal therapy, or would extraction be safer? (If it is preserved, what is the long-term prognosis?)
• Which do you recommend: emergency root canal treatment, complete root canal treatment (or partial pulp treatment)? What is the reason?

(Note: Antibiotics are used only when there are systemic symptoms or a spreading infection, and the key to relieving pain is appropriate dental treatment (root canal therapy and drainage). Please seek dental care as soon as possible.)