If we talk ideally,in stages,any infection first first affect pulp.After affecting pulp it passes through the apical foramen,and from there on the infection becomes the periapical pathology.
Pulpitis can cause sensitivity and pain.
Sensitivity can be due to hot,cold and sweet,depending on the nature of pulpitis (reversible or irreversible).
Pulpal pain most of the time is diffuse and of referred type.
Patient in which the inflammation has not crossed the periapical barrier and is limited to pulp,in that offending tooth will not be found tender on percussion.And even some time patient cant even differentiate between the offending and the normal tooth by himself.The reason behind this is that pulp lacks the proprioceptive nerve fibers,which are found in Periodontal ligaments.
Pulpal pain can radiate to parts of head and neck this is because nerve endings from facial, glossopharyngeal and vagus nerve shows wide intermingling in subnucleus ganglia of trigeminal nerve(supplying to tooth pulp).
But in reality whenever pulpal pathologies like pulpitis happen,some toxins from pulp do pass the apical foramen and cause periapical irritation and inflammation.
So patient shows mixed type of clinical features...
whenver infection affects periodontal tissue,top will come possitive as periodontal fibres have proprioceptive nerve fibres.pulpitis wont give top possitive as pulp lacks proprioceptive fibres.when toxins due to irreversible pulpitis cross the apical foramen and it leads to periapical periodontitis.Periapical periodontitis can be acute or chronic.Chronic periodontitis is same as periapical granuloma and in this tooth is non vital.where as when in acute apical periodontits etiology can be infective or can be due to trauma from occlusion.if patholgy is infective than tooth will be non vital but if etiology is TFO than tooth will be vital and condition is reversible.
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