Dental Pulp Infection

​The dental pulp contains connective tissue, blood vessels and nerves. Dental pulp infection is primarily caused by tooth decay (caries) or it can be secondary to other causes, such as trauma, cracks or excessive tooth wear.

• Unprovoked pain
• Pain on biting
• Prolonged sensitivity to hot or cold
• Discolouration of the tooth
• Tenderness of the overlying gums
• Abscess or swelling

Sometimes, there may be no symptoms at all. When the dental pulp inflammation or infection is left untreated, it can eventually cause severe pain, abscess (swelling) and loss of the supporting bone.

It is best to consult with your dentist if you have any of the symptoms mentioned for a more accurate diagnosis and treatment.

​Regular check-ups with your dentist and practising good oral hygiene are the best modes of prevention. Decay or a defective filling can be detected and treated early before there is irreversible damage to the dental pulp.

Avoid chewing on hard objects such as ice, hard nuts or pens so as to prevent cracked teeth.

You should wear a mouth guard if you participate in contact sports to avoid dental trauma. Any activity involving speed has an increased chance of falling and the potential of getting in contact with a hard piece of equipment.

A mouth guard helps to distribute the force of impact in any accident to prevent the likelihood of dental injury to the front teeth.

Do not clench or grind your teeth. If you clench or grind your teeth at night, speak to your dentist about getting a night guard.

Cause of Dental Pulp Infection

Other pathways for bacterial invasion into the tooth structure and infection of the underlying dental pulp are through:

• Defective fillings or restorations

• Cracks in the tooth structure as a result of excessive biting of hard food or objects are potential pathways for bacteria and noxious stimuli to irritate the dental pulp.

• Traumatic injuries to the face and mouth from sports or other accidents can cause teeth to fracture, loosen or even be knocked completely out of the socket (avulsion). Any damage of the tooth structure, surrounding gum or supporting bone will allow bacteria colonisation from saliva, leading to an inflamed dental pulp.

• Excessive wear of the hard outer layers (enamel and dentine) of the tooth due to parafunctional habits like grinding of teeth also make the dental pulp more vulnerable to bacterial or acidic attack.

​Diagnosis of the dental pulp status of your tooth is done by your dentist using clinical examination and investigations. Some of these investigations include:

• Pulp vitality tests, such as thermal tests or electric pulp tests. These are used to determine if the dental pulp is still alive.
• X-rays (radiographs) are used to determine the extent of tooth decay and surrounding bone inflammation caused by dental pulp infection.

Treatment is determined by the diagnosis.

If the stage of dental pulp inflammation is assessed to be reversible, it can be resolved by eliminating the causative factors e.g. removing the decay and restoring or filling the tooth, sometimes with a medicament base, to return the dental pulp to its normal healthy state.

However, if the dental pulp is irreversibly damaged or infected, root canal treatment has to be carried out.

Root Canal Treatment

Root canal treatment (RCT) treats diseases and injuries to the dental pulp so as to conserve the tooth that will otherwise have to be extracted. The procedure is relatively comfortable and often painless as the tooth is anaesthetised during treatment.

• Removal of the infected or inflamed dental pulp is the first step of RCT. Under local anaesthetic, an opening is made in the crown of the tooth to get access to the infected or inflamed dental pulp within.
• All RCT procedures are done by isolating the tooth with a rubber dam to provide a clean and salivafree environment.

• Using small, specially-designed hand or rotary files, the root canals are cleaned and shaped to a form that can be sealed. Debris within the canals is removed by flushing with an anti-bacterial solution.

• The canals are finally filled or sealed with an inert material called guttapercha.

The tooth should be restored to full shape and function by either a permanent filling or a crown, depending on how much of the tooth is left. This should be done as soon as possible as there could be a risk of tooth fracture due to biting forces.

RCT may be done in single or multiple visits depending on the tooth complexity.

In between treatment appointments, medicaments may be placed within the canals and the tooth is covered with a temporary filling. Often, X-rays are taken to determine the length of the root and to monitor the various treatment stages.

A root canal treated tooth can function normally and can be maintained with routine dental care and oral hygiene measures.