Irreversible Pulpitis From Ultrasonic Cleaning?

[Brause]

In late 2023, I got irreversible pulpitis in tooth 21 (European counting system), a tooth that had never been treated before. It then received RCT.

After a tooth cleaning in early August 2025, tooth 11 became symptomatic 3 weeks later. Trauma from occlusion can be excluded, tooth has also not been treated before. Looks like pulpitis again...it may be too early for a conclusive diagnosis as the infection has not yet pushed through the apex (percussion negative).

I am at a loss what could have caused pulpitis in both cases. Vibrations and heat transfer from the oscillating probe are the only possible causes that come to mind.

However, I have had the same hygienist for the last 15 years. She has been very good and is very experienced.

How frequent is pulpitis from ultrasonic scaling?


Image is from January 2025.

 

[Dr M]

The image provided is very poor quality. Do you perhaps have any other images? From my experience it is extremely rare, although not impossible to get pulpitis from a cleaning. To get pulpitis on two teeth even more so. Do you have some photos of the palatal surface of your teeth? What makes you exclude traumatic occlusion?

 

[Brause]

The image does not include the latest cleaning, is therefore inconclusive and only symbolic. Traumatic occlusion is not indicated because tooth 11 is not clashing with the lower plate at all. Tooth 12 was clashing, hence occlusal trauma was an option.

Previously recorded (pulpal) irritations:

Tooth 41 became symptomatic after a lower nightguard had been fitted a few weeks earlier. It had a peak sticking out (attached image may be side-reversed...taken before corner was ground off) that was absorbing most of the stress of the upper plate clashing down on it. This caused constant pain. When the dentist ground off that corner with a vibrating tool to distribute that stress evenly, that pain was exacerbated 2 days later and remained excruciating. It was not any different from pulpal/periapical pain and the tooth responded to vertical percussion.

No odontogentic reason was ever found, the periapical area remained healthy (X-ray taken 10 months after the onset of pain). Neuropathic pain was assigned as cause and Amitritpylene was prescribed. 1.5 years later, this pain is still being medicated.

The mesial root of tooth 47, following the extraction of tooth 46, showed some resorption/chip and a widened PDL in the CBCT scan 5 months later. The surgeon was of the opinion that this chip was not of iatrogenic origin but resorption from overuse and performed a percussion test with a monstrously heavy burr...way too big for my flavour. This caused pain in tooth 47 the next day...then a 5-day hiatus...followed by 2 weeks of permanent pain. Settled thereafter. That chipped area appears to be protected now by that implant.

 

[Dr M]

Tooth 41 might have become symptomatic after adjustment of the corner, due to the exposure of dentinal tubules, that was previously covered with enamel. Was any de-sensitizing medication applied on the surface of tooth 41, before it was treated by other more severe medication? A lof of times, dentine hypersensitivity is the cause of otherwise undiagnosable pain. Sealing the dentinal tubules alleviates the pain. Recently studies have shown that bioglass is a good material in order seal off these tubules.

 

[Brause]

Tooth 41 might have become symptomatic after adjustment of the corner, due to the exposure of dentinal tubules, that was previously covered with enamel. Was any de-sensitizing medication applied on the surface of tooth 41, before it was treated by other more severe medication? A lof of times, dentine hypersensitivity is the cause of otherwise undiagnosable pain. Sealing the dentinal tubules alleviates the pain. Recently studies have shown that bioglass is a good material in order seal off these tubules.

No, it was not sealed. But the pain started before the corner was ground off.

 

[MattKW]

In late 2023, I got irreversible pulpitis in tooth 21 (European counting system), a tooth that had never been treated before. It then received RCT.

After a tooth cleaning in early August 2025, tooth 11 became symptomatic 3 weeks later. Trauma from occlusion can be excluded, tooth has also not been treated before. Looks like pulpitis again...it may be too early for a conclusive diagnosis as the infection has not yet pushed through the apex (percussion negative).

I am at a loss what could have caused pulpitis in both cases. Vibrations and heat transfer from the oscillating probe are the only possible causes that come to mind.

However, I have had the same hygienist for the last 15 years. She has been very good and is very experienced.

How frequent is pulpitis from ultrasonic scaling?


Image is from January 2025.

There's not enough information to make any firm conclusions, so can you please answer the following:
1. Why did 21 develop irreversible pulpitis (IP)? Any idea?
a. What symptoms did you have?
b. How did the dentist test for IP and reach the conclusion that RCT was needed?
2. What do you mean to say that the 11 became "symptomatic"?
a. What symptoms did you have?
b. How did the dentist test for IP?

 

[Brause]

1. Probably trauma from occlusion. No cavity.
a. Started with strong pulpal pressure transitioning into strong dull toothache (delta fibres) after 2 weeks. Tooth had become sensitive to tongue and to impact when walking upon the onset of pain. Pain increased in intensity after another 16 days. That sensitivity to impact remained until recently.
b. X-ray showed widened PDL around the apex. Then, the endodonist performed an endo ice test (yes, it lingered but was inconclusive in my option), but the CBCT scan showed a "rarefying osteitis".

Tooth 21 has not stopped hurting since Dec 2023 and is scheduled for extraction for the end of the month.


2a. The 11 started being painful and also feeling pressured.
b. No dentist has examined it yet. Dentist will take X-rays next week.

This only started at the end of August. The periapical area may not be involved yet.

In this case, trauma from occlusion can be excluded as well as caries. Maybe, it is referred pain from tooth 21 or even from tooth 12. Tooth 12 reacts when pushing it up (always has since wearinga mandibular nightguard) as it clashes with the nigthtguard. Nightguards are the perfect cause of occlusal traumas: they are hard and offer a large surface area to be hit.

That pain/pressure in tooth 11 comes with headaches...that nasty trigeminal nerve...all of this gets much better when eating/filling my stomach...and in the evenings, when my blood pressure is naturally much lower.

My family physician has loaded me up with daily 150 mg of Topimirate (while reducing Amitriptylene to 10 mg). I had been taking 25 mg of Amitriptylene and 25 mg of Topimirate for neuropathic pain in tooth 41 that had developed strong non-odontogenic pain in April 2024 as mentioned before. I'll be seeing my neurologist again mid month.

Complicated?

Yes!