Pulpitis

Early or reversible pulp inflammation is often linked with a severe toothache made worse by hot or cold changes. As pulp vitality deteriorates toward irreversible inflammation and necrosis, the pain can become more constant.

Pulpitis occurs in the setting of dental infection and commonly brings people to emergency care with acute dental pain. The source must be removed by dental treatment rather than left to progress.

Inflammation may present with pain triggered by temperature and then progress as pulp vitality deteriorates. Further progression can lead to pulp necrosis or a periapical abscess.

Marked difficulty opening the mouth, trouble swallowing, drooling, limited tongue movement, a swollen or firm floor of the mouth, or a hot-potato voice are red flags for a spreading infection and possible airway compromise.

Dental infections are often identified from the history and physical examination, including the character of pain and any local swelling. Moderate, severe or systemic presentations may also involve blood tests such as a complete blood count, CRP or ESR.

Definitive care removes the source through a dental procedure such as drainage, endodontic therapy or extraction. Antibiotics alone do not eliminate the source and can delay proper treatment.

The procedure needed differs when the source is managed with endodontic therapy, drainage or extraction. The dental source has to be removed for treatment to be definitive.

Untreated dental infection can extend beyond the mouth or involve the body systemically. Airway compromise, swallowing difficulty and a swollen floor of the mouth require urgent hospital-level management.

Prompt treatment of the dental source matters because antibiotics alone do not provide definitive care. Rapid assessment is especially important when pain is accompanied by swelling, restricted mouth opening, swallowing difficulty or breathing concerns.