Hot Pulp (Irreversible Pulpitis): Causes, Symptoms, and Treatment Options

"Hot pulp" is a colloquial term for irreversible pulpitis—severe inflammation of the dental pulp causing intense, lingering pain to thermal stimuli.

Causes

• Deep caries approaching pulp.
• Cracked tooth syndrome.
• Trauma (recent or past).
• Repeated dental procedures.
• Large restorations with microleakage.

Symptoms

• Spontaneous, throbbing pain.
• Lingering pain to heat/cold (>30 sec after stimulus removed).
• Pain referral to ear, temple, opposite jaw.
• Night pain disrupting sleep.
• May be relieved by cold water (vasoconstriction reduces intrapulpal pressure).

Treatment

1. Root Canal Therapy (RCT): Remove inflamed pulp, clean/shape canals, obturate. Gold standard; preserves tooth.
2. Extraction: If tooth non-restorable, vertical root fracture, or patient declines RCT.
3. Adjuncts: Antibiotics only if systemic signs (fever, swelling, cellulitis). NSAIDs for pain control.

Prognosis

RCT success >90% at 10 years. Crown recommended for posterior teeth to prevent fracture.