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Medical Forum / General / Dentistry / September 2007

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reversible vs irreversible pulpitis (was pain following..)

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hermit - 13 Sep 2007 01:42 GMT
Clinically how does one determine if pulpitis is irreversible vs
improving/reversible?

My molar with the large composite resin filing seems to be getting
better-heat sensitivity is diminishing as is uncomfortable feeling. Do I
have any expectation the tooth will not progress to RCT candidate? This
is about a month following the replacement of a tooth that was 80%
gone. Latest xrays showed no evidence of infection.
Amatus Cremona - 13 Sep 2007 12:19 GMT
> Clinically how does one determine if pulpitis is irreversible vs
> improving/reversible?

Got a couple of years?

> My molar with the large composite resin filing seems to be getting
> better-heat sensitivity is diminishing as is uncomfortable feeling. Do I
> have any expectation the tooth will not progress to RCT candidate? This
> is about a month following the replacement of a tooth that was 80%
> gone. Latest xrays showed no evidence of infection.

Sounds like you will probably get a RCT
Newbie@bix.nex - 13 Sep 2007 20:06 GMT
>> Clinically how does one determine if pulpitis is irreversible vs
>> improving/reversible?
>
>Got a couple of years?

That quick ? You must be a good instructor.

>> My molar with the large composite resin filing seems to be getting
>> better-heat sensitivity is diminishing as is uncomfortable feeling. Do I
[quoted text clipped - 3 lines]
>
>Sounds like you will probably get a RCT

Agreed and note that visible radiographic evidence of infection
is the very last sign of need for RCT.

There are many other signs and symptoms occur well before
definitive radiographic changes are apparent.
Newbie@bix.nex - 13 Sep 2007 20:02 GMT
>Clinically how does one determine if pulpitis is irreversible vs
>improving/reversible?
[quoted text clipped - 4 lines]
>is about a month following the replacement of a tooth that was 80%
>gone. Latest xrays showed no evidence of infection.

Only time will tell but sensitivity to heat is generally a bad sign.

This is a wait and see situation.
hermit - 13 Sep 2007 22:58 GMT
> hermit@meagain.org

>Only time will tell but sensitivity to heat is generally a bad sign.
>
>This is a wait and see situation.

The guy who did the repair wanted to send me to an endo for consult.
Is there any point in doing that if it is a "wait and see situation"?
Can I assume from your reply there is not test or other marker for when
to do RCT?
Newbie@bix.nex - 13 Sep 2007 23:58 GMT
>> hermit@meagain.org
>
[quoted text clipped - 6 lines]
>Can I assume from your reply there is not test or other marker for when
>to do RCT?

Irreversible pulpitis is largely diagnosed by signs and symptoms.
There are often visible radiographic in the pulp spaces.

Symptoms include thermal sensitivity, esp lingering sensitivity
to cold and sensitivity to hot. Sensitivity to percussion is also
usually present.  Tend to go by the severity of the symptoms
and also check other factors that could be causing sensitivity,
including checking the occlusion <bite> to see if it could be
traumatic occlusion (can also be a contributing factor)

There are just too many factors that go into an evaluation
to go into here but the above may give you some hints.

If you could post an x-ray would be glad to evaluate it for you.

Getting sent for an endo consult gives you a pretty good idea
that you may need RCT in the future.

You can try this test yourself:  place a small piece of ice directly
on the questionable tooth and not touching any other teeth.
If you have a 'violent' reaction to cold, then you should
start planning for RCT.
hermit - 14 Sep 2007 02:11 GMT
Ok thanks much Newbie for the tips. Will let you know how it turns out.

---

>>> hermit@meagain.org
>>
[quoted text clipped - 29 lines]
> If you have a 'violent' reaction to cold, then you should
> start planning for RCT.
Steven Fawks - 14 Sep 2007 13:41 GMT
>>>hermit@meagain.org
>>
[quoted text clipped - 29 lines]
> If you have a 'violent' reaction to cold, then you should
> start planning for RCT.
 
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