Introduction: Epidemiological studies indicate that root filled teeth exhibit higher rates of apical periodontitis and extraction compared to non-root filled teeth, underscoring the importance of vital pulp treatment (VPT) when feasible in teeth with pulpitis. The European Society of Endodontology has established guidelines for treatment of pulpitis, which this article evaluates from a Scandinavian perspective.

Review of available scientific literature: The guidelines are based on three systematic reviews on pulpitis management. For teeth with pulpitis without spontaneous pain, evidence is insufficient to favour direct pulp capping over pulpotomy or selective/stepwise caries removal. In teeth with pulp exposure due to caries, direct pulp capping and pulpotomy show comparable short-term outcomes. For teeth diagnosed with pulpitis, with or without spontaneous pain, pulpotomy and root canal treatment demonstrate similar short-term effectiveness. Root canal treatment is suggested to be performed on teeth as soon as the diagnosis necrosis is confirmed to prevent apical periodontitis.

Discussion: VPT offers advantages, though concerns persist regarding long-term pulp survival and undetected disease progression. ESE’s guidelines are in line with the Scandinavian’s, though evidence is weak concerning balancing short-term benefits against long-term outcomes, emphasizing the need for careful clinical judgment and further research.

Keywords: dental caries, dental pulp capping, dental pulp exposure, pulpectomy, pulpotomy