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Survey on Diagnosis and Management of Reversible Pulpitis Among General Practitioners in Chennai T.Vinaya Swetha, S

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Survey on Diagnosis and Management of Reversible Pulpitis Among General Practitioners in Chennai T.Vinaya Swetha, S Research Article Survey on diagnosis and management of reversible pulpitis among general practitioners in Chennai T.Vinaya Swetha, S. Haripriya* ABSTRACT Aim: This study aims to assess the knowledge among general practitioners in Chennai about various diagnostic methods and different treatment modalities available for the management of reversible pulpitis. Materials and Methods: It includes a questionnaire-based study. The survey was conducted among 250 dentists in Chennai. The questionnaire was circulated and data were collected and statistically analyzed. The survey was conducted through SurveyPlanet. Results: Almost 60% of the dental practitioners state that tooth pain and hypersensitivity are the main symptoms of reversible pulpitis. About 32% of the dentist use cavity test and sensitivity test to differentiate reversible and irreversible pulpitis and about 42% of the dentist says that pain ceases within 1–2 s once the stimulus is removed in case of reversible pulpitis. Conclusion: Reversible pulpitis can be recovered easily if it is treated properly, it is necessary to take proper treatment in the initial stage to prevent the occurrence of irreversible pulpitis. KEY WORDS: Dentist, Irreversible pulpitis, Pulpal pressure, Reversible pulpitis, Treatment INTRODUCTION iatrogenic dental procedures. Electrical injury results from galvanic current from any dissimilar metals.[8] The dental pulp is a connective tissue consisting of nerves fibers, blood vessels, ground substances, interstitial Reversible pulpitis is characterized by sharp fluid, odontoblasts, fibroblasts, and other essential sensitivity to cold, sometimes to sweets and to biting. cellular components. The dental pulp is essential to Discomfort is experienced when stimulus such express numerous mediators of inflammation, which as cold or sweet is applied on the tooth and goes can combine irritating factors.[1-4] Its mechanistic away within a seconds following by the removal [9] response starts with vascular changes mediated by toll- of stimulus. Microscopically, one can see dilated like receptors 4/2-positive cells and which includes the blood vessel, excretion of edema fluids, destruction release of measurable inflammatory mediators such as of the odontoblast layer, reparative dentin, and acute [10] interleukin (IL)-8, IL-6, IL-1, and others.[5-7] and chronic inflammatory cells. The main cause of reversible pulpitis is the lysosomal enzymes The etiology of pulpitis is of two types, physical and discharged by neutrophils result in widespread tissue [11-13] chemical and bacterial. Chemical agents include damage and suppuration. phosphoric acid, acrylic monomer, and other acids that The major symptoms of reversible pulpitis are cause erosion. Bacterial agents include toxins associated characterized by sharp pain lasting for a moment. It with caries, direct intrusion of pulp from caries or is more often bring by cold and hot food or beverages from trauma, and microbial colonization in the pulp and also by cold air. It does not occur immediately by blood-borne microorganisms. Mechanical injury and does not continue when the cause has been results from any trauma, accidental cases, attrition, removed. Periodontal and pulpal inflammation has cracked tooth syndrome, barodontalgia, and during any some similar features: Initially, both bring a soft tissue inflammation caused by microbial infection. Access this article online At a later stage, these pathologic processes combine in bone resorption. It is, therefore, possible that both Website: jprsolutions.info ISSN: 0975-7619 these may express the similar biomarkers. In this Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. S. Haripriya, Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. E-mail: [email protected] Received on: 09-05-2019; Revised on: 07-06-2019; Accepted on: 11-07-2019 Drug Invention Today | Vol 11 • Issue 9 • 2019 2223 T. Vinaya Swetha and S. Haripriya regard, matrix metalloproteinases were expressed to be DISCUSSION potential biomarker for both pulpal[14] and periodontal disease.[15] However, the application of molecular Caries, tooth fracture, and operative procedures can diagnostics in pulpal disease is not used for clinical produce pulp inflammation and necrosis.[19] Dentist decision making.[16] reported that main causes of reversible pulpitis are dental caries, trauma, and disrupted occlusal The best treatment for reversible pulpitis is when it relationship. Major symptoms of reversible pulpitis is identified, removal of the noxious stimuli. Once that patients manifest with are hypersensitivity, the symptoms have subsided, the tooth should be tooth pain, and swelling of jaws. In case of tested for vitality, to prove that pulpal necrosis has not reversible pulpitis, tooth pain gets ceases within occurred. Treatment for irreversible pulpitis is pulp 1–2 s after removal of stimulus. Histopathological extirpation or pulpectomy. Pulpectomy is the most characteristics of reversible pulpitis are that used treatment often used in patients who present with it causes dilated blood vessels, disruption of symptoms of irreversible pulpitis and pulp necrosis odontoblastic layer, and extravasation of edema with or without swelling.[17] Pain arises during the fluid. This may range from hyperemia from mild treatment of reversible pulpitis or any other endodontic to moderate inflammatory changes limited to the treatment can be managed by incision and drainage, reinstrumentation.[18] area of the involved dentinal tubules such as dental caries. MATERIALS AND METHODS Many reports have said that reversible pulpitis is It includes a questionnaire-based study. The survey identified by the absence of bacteria and by liquefaction would be conducted among 250 dentists across necrosis and localized coagulation immediately Chennai, Tamil Nadu, India. It includes 153 male surrounding the irritant, whereas irreversible pulpitis and 97 female participants. This study includes 14 is identified by the presence of bacteria or their questionnaires. The questionnaire would be circulated by-products in dental pulp and by preponderance through SurveyPlanet and they filled up this survey of cute inflammation cells predominantly such as using by registering their e-mail and their data were neutrophils in the tissue under the lesion undergoing collected and the result was statistically analyzed. chemotactic activity. RESULTS S. No. Questionnaires Options % 1) Are you an endodontist? a) Yes 19 b) No 81 2) What are the symptoms of reversible pulpitis that a) Hypersensitivity 25 commonly your patients manifest with? b) Tooth pain 60 c) Swelling of jaws 15 3) What are the main causes of reversible pulpitis? a) Dental caries 24 b) Trauma 21 c) Disrupted occlusal relationship 16 d) All of the above 40 4) Which test helps you in accurate determination of vitality a) Sensitivity test 26 of pulp? b) Pulp vitality test 45 c) All the above 29 5) Which test do you prefer to differentiate reversible and a) Sensitivity test 18 irreversible pulpitis? b) Cavity test 30 c) Pulp vitality test 17 d) All the above 35 6) Within which time does the pain ceases once the stimulus a) 5 min 30 is removed? b) 1–2 s 41 c) 5 s 30 7) What about the state of intrapulpal pressure in reversible a) Increase 34 pulpitis? b) Decrease 39 c) No change 27 8) Do you think that reversible pulpitis cause fever? a) Yes 15 b) No 85 9) Does tooth color changes? a) Yes 32 b) No 68 10) Do you think it is necessary to remove entire tooth in case a) Yes 18 of reversible pulpitis? b) No 72 2224 Drug Invention Today | Vol 11 • Issue 9 • 2019 T. Vinaya Swetha and S. Haripriya S. No. Questionnaires Options % 11) Which treatment do you think is preferred for patients with a) Caries removal 45 reversible pulpitis? b) Root canal treatment 42 c) Deep caries management 14 d) Pulp capping 23 e) No treatment required 6 12) Which method do you think will give the Accurate a) Clinical evaluation 22 determination about extension of inflammation of pulp? b) Signs and symptoms of patients 30 c) Radiographs 37 d) Cavity test 12 13) What are the histopathological characteristics of reversible a) Dilated blood vessel 12 pulpitis? b) Disruption of odontoblastic layer 20 c) Extravasation of edema fluids 33 d) All the above 36 14) Does periapical tissue gets inflamed in patients with a) Yes 64 reversible pulpitis? b) No 37 Before making a diagnosis, it is necessary to treatment in the initial stage to prevent the occurrence determine whether dental pain is of non-odontogenic of irreversible pulpitis. or odontogenic origin. Among the non-odontogenic pathological conditions, referred pain presents more REFERENCES difficulties in differential diagnosis, while majority of the non-odontogenic diseases (e.g., temporomandibular 1. Karapanou V, Kempuraj D, Theoharides TC. Interleukin-8 is increased in gingival crevicular fluid from patients with acute joint syndrome, pericoronitis, mouth ulcers, sinusitis, pulpitis. J Endod 2008;34:148-51. and sialolithiasis) do not present difficulties in 2. Keller JF, Carrouel F, Staquet MJ, Kufer TA, Baudouin C, differential diagnosis.[20] Tooth has four possible pulp Msika P, et al. Expression of NOD2 is increased in inflamed diagnosis: Normally, reversible pulpitis, irreversible human dental
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