Irreversible pulpitis

Woman in pain toothache Ouch


Irreversible pulpitis occurs when the dental pulp - the nerve and blood supply inside a tooth - has become so inflamed that the damage done is, as the name suggests, irreversible. The main feature is intense pain which lasts for quite some time or is constant. It is basically a classic ‘toothache’ and is one of the most common reasons that one might need to obtain emergency dental care. Here are some key features

  • Pain often worse with hot and can sometimes be relieved by cold
  • Can be anything from a sharp pain to a dull, throbbing pain
  • Pain can last minutes, hours or be constant
  • Pain may be worse when biting down
  • Pain worse at night

Home care advice

Irreversible pulpitis is a difficult condition to self-treat from home. The inflammation in the pulp is so great and the inflexible nature of the tooth means the pain can, in some circumstances, be very severe. The treatment of choice is to open up the tooth and clean out the pulp. However in strict lockdown this is going to be difficult. 


  1. Studies suggest that antibiotics are unlikely to be effective as the pulp is inflamed, not infected.

  2. As a profession we are also trying to reduce the use of antibiotics due to the very real problem of antibiotic resistance.

  3. Antibiotic allergies and interactions with existing medications.

Antibiotics would only be indicated if the pulpitis has become a dental abscess and there is significant swelling that cannot be drained.

We therefore recommend talking to dentist, confirming the diagnosis and getting their recommendation as to how to proceed. Pain can be usually be somewhat relieved by a combination of paracetamol and a non steroidal anti-inflammatory drug (NSAID). CARE MUST BE TAKEN TO CHECK FOR ANY CONTRAINDICATIONS DUE TO EXISTING CONDITIONS, MEDICATIONS OR ALLERGIES.

Relief may also be obtained by using anaesthetic gels to numb the area. They usually contain either Benzocaine or lidocaine. Natural remedies such as Clove Oil which contains eugenol - a natural anaesthetic and antiseptic may also help a little.

There has been a suggestion that the use of NSAIDs in patients with Covid19 could worsen the symptoms. Current evidence suggest this could be the case especially with longterm use and severe symptoms. However the current guidelines (as of April 23rd 2020) are that they can be used to manage other causes of pain. 

Clearly, the big unknown is whether any of this evidence applies in the covid-19 epidemic. The evidence to date is not strong enough to support advising against all use of NSAIDs

Editorial BMJ 2020;368:m1185

Written by Andrew Bain BDS MJDF (RCS Eng)
Apr 27, 2020