Pulpitis - Differential diagnosis

Differential diagnosis of pulpitis is perhaps the most difficult area in endodontic diagnosis. It has been estimated that approximately 80% of teeth with pulpitis are symptom-free. When symptoms are present, it is often difficult to verify the origin of the symptoms. Hypersensitive dentine (top left), dentine microfractures (top right), herpes, ulcers, oral wounds, oral infections (apical & marginal periodontitis), neuralgia, neuritis, and neuropathic pain have to be considered when pain is present. In particular, when no obvious cause for pulpitis can be found and when pain has existed for a long time, caution must be exercised to avoid the hasty commencement of endodontic treatment of a tooth or teeth that are in the region of the pain.

Psychogenic and unknown factors, unfortunately still account for a considerable amount of chronic orofacial pain. Close co-operation with other specialists in other dental disciplines is often required to help these patients.