When we think of potential problems with our oral health, most of us worry about the outside of our teeth. But, what about what’s going on inside? The hard enamel of our teeth protects the blood vessels, living cells, and nerves inside the tooth. These materials are referred to as the dental pulp. Pulpitis is an inflammation of this tender dental pulp, and irreversible pulpitis is the most serious type of inflammation.

What is irreversible pulpitis?

Irreversible pulpitis is an inflammation of the dental pulp that causes the nerves inside the tooth to die.

A number of different factors can cause this, including:

  • Injury to the tooth
  • Cavity
  • Demineralizing of the teeth
  • Hard biting

Injury to the tooth

Injury to the tooth can be any blow or trauma. This includes trauma from dental procedures (e.g., drilling) or injury due to any blow to the mouth or tooth.


Cavity that erodes the tooth enamel to such a degree that it reaches the dental pulp can cause infection and inflammation that leads to irreversible pulpitis.

Demineralization of the teeth

Overuse of at-home tooth whitening systems and bleaches and whitening toothpastes can demineralize (breakdown) teeth. Excessive consumption of acidic foods like juices and soda can also break down teeth. This can allow bacteria to reach the dental pulp, causing infection.

Hard biting

While our teeth are designed to chew even the hardest of foods, over time this can cause cracks and chips in the teeth that can open the way for irreversible pulpitis.

Irreversible pulpitis symptoms

Symptoms may be similar to signs of other oral health issues, so it’s important to work closely with your dentist for a proper diagnosis.

Symptoms of irreversible pulpitis include:

  • Increased and prolonged sensitivity to hot and cold temperatures
  • Sensitivity to sweets
  • Low, dull ache in the jaw and affected tooth
  • Pain that is difficult to pinpoint exactly

As the pulpitis becomes irreversible, the tooth becomes less sensitive as the nerve inside the tooth dies. Eventually, the tooth will become necrotic.

Irreversible pulpitis is diagnosed using a thorough examination and, sometimes, dental X-rays. Your dentist may apply hot and cold stimuli to assess the degree of severity and to see if they can save the tooth.

What’s the difference between reversible and irreversible pulpitis?

Irreversible pulpitis has its twin in reversible pulpitis. While irreversible pulpitis most often results in the complete death of the nerve tissue inside the dental pulp, reversible pulpitis can sometimes be treated, restoring the health of the tooth.

Reversible pulpitis symptoms are usually less severe than irreversible pulpitis symptoms. In general, pain occurs in the affected tooth when you apply a stimulus (e.g, hot, cold, or pressure) but then goes away within a couple seconds. There is not the persistent dull ache that is associated with irreversible pulpitis.

Reversible pulpitis may occur in some people after dental procedures. The blood supply to the tooth may be compromised, resulting in pain and a slight inflammation that can be treated with antibiotics.

If a cavity is causing the inflammation in the dental pulp, treating the cavity and utilizing antibiotics may be treatment enough. For people with compromised immune systems, reversible pulpitis may be challenging to treat and become irreversible.

Irreversible pulpitis requires much more invasive treatments than reversible pulpitis.

How to treat irreversible pulpitis

Irreversible pulpitis treatment options vary depending on the state of the tooth that is affected. If this condition begins with reversible pulpitis, chances are good that your dentist has already treated the cavity with either a filling or, in the case of multiple cavities in the same tooth or deep cavity, a crown.

If these two treatments have not worked and the tooth is on its way to becoming necrotic, there are two main treatment options: root canal and extraction.

Root canal

Root canal, also known as endodontic therapy, is the most conservative irreversible pulpitis treatment option as it attempts to preserve the outside of the tooth. Your dentist will enter the tooth and use a tool to remove all of the infected or dead dental pulp. Then, your dentist will fill the inside of