“Pulpitis is inflammation of the dental pulp. It is how a dentist might describe ‘toothache.’ The pulp inside a tooth consists of vascular tissues, blood supply, nerves, and connective tissue. When the pulp is inflamed, a person may experience pain from the tooth’s nerve. Pulpitis can be reversible or irreversible.”
– Medical News Today

OK, so many of us are very familiar with having tooth ache. Indeed, it is likely the number one reason why we attend a dental clinic to get relief from this common but most painful experience. We go to the dentist but the individual dentist must then make a call on how she or he is going to treat the problem. Treatment options for irreversible pulpitis: Dentists directing their patients. We put our oral care in the hands of these healthcare professionals.

What Dentists Do About Treating Irreversible Pulpitis

“Various factors influence the decision towards conservative or less conservative treatments. While the impact of these variables has been explored in medicine and dentistry, there is a noticeable gap in the literature concerning their effect on decision-making in the treatment of teeth with irreversible pulpitis. This study aimed to evaluate the respective influence of dentists, patients, and clinical factors on treatment approaches for permanent mature teeth with irreversible pulpitis.”
– Y.Alfaisal, G.Idris, CI.Peters & OAPeters & S.Zafar, 8 June 2024, Australian Dental Journal

How a dentist decides to treat your tooth ache is determined by a variety of variables, as the study quoted indicates. It may be the level of training your dentist has received or where they were trained. It might be gender related. It may have something to do with the age of your dentist and how long they have been practicing. What is important for the public to understand is that treatments are not narrowly defined to the extent that many might believe.

“Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants.”
– Online Library

VPT is Vital Pulp Therapy. VPT is a restorative dental procedure as an alternative to root canal treatment and the removal of all pulp material. – Wells C, Dulong C, McCormack S. Vital Pulp Therapy for Endodontic Treatment of Mature Teeth: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jul 10. Available from: NCBI.gov Books

Changing Trends In Dentistry

The shift away from ripping out all pulp material whether compromised or not can be seen as an evolutionary progression in dentistry from the darker ages into the light of the 21C.

“Currently, there is an increased tendency towards minimally invasive interventions in dentistry, which is supported by the improved understanding of pulp biology and advancements in pulp capping materials that have allowed the adoption of more conservative approaches aiming to preserve pulp vitality.8, 9 Recent findings proposed vital pulp therapy (VPT) as an alternative to root canal treatment (RCT) not only in teeth diagnosed with reversible pulpitis, or in immature teeth, but also in permanent mature teeth with signs and symptoms consistent with a diagnosis of irreversible pulpitis.”
– Y.Alfaisal, G.Idris, CI.Peters & OAPeters & S.Zafar, 8 June 2024, Australian Dental Journal.

In light of the findings of this study it may well benefit the public to ask questions of their potential dentists as to their treatment proclivities and attitudes toward such things as VPT vs root canal therapy. It may be a case of old school vs those trained in more progressive approaches to 21C dentistry. I mean not so long ago it was dental practice in some regional areas to remove all the teeth in a compromised oral cavity and replace them with what were commonly referred to as false teeth. Homosexuality was included in the Diagnostic and Statistical Manual (DSM) as a disorder of the mind up until 1973. Things change in science, as do community and cultural attitudes toward human behaviours. – NCBI.gov

Hamlet may not have been a Danish dentist operating some time ago, but the pertinence of the question remains the same.

“Urban dentists chose extraction less often than clinicians from other areas, and this finding should be interpreted with caution because most of the participants worked in urban areas (n = 210, 88.2%) compared to non-urban areas (n = 35, 14.2%). However, the distribution of registered dentists in Queensland according to the Dental Board of Queensland (QLD) in 2009 between urban and non-urban areas reveals that 72.5% practise in Brisbane and southeast QLD; 16.0% practise elsewhere in QLD, including rural areas, and 11.0% work outside QLD (Dental Board of Queensland, 2009).”
– Y.Alfaisal, G.Idris, CI.Peters & OAPeters & S.Zafar, 8 June 2024, Australian Dental Journal.

Tooth removal is far more popular in regional areas and possibly this can be understood by the paucity of dentists in the bush and the differing expectations of the denizens of country areas to urban Australians. “Just rip it out Doc!” Economics plays a big part in the dental treatment decisions made by patients. It is invariably cheaper to choose extraction over most other treatment options for irreversible pulpitis. Saving natural teeth can be a risky and expensive course of action for patients. The number of accounts I have been privy to involving expensive failed crowns and such like are legion. Such outcomes tend to give dentists a bad name among the general public. In by far the majority of cases dentists are doing their best by their patients in the treatment decisions made and enacted. Unfortunately bridging and crowning procedures do not always endure to the satisfaction of patients for a variety of reasons.

Choosing The Right Dentist For You

Will you choose a younger dentist over an older dentist going forward? Or will you select a female dentist rather than a male dentist? How about an overseas trained dental healthcare professional in preference to a local product? Treatment options for irreversible pulpitis are numerous, with dentists directing their patients toward favoured therapeutic procedures. Getting the best outcome for your oral care may be determined by who your dentist is.

“In conclusion, the study showed that treatment decision-making in teeth with irreversible pulpitis is influenced by the clinician’s age, gender, years of experience, place of primary dental qualification, speciality training and guidelines of the practising sector. Female dentists, more experienced clinicians, overseas graduates and endodontists opted for VPT as a treatment for permanent mature teeth with irreversible pulpitis more frequently than other participants. With an increased body of emerging evidence indicating that VPT is an efficient, minimally invasive, predictable, and cost-effective alternative to conventional RCT, this study alerts readers to the lack of uptake of this treatment modality for teeth with symptomatic irreversible pulpitis. “
– Y.Alfaisal, G.Idris, CI.Peters & OAPeters & S.Zafar, 8 June 2024, Australian Dental Journal.

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