Is covering pulpitis with dental gypsum (a temporary protective measure) an appropriate treatment for a patient presenting with pulpitis?

Dental Gypsum is NOT Appropriate for Treating Pulpitis

Pulpitis requires definitive dental treatment—either vital pulp therapy (pulpotomy) or root canal therapy—not temporary covering with dental gypsum. Dental gypsum has no role in the management of pulpitis and will not address the underlying inflammation or prevent progression to pulp necrosis.

Definitive Treatment Approach

For Irreversible Pulpitis

• Endodontic debridement (root canal therapy) is the definitive treatment for irreversible pulpitis, providing predictable pain relief 1
• Vital pulp therapy (pulpotomy) has emerged as an effective alternative even for teeth with signs and symptoms of irreversible pulpitis, with 90% success rates at 1 year 2
• Antibiotics alone are NOT effective for treating pulpitis pain—there is insufficient evidence that systemic antibiotics (including penicillin) reduce pain compared to placebo 3

Emergency Management When Immediate Treatment Cannot Be Provided

• Analgesics are the mainstay for temporary pain control until definitive treatment can be rendered 3
• Ibuprofen and acetaminophen (with or without codeine) are appropriate for pain management 3, 4
• Intraosseous injection of corticosteroids (Depo-Medrol 40mg) can temporarily reduce pain and percussion sensitivity over 7 days when definitive treatment must be delayed 4
• Long-acting local anesthetics (liposomal bupivacaine) do NOT provide clinically meaningful pain reduction in untreated pulpitis 1

Why Dental Gypsum is Inappropriate

Dental gypsum (calcium sulfate) is a material used for making dental casts and models—it has no therapeutic role in treating inflamed pulp tissue. The evidence clearly indicates that:

• Pulpitis requires removal or treatment of the inflamed pulp tissue, not simply covering the tooth 1, 2
• Covering exposed dentin in crown fractures is appropriate to reduce bacterial contamination, but this applies to tooth-colored dental materials or calcium hydroxide-based materials, not gypsum 5
• No guidelines or research support the use of gypsum for any aspect of pulpitis management 5, 6, 3, 1, 4, 2

Critical Treatment Algorithm

1. Immediate dental referral for definitive treatment (pulpotomy or root canal therapy) 2
2. Prescribe appropriate analgesics (NSAIDs ± acetaminophen/opioids) for pain control 3, 4
3. Do NOT prescribe antibiotics unless there are signs of systemic infection (fever, facial swelling, lymphadenopathy) 3
4. If definitive treatment must be delayed, consider intraosseous corticosteroid injection by a trained provider 4

Common Pitfalls to Avoid

• Never use antibiotics as a substitute for definitive dental treatment—they do not relieve pulpitis pain 3
• Do not delay definitive treatment expecting temporary measures to resolve the condition—untreated pulpitis progresses to pulp necrosis 7
• Avoid using inappropriate materials like dental gypsum that have no therapeutic benefit and may give false reassurance while the condition worsens 5