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The pulp has been damaged beyond

repair, and even with removal of the
irritant it will not heal.

The pulp will progressively degenerate,

causing necrosis and reactive destruction

ost commonly the bacterial

involvement of pulp through dental
caries, Chemical, mechanical or thermal
injuries that cause inflammation of the

Untreated reversible pulpitis can lead to

irreversible pulpitis

Y rapid onset of pain when any stimulus like

cold foods, or sweet food, pressure from
packing of food into cavity, or pressure
exerted by tongue, that results in congestion
of the blood vessels of the pulp.
The pain may be caused by sudden
temperature changes, which is prolonged.
prolonged episodes of pain even after the
source of the pain is removed

The pain may be sharp, shooting or

piercing in nature.
The pain may be referred to adjacent
teeth sometimes, and also to ear if lower
teeth are involved, and to temple region
if the upper teeth are involved.
The pain caused by cold stimulation can
be relieved by heat, and similarly, the
pain caused by heat can be relieved by

Ôisual ʹ Diagnosis through direct vision,
showing a deep cavity involving the pulp,
or any secondary caries under any

Radiograph ʹ It may show exposure of

the pulp, caries under any filling, and
deep cavity.

The periapical area usually is normal,

with some widening of the periodontal
ligament sometimes.
r  ! "
Cold test Throbbing and lingering
pain. lasting several
Heat test minutes or hours
EPT Response in normal limit

Test cavity #

Percussion + if periodontal ligament

becomes involved.
obility $

palpation $

Generally not tender to percussion or palpation



Radiologically there may be early signs of

periodontal ligament widening

when the periodontal ligament becomes

involved, the pain will be localised

Y widened periodontal ligament may be

seen radiographically in the later stages.

Complete removal of the pulp and total

cleaning and shaping of the root canal
system are the treatment of choice for
emergent irreversible pulpitis

In multirooted teeth, a pulpotomy

(removal of the coronal pulp or tissue
from the widest canal) has been
advocated for emergency treatment of
irreversible pulpitis
Y file should not be introduced into
any canal unless a   is

Pain symptoms can persist or worsen

if inflamed pulp remains in the root

Intracanal medicaments helped

control or prevent additional pain
was very popular
Complete removal of the pulp is the best
treatment of irreversible pulpitis

Single-visit endodontic treatment for

teeth diagnosed with irreversible pulpitis
is not contraindicated

Occlusal reduction is not indicated in

these cases without periapical


etween visits, the canals should be

medicated with calcium hydroxide to
prevent bacterial regrowth.

Occlusal reduction has been reported

to reduce postoperative pain.

Yntibiotics are not recommended for

irreversible pulpitis or acute apical
ëinally, teeth with irreversible
pulpitis should not be left open
between visits because bacterial
contamination of the cleansed canal
will occur



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