Electric pulp test Treatment Treatment should resolve reversible pulpitis; early treating may help prevent irreversible pulpitis Follow-up required to determine whether the reversible pulpitis has returned to a normal status Prevention Regular check-ups When preparing cavities, dehydrate with sufficient alcohol/chloroform and apply sufficient varnish to protect the pulp Irreversible pulpitis Pulpitis is established when the pulp chamber is compromised by bacterial infection. Irreversible pulpitis is diagnosed when the pulp is inflamed and infected beyond healing. Removal of the aetiological agent does not permit healing, and a root canal is often indicated. Irreversible pulpitis follows reversible pulpitis absent early intervention. While the pulp is still vital and vascularised, it is not classified as 'dead pulp'. Irreversible and reversible pulpitis are distinguished by the pain responses to thermal stimulation. If the condition is reversible, the pulp's pain response lasts a few seconds upon exposure to cold or hot. If the pain lingers from minutes to hours, the condition is classified as irreversible. This is a common presenting complaint that facilitates initial diagnosis. Irreversible puplitis may be symptomatic or asymptomatic. Asymptomatic irreversible pulpitis results from transition of symptomatic irreversible pulpitis into an inactive/quiescent state. This is due to its aetiology; inflammatory exudate can be quickly removed, e.g. through a large carious cavity or previous trauma that caused painless pulp exposure. The build-up of pressure in a confined pulp space initiates pain reflexes. When this pressure is relieved, pain subsides. As the names imply, these diseases are largely characterised by their symptoms: pain duration and location, and exacerbating and relieving factors. Inputs include clinical tests (cold ethyl chloride, EPT, hot-gutta percha, palpation), radiographic analysis (peri-apical and/or cone-beam computed tomography) and others. Thermal tests are subjective, and are therefore performed the compromised tooth and the adjacent and contralateral teeth, allowing the patient to compare them. Normal healthy teeth are used as a baseline for diagnoses. Key characteristics of symptomatic irreversible pulpitis include: Spontaneous and unpredictable pain at any time, and specific causal factors cannot be identified Patient may complain of sharp lingering pains that last longer than 30 seconds, even after removal of stimulus Possible referred pain Pain may increase with changes of posture, e.g. from lying down to standing. Analgesics tend to be ineffective. No pain on percussion because the bacteria are not present in the peri-apical region. Key characteristics of asymptomatic irreversible pulpitis include: No clinical symptoms. Pulp will respond to sensitiviity tests