Diagnosis
Diagnosis
Diagnosis of chronic pulpitis relies on integration of history (duration, character, frequency of symptoms), vitality testing, and radiographic findings. The absence of symptoms does not exclude significant pathology.
Periapical radiographs are particularly informative: deep caries or large restorations adjacent to the pulp, radiographic evidence of pulp chamber reduction from tertiary dentin, pulp calcifications, or widening of the periodontal ligament space suggest chronic pulp involvement. CBCT provides superior 3D imaging when standard radiographs are inconclusive.
Pulp calcifications visible radiographically (pulp stones) do not definitively indicate pulpitis, but their presence in conjunction with symptoms or large restorations raises suspicion. Calcification severity is associated with reduced pulp vitality and anesthesia difficulty.
Histological diagnosis is definitive — lymphoplasmacytic infiltrate, fibrous replacement, calcifications — but only available after extraction or root canal treatment. Clinicians must therefore rely on indirect indicators. The asymptomatic presentation of much chronic pulpitis underscores the importance of routine radiographic monitoring.