Dental Pain From Teeth

Classification of pulp status	Features
Healthy pulp	Asymptomatic with mild and transient responses to various stimuli e.g. hot, cold pressure. Histological no inflammation is present. Can include dentine hypersensitivity.
Reversible pulpitis	Area of exposed dentine or pathway to exposed dentine. Stimulated by hot, cold, sweet, touch, biting. Mild sharp pain of short duration; “Sharp” “shooting” pain. Well-localised. No spontaneous or nocturnal pain. Histologically the pulp would show a superficial zone of inflammation.
Irreversible pulpitis	Area of exposed dentine, stimulated by hot, cold, sweet, touch, biting. Moderate to severe pain that lingers. Poorly localised. Spontaneous and nocturnal pain. Histologically the pulp is vital and show an intense inflammatory response.
Pulpal necrosis	Area of exposed dentine that has resulted in pulp exposure to the oral environment. Usually no true symptoms as the pulpal sensory nerves have been destroyed. Histologically the pulp is non-vital and usually is heavily infiltrated with bacteria.
Pulp necrobiosis	Phenomenon that occurs in multirooted teeth where one part of the pulp is vital and irreversibly inflamed and the other parts are necrotic.

Peri-radicular pain

Peri-radicular pain can be of pulpal origin, most commonly due to disease in the pulp extending into the peri-radicular tissues but can also be of periodontal origin due to periodontal disease.

Apical periodontitis

Apical periodontitis is a term used to describe acute inflammation of the periodontal ligament surrounding the tooth. This can be caused by inflammatory mediators from irreversibly inflamed pulp, bacterial toxins from necrotic pulp, restorations that have not been properly contoured and in some cases, from treatments such as endodontic treatment. There is both an acute and chronic form of this condition. Acute apical periodontitis features include moderate to severe pain, usually stimulated by touch and pressure and may also include spontaneous pain. The chronic form of the condition can be asymptomatic but may also include pain from surrounding tissues when stimulated.

Apical Abscess

Apical abscess is a term used to describe an extension of apical periodontitis where the bacteria have infiltrated the peri radicular tissues and are causing a severe inflammatory response; there is also an acute and chronic form of this condition.

An acute apical abscess can cause facial swelling and can cause other systemic consequences such as a high temperature and feelings of malaise. In some cases, this condition can be life-threatening when the inflammation compromises the airway; this is termed Ludwig’s Angina.

A chronic apical abscess can be asymptomatic as the pressure from the inflammation is being drained through a sinus tract; a draining sinus can usually be seen clinically.

A periodontal abscess is a localized inflammation affecting the periodontal tissues. It is caused by bacteria pre-existing in the periodontal pockets, traumatic insertion of bacteria or a foreign body, or can occur after periodontal treatment. This condition has a rapid onset, is stimulated by touch, and involves spontaneous pain. It is important to note that an apical abscess may drain through the periodontal pocket giving a false interpretation of periodontal abscess or a periodontal abscess may appear at the apex of the tooth giving a false interpretation of apical abscess; a tooth may also have both lesions at one point in time.

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