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Dentistry/Reversible vs. Irreversible Pulpitis



Hope you are well. I had a deep cavity filled that breached the pulp. My dentist said it looks "reversible" on x-ray, 4 days following the filling. The tooth is extremely sensitive to cold (ice cream), less sensitive to heat (soup), does not hurt to chew (pressure, or tapping), but the pain lingers in the form of an ache in my cheek, after cold stimuli, until I take Tylenol, and/or apply a hot water bottle to my face.

It is now 1.5 weeks after the cavity was filled. How long should one wait to see if the pulpitis truly will resolve?

Thank you,

Greetings Taylor,

Sorry to read about your problem.  Once the pulp has been breached the most likely outcome will eventually be irreversible pulpitis leading to root canal or extraction.  The fact that it is now sensitive to cold instead of heat is an indication that it may get better before it gets worse.  It is possible that the sensitivity to cold may slowly get better and the tooth may even feel that the problem has resolved.  Although it is possible to have the tooth recover completely, the most likely scenario would be for the problem to reccur months or even years down the road.  This would necessitate further treatment.

I'm not clear on how an x ray taken after the filling was done could predict whether or not the pulpitis would be reversible.  Once the pulp has been exposed the most common outcome is eventual further complications.  That is why modern dentists are trained to avoid following decay all the way to the pulp to remove it.  The accepted routine now is to avoid drilling or removing all decay if that removal would breach the pulp.  The accepted method would be to stop short of the pulp even if that means leaving some decay under the filling.  This strategy includes using a base material under the filling that will promote remineralization of the small amount of decay that is left under the filling.

Your future outcome will be based upon your individual tolerance of the cold sensitivity while time tries to lessen your sensitivity to cold.  If and when it becomes more sensitive to heat and or pressure, that will be a sign of further downhill activity.

My hope is that your case will be one of those that recover completely with no further treatment.  Either way, you can expect cold sensitivity to continue and hope it gets better over time.

Larry Burnett DDS  


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Larry Burnett DDS


Preventative Dentistry. Conservative Periodontal Therapy


National lecturer on conservative treatment of periodontal diseases and elimination of tooth decay. Former adjunct professor of oral microbiology at a Leading school of dental hygiene. Former investigator for State Board of Dentistry. Retired from private dental practice.


RDH Magazine. Numerous articles

Graduate of Medical College of VA School of Dentistry. 20 years teaching hygienists at NOVA

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