Pulpitis: symptoms and effective methods of treatment. Pulpitis acute and chronic

Don't worry, people don't notice it. But after a while, the tooth declares itself. Getting to the dentist, a person hears the diagnosis: inflammation of pulpitis. Microorganisms entered the tooth, and everything became inflamed. Pulpitis inflammation of the gums especially disturbing in the evening and at night. The cause of pain is inflammation of the dental pulp.

Symptoms

• Pain occurs when eating cold or hot.
• The pain increases in the evening.
• The pain responds in the temporal region and in the auricle. This is due to the propagation of a nerve impulse along the trigeminal nerve.
• At the beginning of pulpitis, pain is quickly removed with analgesics.
• Attacks may not occur every day, but once a week.
• If you do not come to the doctor, there comes an acute stage. Body temperature may rise.

Types of pulpitis

• Chronic hypertrophic.
• Chronic gangrenous.
• Purulent.

The reasons

• The main root cause of the disease is neglected caries. With deep caries, the pulp is regularly irritated by bacteria and toxins. Thinned enamel allows you to constantly irritate the pulp. It is affected by chemical and thermal stimuli. Hot, sour, sweet - all this injures the pulp.
• Getting a pulp burn can actually be done right in the dentist's chair. This can happen when filling or installing a denture.
• Injury to the tooth can also be the root cause of the disease. The presence of chipped areas on the tooth creates conditions for the passage of bacteria. The same thing happens when there are cracks in the enamel.
• The disease also sometimes occurs due to the fault of the dentist. In the treatment of caries, filling procedures were carried out inaccurately. There was a mechanical, chemical or thermal injury to the pulp. The doctor did not pay attention to this and after a rather long time pulpitis developed.

The danger of pulpitis

The real complication is periodontitis - inflammation of the gums. Microbes spread beyond the boundaries of the tooth, affecting neighboring tissues. Such a tooth can no longer be saved in 9 cases out of 10. During the transition to the purulent stage, pulpitis produces severe pain. The patient may faint from pain shock. When using folk methods of treatment, you can kill the nerve, the pain will pass. But the tooth cannot be saved this way, it will collapse over time. Sometimes, if pulpitis is ignored, death from general sepsis occurs. With timely access to the dentist, the smile will remain in an aesthetic form. Timely treatment will be prompt and painless.

Diagnosis of the disease

Diagnosis inflammation of pulpitis” is set after examination and history taking. X-ray examination is also used. Sometimes they find out the threshold of electrical excitability of the pulp. Examination reveals the presence of caries, reaction to hot, cold, sour. Soft tissue is often noted. Probing the cavity can give different results. In acute form, pulpitis gives a sharp pain. If the disease is chronic, then the pain is less. There is no response to tapping. Acute inflammation is not visible on x-ray. The chronic stage of the disease on the x-ray will show an enlarged periodontal gap.

Electrical excitability of the pulp gradually decreases. In the acute phase of the disease, EOD is 20-40 μA, in the chronic phase - about 70 μA. How not to confuse pulpitis with similar dental diseases?

Distinguish inflammation of pulpitis from caries easily. If the pain disappears immediately after the cessation of exposure, this is caries. With pulpitis, pain persists from a minute to several hours. This applies to both mechanical and thermal effects.

Periodontitis differs from pulpitis in the focus of inflammation. With pulpitis, it is in the tooth itself. With periodontitis - in the roots. Therefore, the pain is throbbing with pulpitis. She barely responds to tapping. But it responds to hot. With periodontitis, pain increases from a light touch. But there is no reaction to hot-cold.

Pulpitis treatment

The doctor usually begins the treatment process with the introduction of an anesthetic. He drills a hole and removes the nerve, you can amputate the pulp. Then the channel is filled with filling material. Treated only in the outpatient clinic. The treatment process often consists of two separate steps. At the first stage, arsenic is placed in the hole. This leads to necrosis of the nerves in the pulp. On the second visit to the dentist, a couple of days later, the nerve is removed. Everything is carefully processed, the channels are sealed. This method refers to surgical, it is very common. The popularity of the method is associated with a low percentage of complications.

If the patient is young, all tooth functions can be preserved. For this, a conservative biological method is used. After opening the cavity, drugs are placed on the pulp. They stop development, kill microorganisms. If within a few days the pain does not recur, it is sealed. The pulp remains alive - this has a positive effect on oral health. But this method is difficult to implement. Only a highly qualified dentist is able to carry out such treatment. This method is not suitable for everyone, it has many limitations.

As a rule, we do not think about the fact that nerve endings and blood vessels run inside each tooth. However, acute inflammation can remind you of this at any time. Pulpitis is a pathology that everyone encounters at least once in their life. The good news is that modern dentistry has proven methods of treatment that can solve the problem quickly and effectively.

But maybe everything is not so scary and you can just endure the pain? After all, sometimes you don’t want to go to the dentist! Let's see what processes occur inside the tooth with pulpitis and why a visit to the doctor should not be postponed.

General characteristics of the disease

Pulpitis is an inflammation of the dental nerve (pulp), which is located in the dental cavity and root canals. The pulp is extremely sensitive, and if the tooth is deeply damaged by caries, there is a crack in it, or a filling has fallen out of it, then the likelihood of developing pulpitis is quite high. Inflammation can also occur during treatment or preparation for dental surgery if the doctor is not careful enough. In rare cases, an infectious disease becomes a provoking factor.

Pain can occur when the tooth is exposed to cold or heat, acidic foods, alcohol, sugar. If you immediately consult a doctor, the inflammation can be suppressed. However, patients often try to relieve pain with analgesics, wasting precious time. As a result, nerve damage becomes irreversible and the pulp must be removed. The danger of pulpitis is that, without treatment, inflammation can spread to the tooth root, which increases the risk of tooth loss. Sometimes the pain goes away spontaneously, but this is not an indicator of recovery. This situation may indicate that the nerve is irreversibly damaged by harmful bacteria and a purulent mass begins to form in the tooth cavity. The latter, when it enters the base of the tooth root, can cause a flux - a purulent lesion of the jaw.

If the inflammatory process has been giving you discomfort for a long time, you should not delay going to the doctor: the removed nerve in time will help to avoid complications. Of course, there is a psychological factor: many patients do not like going to the dentist, they are afraid of pain, they do not want to waste time and money. Here it is important to make a sound decision so as not to aggravate the situation, especially since modern dentistry is affordable and practically painless.

How pulpitis is treated: modern approaches and methods

Treatment of pulpitis is to eliminate inflammation. This can be done in two ways: either by performing healing and restorative procedures on the pulp, or by completely removing it. The choice of doctor will depend on the condition of the pulp and the stage of inflammation.

Conservative treatment of pulpitis (biological method)

If immediately after the onset of acute pain, the patient consults a doctor, it is possible to stop the inflammation, while preserving the nerve. The pulp is exposed, treated with an antibacterial drug, a microbandage with calcium hydroxide is applied on top and the hole is closed with a temporary filling. A few days later, an x-ray is taken, the condition of the pulp is assessed and, if the inflammation has stopped, a permanent filling is placed. It must be borne in mind that this method is not always applicable and requires a highly qualified doctor, so conservative treatment will not be offered to you in every dental clinic.

Surgical treatment of pulpitis

A traditional method that has different implementation options depending on the specific case and the age of the patient. It consists in the complete or partial extraction of the pulp from the cavity of the tooth.

Extirpation. Used in the vast majority of cases. Represents the complete removal of the pulp.

1. vital. Under anesthesia, the living tissue of the pulp is removed. First, the tooth tissue affected by caries is removed, treated with an antiseptic, then the infected nerve is removed and the cavity is sealed. One visit to the dentist is enough for the procedure, it is universal for all forms of pulpitis, but not applicable for patients allergic to anesthetics.
2. Devital. If vital extirpation is not possible, the pulp is exposed to paste-like toxic substances (such as arsenic) so that it can then be painlessly removed. The paste is applied for 24-48 hours, if the patient can come for a second appointment quickly enough, or for up to 14 days - in this case, mildly acting formulations are used. The cavity is closed with a temporary filling until the next procedure. At the second appointment, the doctor removes the dead pulp, cleans the channels and puts a permanent filling. With purulent pulpitis or tissue necrosis, the method is not applied.

Amputation. In this case, only the coronal part of the pulp is removed, the root remains in place. For teeth with a single root, amputation is not suitable, since in this case it is almost impossible to isolate individual elements of the pulp. Amputation is usually prescribed for acute pulpitis or accidental mechanical damage to the tooth.

1. Vital. The necessary part of the nerve is amputated under anesthesia in one session. The method is indicated for patients under the age of 45 with a healthy periodontium.
2. Devital. After exposure to the pulp with a toxic paste, the dead area is removed, and the healthy one is deliberately mummified, for example, with an antiseptic paste based on zinc oxide-eugenol, so that the infection cannot re-develop. Devital amputation is used in difficult cases when it is impossible to reach the desired area of ​​the pulp. The modern arsenal of dentists includes flexible nickel and titanium instruments. With their help, even the most curved canals can be processed, which eliminates complex techniques.

The use of arsenic for the treatment of pulpitis was proposed only at the end of the 19th century. Prior to this, the inflamed pulp was destroyed with hot oil or burned out with a red-hot iron. These methods were used by ancient Greek and ancient Egyptian dentists.

Stages of pulpitis treatment

Let us dwell in more detail on the method of extirpation - as the most common and lengthy. The procedure requires two to three visits to the doctor, depending on the number of roots of the diseased tooth.

1. Removal of tissue affected by caries. The tooth is cleaned, opened and the pulp chamber exposed. With the devital treatment option, arsenic is placed in the tooth cavity, a temporary filling is placed and the date of the next appointment is set. If the pulp can be removed immediately, treatment begins with the next step.
2. Pulp removal. A special pulp extractor is used.
3. X-ray. A picture is needed to determine the length and shape of the canals.
4. Cleaning the canals and the tooth in general. This stage is necessary to exclude new inflammation.
5. Seal installation. First, the canals are sealed, then the coronal part.

The last step can be completed in two visits. In some cases, drug anti-inflammatory therapy is prescribed.

After the installation of the seal, the so-called post-filling pain when biting is possible. It is considered a variant of the norm, unless it lasts more than a week. Some dentists consider it unacceptable. In any case, it should not be strong. If you are experiencing serious discomfort, you should additionally consult with your doctor.

Features of the treatment of various forms of damage to the dental nerve

In the modern classification, pulpitis is divided into acute and chronic. It is easy to distinguish characteristic stages in each of the two forms.

Acute pulpitis. One of the most common complications of deep caries. It is manifested by severe pain, which can be aggravated by pressure on the tooth, exposure to heat or cold, sour or spicy food. Attacks of pain often occur at night. In children, due to the structural features of the jaw, acute pulpitis practically does not occur; in adulthood, men and women are equally affected by it. The disease passes in two stages, after which, in the absence of treatment, it flows into a chronic form.

1. Focal. The initial stage lasts up to 2 days. The inflammatory focus is close to the carious cavity. The pain is sharp, “shooting”, in nature, the attacks last for 10-30 minutes with breaks for several hours. At this stage, it is easy to determine the diseased tooth, since the pain is point.
2. diffuse. The second stage, which occurs with the defeat of the coronal and root parts of the pulp. The pain is scattered, radiating to different parts of the jaw, temporal and occipital part of the head, cheekbones. The attacks are longer, and the pauses between them are only 30-40 minutes. Acute diffuse pulpitis lasts no more than 2 weeks. If during this time the patient has not consulted a doctor, the disease becomes chronic.

Chronic pulpitis. It can last, without disturbing the patient too much, up to several years. Toothache is significantly dulled, you can get used to it, although chewing is difficult, and with external influences, pain intensifies. Exacerbations are possible from time to time. The method of treatment depends on the type of chronic pulpitis.

1. Fibrous. It is characterized by the presence of a deep carious cavity, which does not always reach the pulp chamber. The pain is weak, aggravated only with pressure on the tooth, blood appears from time to time.
2. Gangrenous. If an infection joins the fibrous pulpitis, the pulp atrophies, becomes dirty gray, the pain intensifies, the carious cavity expands. There is a smell from the mouth.
3. Hypertrophic. It is characterized by the fusion of the carious cavity with the cavity of the tooth and the formation of a polyp from granulation tissue, which bleeds and hurts when pressed. But usually there is no pain.
4. Exacerbation of chronic pulpitis. Simultaneous manifestation of signs of acute and chronic pulpitis. The patient experiences attacks of sharp pain, aggravated by pressure on the tooth. Possible destruction of bone tissue, periodontal infection.

Most often, patients with fibrous chronic pulpitis turn to dentists. Less common is gangrenous, in last place - hypertrophic. If the pulpitis has managed to become chronic, in 90% of cases surgical treatment is required. Acute forms are also amenable to conservative therapy. In any case, you will need a reliable clinic, where they will not only competently carry out the procedure for restoring or removing the pulp, but also put a high-quality permanent filling. The loss of a filling can provoke damage and pulpitis of adjacent teeth.

How to choose a reliable dental clinic?

Many patients, under the influence of acute pain, choose a clinic spontaneously, and then continue to go there for years without thinking about the quality of the services provided. Of course, there is no time to search and compare data in such a situation. We asked a representative of the Dental Association to comment on this issue:

“Of course, if you have acute pain, you can go to the nearest dentist, this is a natural solution. However, try to pay attention to the following details:

• Dialogue with the doctor - the dentist should ask you in detail about your feelings, check the reaction of the tooth to various influences. Next, the patient is informed about the possible methods of treatment.
• Clear treatment plan - after talking with the doctor, you should understand how many treatments will be needed, at what interval and why.
• The possibility of an unscheduled appointment - in the event of a sudden complication, you should be seen at a convenient time for you.

If you don’t like something, you can go through the next stages of treatment in another clinic, which you choose already in a calm state when the pain subsides.

Our Association has opened a hotline for dental treatment. Around the clock, seven days a week, specialists from various areas of dentistry will consult you for free by phone, tell you about a possible treatment plan, and suggest a particular clinic. In case of treatment in the direction of the Association, guarantees are given for materials and services rendered, competitive prices are offered. Our dentists have extensive experience in the treatment and surgery of various forms and stages of pulpitis, and you can be sure that after treatment, the tooth will not cause you any anxiety.”

P.S. The site presents prices for all-inclusive treatment, which will allow you to avoid unexpected expenses during treatment.

Toothache is one of the most common health problems. A person encounters it in everyday life as often as with ordinary SARS or acute respiratory infections. One of the likely reasons why a tooth may start to hurt is pulpitis. It is capable of delivering painful sensations, and without proper treatment it is dangerous with complications.

What is pulpitis and its differences

Pulpitis is an inflammation of the pulp, the neurovascular bundle in the tooth. The inflammatory process provokes a high accumulation of pathogenic microorganisms such as lactobacilli, staphylococci, streptococci or their toxins, penetrating into the soft tissues of the pulp.

Determining pulpitis on your own is not an easy task, because it has many common features with other diseases of the oral cavity, and the difference is minimal. However, there are a number of symptoms by which it can be distinguished. For example, with caries, after the cessation of exposure to the stimulus, the pain goes away, with pulpitis - no. With neuralgia at night, the pain decreases, with pulpitis it becomes stronger. Periodontitis is different in that the tooth hurts after any physical impact. On the pulpit part of the jaw, tapping or biting does not produce a painful effect. In order to avoid complications and errors, it is better to entrust the diagnosis when the first symptoms occur to an experienced dentist.

Varieties of pulpitis

There are 2 classic forms of dental pulpitis:

• acute;
• chronic.

The acute form is characterized by spontaneous development, with the sudden onset of paroxysmal pain. At the initial stage, a brown-black hole is formed in the enamel structure, which becomes deep over time. Damage affects the root canals of the tooth.

Acute pulpitis has its own classification:

1. Focal. Its duration is about 2 days from the moment the dentin is damaged. Attacks of pain last from 10 to 20 minutes, intervals between which can be several hours. Swelling of nearby tissues and the occurrence of pain in the lymph nodes are also likely.
2. diffuse. Inflammation extends to the crown, nerve endings and even the root of the pulp pocket. This disrupts the blood supply. The pain during pulpitis develops into a throbbing one, the attacks become longer, and the intervals between them are shorter.
3. Purulent. A distinctive feature is the accumulation of pus at the bottom of the cavity of the damaged tooth. Accompanied by constant throbbing pain and deterioration of well-being.
4. Serous. According to statistics, children are more susceptible to it. It is infectious in nature, and is accompanied by brief bouts of pain.

If the process of inflammation of the pulp lasts longer than three weeks, then the disease becomes chronic. Pain attacks acquire periodicity and appear not only at night.

The chronic form of the disease is divided into:

Rare types of pulpitis

One of the rare varieties of the disease is retrograde pulpitis. With retrograde pulpitis, the spread of inflammation does not occur from top to bottom, but vice versa. First, the root part of the pulp is affected, and then its crown.

In the case of retrograde pulpitis, there is no carious cavity, and characteristic symptoms, including prolonged nocturnal pain attacks, are present. The infection enters the tooth through holes in the upper part of the root. To provoke the development of retrograde pulpitis can:

Another rare species is calculus. It is non-infectious. Stones are formed in the pulp - parietal deposits that squeeze it for a long time, or replacement dentin is formed. Often seen in older people.

Traumatic pulpitis. The cause of the appearance of such pulpitis is a trauma to the tooth, leading to inflammation. Sometimes an infection in the oral cavity joins it. Most often, this form of the disease occurs in children, adolescents and asocial people. It is characterized by typical symptoms for pulpitis.

The reasons

The treatment of pulpitis largely depends on the knowledge of the causes that provoked the development of the disease. The factors that most often lead to inflammation of the pulp include:

Symptoms

Each type of tooth pulpitis has its own differences, but they all have common symptoms. At the initial stage of pulp inflammation, a diseased tooth begins to react painfully to temperature changes and other irritating factors. Further development of the disease is accompanied by a sharp throbbing pain, aggravated at night or in the supine position. Attacks are spontaneous, but can be triggered by external stimuli.

It can be difficult to understand which tooth has been damaged, due to the presence of a headache that even radiates to the neck or throat. For example, if a tooth in the upper jaw is affected, the pain can spread to the temples, in the lower jaw - to the ears.

However, there are external signs that will help to suspect pulpitis:

• enamel acquires a gray tint;
• the tooth becomes mobile;
• bleeding;
• gums redden;
• the appearance of swelling around the inflamed tooth;
• fistula formation.

The chronic form can proceed with the absence of typical symptoms of pulpitis. Often with it there is a rotten smell in the mouth and aching pain.

Diagnostics

The characteristic signs of the disease, and how the tooth looks outwardly with pulpitis, resembles many other diseases, such as periodontitis or deep caries. In this regard, the doctor is obliged to deal with the diagnosis. An accurate diagnosis is established on the basis of the following studies:

Possible Complications

If pulpitis is not completely cured or treated incorrectly, it is dangerous for the development of complications such as:

Among other complications after pulpitis, osteomelitis is possible - inflammation in the bone tissues of the jaw, phlegnoma - an inflammatory process that affects the tissues of the jaw and soft tissues of the face. This list of complications is incomplete, so timely treatment and prevention are important.

First aid

Before seeing a doctor and prescribing treatment, the following measures can be taken to relieve pain:

However, this is only a temporary solution that cannot cure the disease. It is not recommended to take other medicines or do warm compresses that are not prescribed by a doctor.

Treatment and prevention

Professional treatment of pulpitis in dentistry is divided into two methods:

The main point of therapy in the first variant is reduced to a high-quality treatment of the tooth cavity and the establishment of a permanent filling. For processing, antiseptics, antibiotics, corticosteroids that relieve inflammation, enzymes and vitamins are used. This is a more gentle method, which is especially true for children's and women's teeth during pregnancy.

One of the effective drugs for the treatment of inflammation of the pulp is dimexide. It has a local anesthetic and antimicrobial effect. According to the instructions for use, applications with dimexide should be done 2-3 times a day. A napkin with dimexide is applied to the affected area for 10-30 minutes on the recommendation of a doctor.

Among other drugs that are relevant in the fight against pulpitis:

• chlorhexidine;
• ketorol;
• ibuklin;
• indomethacin;
• voltaren;
• etodolac;
• meloxicam;
• lornoxicam;
• nimesulide;
• nabumetone;
• celebrex;
• viox;
• tenoxicam;
• miramistin and others.

In any case, the use of medicines is allowed after consultation with a doctor. As for the prevention of pulpitis, it comes down to:

• timely caries therapy and hole filling;
• visiting the dentist 2 times a year;
• proper nutrition, including vitamins, calcium, and a minimum of carbohydrates;
• the use of fluoridated water, which strengthens the enamel;
• oral care, including brushing, flossing and rinsing.

Pulpitis is an inflammation that affects the neurovascular bundle hidden inside the root canal and the coronal chamber of the tooth. The pulp normally provides nutrition to hard tissues from the inside. As a rule, pathology develops due to previously untreated and infection of soft tissues. Depending on the type of pulpitis, symptoms and treatment (medical tactics) may vary. The "classic" manifestation of pathology is pronounced, growing under the influence of thermal stimuli, and at night - and spontaneously. In very rare cases, an asymptomatic course is possible. By the nature of the course, like other inflammatory diseases, pulpitis can be both acute and chronic.

The chronic form is characterized by alternating periods of exacerbation and remission (subsidence of symptoms).

If you postpone a visit to the doctor over and over again, the process will inevitably progress. This can cause not only the loss of a dental unit, but also the spread of the inflammatory process to the structures of the jawbone and blood poisoning (septic process).

note

In people with a weakened immune system, sepsis, which poses a serious threat to life, develops much more often than in people with high immunity tension.

Classification of pulpitis

According to the modern classification, the following types of the disease are distinguished:

• spicy;
• chronic;
• exacerbation of a chronic process;
• focal purulent;
• diffuse purulent;
• hypertrophic;
• fibrous;
• gangrenous;
• condition after amputation or extirpation of the pulp.

The reasons

The disease always develops against the background of infection. Most often, infectious agents are introduced into the pulp intradentally, i.e. through the coronal part, partially destroyed by the carious process. However, in some cases, doctors also have to observe the retrograde spread of pathogenic microflora, i.e., its penetration through the apical (apical) opening from nearby foci of chronic infection.

According to WHO statistical studies, pulpitis at least once developed in 20% of the world's population.

Usually, pulpitis is a direct consequence of caries, in which the hard tissues of the destroyed part of the crown are literally “saturated” with pathogenic bacteria.

There is also an iatrogenic form associated with an insufficiently high qualification of the dentist. The doctor can overheat the pulp, preparing the tooth for a crown, bridge, or even a veneer, use poor-quality filling materials, or use an aggressive material without a special insulating gasket.

It is customary to distinguish 3 types of factors provoking the development of this pathology:

1. physical;
2. biological;
3. Chemical.

The physical ones are:

• trauma to the tooth, leading to a violation of the integrity of the pulp chamber;
• excessive heating of the pulp during the processing of its hard tissues without sufficient cooling;
• accidental opening of the pulp chamber during the treatment of medium or deep caries;
• the formation of dense deposits in the pulp (petrificates and denticles) that can irritate nerve endings, compress blood vessels and disrupt microcirculation.
• pronounced pathological abrasion of enamel and dentin.

Chemical Factors

Intoxication of soft tissues in 100% of cases is a direct consequence of insufficiently professional actions of the dentist.

Common medical errors include non-compliance with the exposure of an aggressive hard tissue etching gel, incomplete rinsing of this substance, unjustified use of powerful antiseptics during the treatment of a carious cavity, or direct toxic effects of a composite filling delivered without an insulating gasket.

Biological factors:

• bacterial infection is possible with a complication of caries (including secondary - developing after the installation of a permanent filling);
• microorganisms in the rarest situations are able to penetrate the dentinal tubules (in particular, when taking an orthopedic impression under high pressure);
• penetration of pathogenic microflora is possible through the apical foramen on the background of osteomyelitis of the jaw or during a surgical procedure - curettage of pathological dentogingival pockets in periodontitis.

Pathogenesis

At acute pulpitis the chamber is closed, and the process at an early stage is focal. It initially proceeds as a serous inflammation, but soon a purulent discharge appears. Intense pain syndrome is caused by the accumulation of a significant amount of exudate in the absence of outflow.

chronic process regarded as the outcome of acute inflammation. Most often, dentists have to deal with fibrous form associated with connective tissue hypertrophy.

At gangrenous pulpitis during instrumental research, necrotic dark-colored tissue (putrid masses) is found in the canal. A typical symptom is a putrid odor from the mouth.

Symptoms of pulpitis

The "classic" symptoms of acute focal and diffuse pulpitis are:

Chronic fibrous pulpitis is usually asymptomatic.. In the hypertrophic form, the dentist finds an overgrown polyp in the cavity. With strong pressure, it starts to hurt and bleed, but the rest of the time it does not bother.

In acute purulent form, the following symptoms are noted:

• severe pain;
• high sensitivity of the causative tooth to hot (cold is able to stop the pain syndrome).

note

If a purulent discharge penetrates the gum through the apical opening, a fistulous tract may form. When a pathological discharge exits through it, the patient feels temporary relief.

Treatment of pulpitis

It is believed that serous pulpitis is subject to conservative treatment if the patient's age does not exceed 30 years, and he does not have serious general somatic diseases.. An important condition for the success of the biological method of therapy is high caries resistance, due to which the rapid formation of secondary dentin is possible. In the course of treatment, I apply dressings to the patient, impregnated with solutions and preparations with a high content of calcium. An alternative technique is the removal of the coronal part of the pulp while preserving the root, but now the so-called. "vital amputation" is rarely used (mostly in children).

The main method of treating pathology is the mechanical removal of the entire neurovascular bundle, followed by instrumental and drug treatment of the canal. After these procedures, the cavity is hermetically sealed.

Extirpation can be carried out in one or two visits. In the first case, the patient is given conduction (if necessary, infiltration) anesthesia, after which the pulp is completely removed, the canal is processed, and filling material is introduced into it. When sealing with cements, x-ray control is required– it is important that the pulp chamber is completely obturated, but even a minimal amount of material does not get past the apical foramen (to avoid further periapical inflammation and cyst formation). An excellent modern alternative is the use of gutta-percha pins (they are pre-selected by diameter).

In two visits, treatment is now carried out less and less (mainly with suspicion of the onset of development).

A devitalizing paste is applied to the instrumentally opened area of ​​the pulp (on a single-rooted tooth - for a day, on a multi-rooted tooth - for two days). During the second visit, the vessels and nerves that died under the action of an aggressive chemical are painlessly removed, after which the canal is also processed and sealed.

note

Relatively recently, arsenic paste was used for devitalization, but it was abandoned due to the high probability of developing arsenic periodontitis. Currently, a composition consisting of paraformaldehyde and an anesthetic is applied. Even if for some reason this paste is not removed within a week, there will be no harm. Devitalizing components are closed with a temporary filling of water dentin.

A pulpless tooth often darkens and is relatively weakly fixed in the hole. Therefore, it needs to be reinforced with a metal alloy pin or covered with a crown.

Possible complications of pulpitis

The main complication of pulpitis not treated in a timely manner is periodontitis, often leading to the loss of a tooth unit. Insufficiently professional actions of the dentist lead to similar consequences.

It is important to remember that a “dead” tooth cannot be completely sterilized. Therefore, there is a possibility that sooner or later colonies of microorganisms resistant to antibiotics will appear in it.

Plisov Vladimir, dentist, medical commentator

Pulpitis is a disease of the pulp caused by its inflammation. Due to the presence of a nerve ending in it, this process is accompanied by severe acute pain, which can be either continuous or periodically stopping.
In most cases, acute or chronic pulpitis is formed due to untimely treatment of caries. It is under the influence of this disease that the hard tissues of the tooth are destroyed to such an extent that the infection manages to get to the roots of the tooth, destroying the soft tissues.

• Reasons for the development of pulpitis
• Kinds
• Classification
• Symptoms
• How is pulpitis treated?
• Treatment of pulpitis in children

Reasons for the development of pulpitis

In addition to the fact that pulpitis can become a complication of such a common dental disease as caries, it often develops as a result of improperly performed procedures by a low-skilled dentist. For example, often such complications are manifested due to:

• The use of low-quality filling materials during the treatment of caries;
• Irregularity in the turning of the tooth, necessary for subsequent prosthetics;
• Errors in surgical interventions in the treatment of periodontitis;
• Effects on the patient's body of all kinds of chemicals used by the dentist.

There are a number of other factors that can cause inflammation of the pulp, which include all kinds of physical effects on the teeth. As practice shows, usually the appearance of a disease is the result of a combined effect of microorganisms present in carious cavities, and that is why they need to be disposed of in a timely manner, without postponing a visit to the dentist's office for an indefinite period.

At the same time, pulpitis often appears separately from caries, and the reason for this, as in the previous case, are microorganisms penetrating the neurovascular bundle. In particular, the development of the disease is caused by the growth and development of streptococci, lactobacilli or staphylococci, so the best way to prevent the growth of such microbes is strict adherence to the rules of oral hygiene.

Kinds

Pulpitis, as well as any other diseases, can have a very different form. According to their location, they can be:

• Crown;
• root;
• Total.

In addition, diseases are divided according to the nature of the course, and occur in the following forms:

• Acute;
• chronic;
• Chronic with exacerbations.

The most frequently encountered is acute form of pulpitis. It develops near the carious cavity, and leads to serous inflammation. Subsequently, the disease in the course of development of various chemical and biological processes evolves into purulent focal pulpitis, which develops into diffuse purulent pulpitis. The transition from one stage to another can last for a matter of days, and at each stage, the destruction of the pulp becomes more serious, and the treatment - the most difficult.

Chronic pulpitis differ from acute ones in that they do not appear simultaneously, but periodically, which is associated with the constant ingress of bacteria to the soft tissues of the tooth. Often they appear as a result of the development of an acute form, but they can develop on their own. As for the complications that can develop against the background of the disease, apical periodontitis is one of them. Therefore, at the first symptoms of pulpitis, we recommend that you do not postpone a visit to the dentist, but seek qualified medical help as soon as possible.

Classification

Additionally, pulpitis can also be classified according to morphological features. In such a situation, the classification assumes the following forms:

• Gangrenous pulpitis. The formation of such a variation of the disease begins with an acute form, which led to the death of part of the pulp. The remaining part of it suffers from serous inflammation, accompanied by the formation and increase in the amount of granulation tissue, which has a limiting effect on dead areas.
• Hypertrophic pulpitis accompanied by the appearance of a granulation cavity. This form of the disease is chronic, respectively, inflammatory processes occur over a long time interval. The granulation cavity gradually replaces the dental cavity and the carious cavity communicating with it, as can be judged by the softness of the formation and its slight bleeding.
• Fibrous pulpitis- this is a special form of the disease, which is characterized by the presence in the oral cavity of a significant amount of collagen fibers and plasma cells.

In view of such a variety of forms of the same disease, it is not surprising that its symptoms can manifest themselves in various ways.

Symptoms

As we have already noted, the main sign of the appearance of pulpitis may be the presence of continuous or intermittent pain, which often intensifies at night. in addition, a change in temperature, characteristic of most patients, can also become a symptom of the development of the disease.

At the initial stage of pulpitis, the pain sensations are rather weak, and are rather aching in nature. And the longer the visit to the dentist is postponed, the more advanced the disease becomes, and the more serious the discomfort. After a while, the pains become pulsating and prolonged, making it difficult for a person to lead a normal life.

All of the above is typical for the acute form of pulpitis, while in the case of chronic pain they do not appear constantly, but only at times of exacerbations. Also, a symptom of the chronic and purulent form of pulpitis can become soreness, which manifests itself as a result of even the slightest pressure on the affected tooth.

Symptoms of acute focal and diffuse pulpitis are very severe pains of a spreading nature, transmitted from the affected tooth to the neighboring ones. These sensations do not appear constantly, but with a certain frequency, which becomes more frequent at night. A sick tooth becomes extremely sensitive to any kind of irritants, and even the elimination of these irritating factors does not lead to a decrease in pain.

The course of chronic fibrous pulpitis is characterized by the almost complete absence of any signs, and only periodically manifested unpleasant sensations of a non-symptomatic nature can indicate its presence. In view of this, this form of the disease is most often not diagnosed by the patient on his own, which leads to the development of a hypertrophic chronic form, accompanied by destructive changes that occur in the periodontal tissues.

For the gangrenous form of pulpitis, there are also the nature of the manifestation of severe pain with rather unusual stimuli. For example, a tooth may begin to feel itself under the influence of warm food, and calm down from the cold. In most cases, discomfort does not last long, and quickly disappear on its own, as it appeared.

In any case, the appearance of toothaches, regardless of their form, indicates the development of pulpitis. Therefore, it is worth contacting a dental clinic even if they were episodic.

How is pulpitis treated?

It is immediately worth noting that such a serious disease as pulpitis does not involve treatment at home, which is why it is not possible to eliminate it without the help of a dentist. In fact, today there are two main methods of treating this disease, such as:

• conservative;
• Surgical.

The conservative method is the most gentle, since it involves the treatment of the inflamed pulp, and not its physical removal. In this case, the full viability of the neurovascular bundle is preserved, for which the doctor uses all kinds of antiseptics, antibiotics and other drugs. At the same time, this method has serious limitations associated with the inability to restore the pulp as a result of its serious destruction, which is why the conservative method is most often used for pulpitis resulting from trauma.

The surgical method is used by dentists much more often due to its overall effectiveness. This technology involves the removal of the inflamed pulp, after which the dentist treats the canals of the tooth, which implies their disinfection and filling with a special filling material. The only exception is the pulpitis of the wisdom tooth, which, due to the location of the channels in such a tooth, is usually not treated. The surgical method of treatment has two varieties:

• vital. Differs in the universality allowing to apply treatment at any forms of development of a disease. Pulp removal is performed within one visit to the dentist's office, under general or local anesthesia.
• Devital. This form is more sparing, since it involves the removal by a doctor of an already dead nerve, destroyed under the influence of a special drug embedded in the carious cavity. Such removal of the pulp occurs in several stages, which is associated with the inability to instantly kill the nerve.

It should be noted that it is much easier to cure the initial pulpitis than its more serious stages. In view of this, we strongly recommend that you regularly visit the dentist's office, which will allow you to control the condition of your teeth, preventing the development of this disease itself.

Treatment of pulpitis in children

The occurrence of pulpitis in children today is not uncommon, which is associated with a number of structural features of milk teeth and low immunity of a growing organism. Due to the fact that the neurovascular bundle in such teeth is rather poorly developed, the disease is diagnosed already in the later stages, when only a surgical method of treatment remains possible.

As in the case of adults, the dentist removes the affected pulp, but does this exclusively in the rind part, since milk teeth do not have formed roots. Therefore, after removing the soft tissues of the upper part, the doctor applies a special medicine to the bottom of the cavity, which has disinfectant properties that prevent the spread of infection. As a result, a new, completely healthy tooth grows in place of the healed tooth.

A significant factor is the fact that incorrect or untimely treatment of pulpitis in a child can cause a lot of problems in the future. Therefore, as in the case of adults, it is necessary to visit the dentist's office regularly to diagnose the current state of the oral cavity.

Treatment of pulpitis during pregnancy

Since the pregnancy process is accompanied by serious fluctuations in the hormonal background, during it, expectant mothers often encounter manifestations of pulpitis. And, contrary to popular belief, it is possible to treat the disease without the risk of harming the child even during pregnancy, especially since untreated purulent inflammations will be more harmful than medical intervention.

All medical procedures for the removal of pulpitis in pregnant women should be limited to the minimum use of medications, including painkillers. The main goal facing the dentist is to eliminate inflammation and pain, while the end of treatment is usually done after the birth of the baby.