Irreversible acute pulpitis
This condition may diagnose as acute pulpitis. It is always irreversible and may leads to the supporative pulpitis or pulp abscess or necrosis.
- Recent dental scaling
- Recent restoration
- Deep restoration
- Deep caries
- History of trauma
- Unilateral initially sharp and stabbing pain later becoming dull or throbbing with time.
- Initially the pain is an exaggerated response mainly to hot stimuli and is of long duration persisting for more than 15 seconds even up to several hours after the stimuli is removed.
- Spontaneous pain and is often worse at night.
- Radiation of pain is wide spread and referral is common.
- Pain may prevent sleep or awaken the patient from sleep.
- The pain is poorly localized until acute apical periodontitis develop.
- Cold may reduce pain or pressure.
- Problem persists for several days or weeks than stop quite suddenly as the pulp necrosis occur
- Large restoration or carious lesion
- Fracture or discolor tooth.
- The tooth will initially not be tender to bite on but will become tender in the late stage when acute apical periodontitis develop.
- Diagnostic local anesthesia may be required to localized the affected teeth.
- Vitality test: there will be an exaggerated response to heat and electrical vitality test but later when chronic stage develop then no response to vitality test.
Radiograph may show deep caries or restoration . In the late stage widening of PDL space and loss of lamina dura .