Sunday, February 28, 2021

Pulpitis in the Dog


Animal Dentistry Solutions

Pulpitis in the Dog

Reversible v. Irreversible

Donald H DeForge, VMD

Fellow of the Academy of Veterinary Dentistry


Tri State Veterinary Dentistry


Below is a special summary about pulpitis in people.  It completely applies to pulpitis in dogs and cats.

Does you dog or cat have a discolored tooth.  Is it pink; purple; red; brown; or dark in color.  The discolored tooth cannot be ignored.

It can lead to endodontic disease-disease of the pulp- if it is irreversible.  

Read Dr. Marias' summary:

Do nerves in teeth heal by themselves?  It is worth the read!

Dr. Don DeForge

Fellow of the Academy of Veterinary Dentistry

In human endodontics, the biggest dilemma is always reversible versus irreversible pulpitis. It was also my favorite question when setting exam papers for dental students. How does one know whether this tooth’s nerve will heal or not?

The premise is pain, toothache. Where pain is involved so are emotions. The subjectivity of emotions is one of the things that make it difficult to come to a conclusion (reversible versus irreversible), but there are other issues as well.

For a start lets understand and accept the principle that teeth’s nerves can indeed heal themselves, at least on a histological and physiological level, that is when we look at things through a microscope. All the nerves in all our teeth are assaulted on a daily basis by a multitude of insults, eg hot and cold temperatures, biting forces, bacteria, acids and so on. 

Each insult which crosses a certain threshold causes inflammation and if circumstances are favorable which are the case most of the time, the nerve will heal itself. Otherwise we would all have root canal treatments (or extractions) on all our teeth very soon after they had appeared in our mouths.

Inflammation and repair, degeneration and regeneration are ongoing processes in all our tissues, except nerve tissue. The regeneration and repair of nervous tissue are very limited. That is why people become paralysed after accidents.

Hey, is the tooth’s nerve then not a nerve? How come it can't repair?

The tooth’s nerve is actually called the pulp, because it it is more than just nervous tissue. The pulp also contains blood vessels and other tissues. In reality it is an organ, say like your tonsils or appendix or spleen. It is not just a simple strand of nerves. The presence of blood vessels in the pulp is the basis of healing: no blood, no healing.

In certain cases the insult, mostly bacteria, overpowers the powers of healing of the pulp and the inflammation progresses to a full blown infection. Some authorities are of the opinion that once bacteria has entered the pulp healing will not take place, always ending in an abscess. In other words as a general rule one can say that inflammation of a pulp has the potential to heal spontaneously whereas infection of the pulp has no such potential.

In clinical terms disease of the pulp goes through certain stages. I will give certain general guidelines but one must remember that each individual case differs. 

Generally the first sign of a diseased pulp is fleeting sensitivity.  That is a condition that can and does heal most often, in other words this is a reversible condition. 

If it does not heal the fleeting pain may become lingering in nature, a sign that things have worsened. The next stage is when the tooth becomes more sensitive.  This is mostly irreversible. Now you will need a root canal treatment or extraction. Other signs of an irreversible disease of the pulp will be pain that wakes you at night or spontaneous pain, that is pain without hot or cold stimuli. At this stage you will run, not walk to the dentist.

Yes, the nerve in a tooth can heal, but our ability to tell whether it will is limited.

Footnote: by Dr. Don DeForge

Fellow of the Academy of Veterinary Dentistry

If you pet has a discolored tooth ask for a referral to an animal dentist.  There is minimal objective pain discernment in pets from hot or cold.........pets can live in pain day after day believing that it is normal.  Allow the animal dentist you choose to explain reversible v. irreversible pulpitis.  Root canals are now common place and can remove the discomfort leading to a pain free quality of life.

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