Do you get toothache when drinking ice water? There may be something wrong with your teeth! Don’t blame the ice water anymore!

Toothache is not a disease, but it can be life-threatening. Have you ever experienced such severe toothache?

Some people's teeth will hurt when they drink water that is too cold or too hot, and even brushing their teeth with cold water will cause soreness, but without these stimuli, the teeth will not hurt.

This type of toothache is mostly related to damage to the tooth surface, and is generally more common in teeth with cavities, trauma, or wear.

When there is no temperature stimulation to the teeth, severe toothache occurs, which is called spontaneous pain .

Moreover, the pain at night is more obvious than during the day and is difficult to bear. When it hurts, you can't tell which tooth it is, or even whether it is a lower or upper toothache.

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If the above situation occurs, the tooth may have acute pulpitis or acute attack of chronic pulpitis . Before understanding acute pulpitis, let's first understand the structure of the tooth and see what the "pulp" is.

01

What is dental pulp?

The part of the tooth that can be seen from the mouth is called the crown. The outer layer of the crown is enamel, and the inner layer is dentin. Dentin is not only part of the crown, but also part of the root. The soft tissue in the middle of the dentin is the pulp. The pulp contains blood, nerves and lymph, which can nourish the teeth.

Once a tooth is damaged, such as by caries, trauma, etc., bacteria may infect the pulp through the damaged area of ​​the tooth, which may lead to pulpitis.

Toothache caused by acute pulpitis has four major characteristics:

1. The pain is severe and generally difficult to tolerate;

2. Spontaneous pain, which is pain even without stimulation;

3. The pain is more obvious at night than during the day;

4. The painful tooth cannot be identified. This is because the dental pulp nerve comes from the trigeminal nerve, which is divided into three branches: upper, middle and lower. The pain feedback to the central nervous system is easily confused.

This type of toothache caused by acute pulpitis cannot be relieved by taking medicine because the pressure in the pulp cavity is very high. It is recommended that patients go to the hospital for treatment as soon as possible.

02

How to treat acute pulpitis?

The treatment of acute pulpitis mainly involves removing the pulp , preparing and filling the root canal, which is commonly known as " root canal therapy ."

If pulpitis is caused by caries, drilling through the pulp cavity with a dental drill can release the pressure in the pulp cavity and relieve the pain immediately. Since the pulp of acute pulpitis is active, it needs to be operated under anesthesia.

A more thorough method of pain relief is to remove the pulp, that is, to remove the inflamed pulp (dental nerve) inside the tooth under local anesthesia. After removal, the patient's pain symptoms will basically be eliminated.

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Regardless of whether the pulp is exposed or not, if time and conditions permit, the doctor should perform complete root canal treatment after removing the pulp.

Root canal treatment is to thoroughly clean the pulp, prepare the root canal into the required shape, and then use biocompatible materials such as gutta-percha and sealants to tightly fill the root canal to prevent periapical lesions.

At present, root canal treatment is the best treatment option for pulpitis, pulp necrosis, apical periodontitis, etc. It can effectively prevent bacteria from other parts of the oral cavity from entering the pulp cavity, so that the affected tooth will no longer develop lesions and can be preserved.

So, does the pulp need to be removed after pulpitis occurs? Can it still be preserved?

03

Which patients with pulpitis can preserve their pulp?

What is not allowed?

Pulpitis is divided into reversible pulpitis and irreversible pulpitis .

Reversible pulpitis is generally manifested as transient pain in the teeth after stimulation by cold or heat. The pain is very short-lived, lasting only a few seconds, and then recovers quickly on its own.

The characteristic is that the pain occurs when the temperature is stimulated, and the pain disappears immediately after the stimulation is removed.

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Reversible pulpitis causes less damage to the dental pulp. After timely removal of the irritating factors and certain treatments, the dental pulp can return to its original state and can generally be preserved.

Irreversible pulpitis is divided into acute pulpitis, chronic pulpitis, residual pulpitis and retrograde pulpitis.

In case of irreversible pulpitis, the dental pulp cannot be preserved in general and should be removed for root canal treatment.

04

How to prevent acute pulpitis?

Bacteria in the mouth attach to teeth to form plaque. These bacteria metabolize carbohydrates to produce acid, which can corrode teeth and form caries.

Tooth decay will slowly develop from shallow caries to moderate caries and deep caries. Bacteria and their toxins invade the pulp cavity, causing pulp infection and pulpitis.

If pulpitis is not treated promptly and effectively, it will further develop into pulp necrosis and apical periodontitis.

Therefore, the most fundamental way to prevent pulpitis is to prevent dental caries. There are three main preventive measures to prevent dental caries:

Primary prevention: Actively learn about oral health care, brush teeth effectively, clean teeth regularly, and perform pit and fissure sealing in a timely manner after children’s sixth molars erupt.

Secondary prevention: Go to an oral medical institution for regular oral examinations, and have an oral physical examination at least once a year, for early detection, early diagnosis, and early treatment.

Level 3 prevention: If your teeth have already developed disease, you must go to the hospital for diagnosis and treatment as soon as possible.

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When you have caries, you must fill your teeth early to avoid developing deep caries, pulpitis, etc. When you have periodontitis, you must treat it as soon as possible to avoid severe periodontitis and retrograde infection to the pulp.

To prevent pulpitis, we must start with preventing tooth decay. Preventing tooth decay starts from childhood. Maintaining good oral hygiene from an early age will allow you to have a set of healthy teeth when you are old.

Good teeth make food taste better and are good for your health.

Produced by: Chinese Medical Association

Author: Hou Benxiang, Chief Physician, Beijing Stomatological Hospital, Capital Medical University

Reviewer: Luan Qingxian, Chief Physician, Peking University School of Stomatology

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