Inflamed pulp. Inflammation of the dental pulp: methods of treatment

Pulpitis of the tooth- an inflammatory process that occurs in the soft tissues of the tooth located inside the crown. With this disease, inflammation affects the blood vessels and nerve endings that are in the pulp chamber and in the root canals. This is a fairly common problem, it ranks second among dental diseases and accounts for 15% of all visits to the dentist.

tooth anatomy

Anatomically distinguish:

• tooth crown- the part protruding above the gum;
• the neck of the tooth- a narrowed area with the thinnest enamel, where the crown passes into the root of the tooth;
• tooth root- the part located in the alveolar process of the jaw and covered by the gum.

Causes of pulpitis

Symptoms of pulpitis

At acute form of pulpitis the following symptoms occur:

• pain persists for a long time after removal of irritants
• spontaneous pains that are not a reaction to cold, hot, or sour foods
• increased pain at night
• paroxysmal pain (periods of calm alternate with periods of increased discomfort that last 20-30 minutes)
• pain may radiate along the trigeminal nerve to the ear, jaw, or temple

• pain is less intense and occurs intermittently
• Discomfort worsens after eating hot or cold food
• mild spontaneous pain

In advanced cases, severe complications of pulpitis: periodontitis, cyst, jaw necrosis.

Differential diagnosis of pulpitis

To differentiate pulpitis from an exacerbation of chronic periodontitis, it is enough to knock on a diseased tooth. With periodontitis, this action will cause discomfort.

With hypertrophic pulpitis, the pain is mild, but the tooth bleeds heavily with mechanical irritation.

At fibrous pulpitis pulp is visible under a thin layer of dentin in the carious cavity. Touching the probe in this place causes severe sharp pain.

When diagnosing hypertrophic pulpitis it must be distinguished from the growth of the gingival papilla. In the latter case, the overgrown papilla can be pushed aside with a probe, passing it along the outer edge of the carious cavity.
In the differential diagnosis of pulpitis and inflammation of the trigeminal nerve, it is important to remember that with tooth pathology, the pain intensifies at night. With neuralgia, on the contrary, at night the pain almost completely disappears.

Diagnosis of pulpitis

In modern dentistry, both traditional methods and modern developments are used to diagnose pulpitis.

Classification of pulpitis

Acute pulpitis subdivided into:

• focal pulpitis
• diffuse pulpitis

Symptoms of focal pulpitis: a sharp spontaneous pain that lasts from several minutes to half an hour. It can subside for 3-5 hours and sharply intensify at night. Unpleasant sensations in a diseased tooth that occur in response to exposure to stimuli do not go away for a long time.

The patient can clearly indicate which tooth hurts him. When probing, there is a sharp pain at one point, more often in the region of the horn of the pulp of the tooth. In this case, the cavity of the tooth remains unopened.

Acute diffuse pulpitis- at this stage, the inflammatory process covers the entire pulp. There are prolonged bouts of severe pain. Periods of reduction of unpleasant sensations become short-lived. When the process turns from serous to purulent, the pain intensifies and becomes constant. A person begins to feel pain in the temple, ear and the entire half of the jaw, on which the tooth with pulpitis is located. From hot pain becomes stronger, and from cold it may weaken somewhat. This suggests that the inflammation has passed into the purulent stage.

Acute diffuse pulpitis can last from 2 to 14 days. Then the process goes into a chronic stage.

Chronic pulpitis subdivided into:

• fibrous pulpitis
• hypertrophic pulpitis
• gangrenous pulpitis
• retrograde pulpitis

Chronic hypertrophic pulpitis- a form of the development of the disease, in which the carious cavity is connected to the cavity of the tooth. In this case, the pulp grows and forms a process - a polyp that fills all the free space. The patient has pain during chewing, bleeding from the tooth is often noted. These sensations replace the severe pain that occurs in the acute period of the disease.

Chronic gangrenous pulpitis- develops against the background of chronic fibrous pulpitis, after a putrefactive infection. At the same time, there is a putrid smell from the mouth, prolonged aching pain from irritants, which is especially aggravated after eating hot food.
Often a diseased tooth has a deep and extensive carious cavity, inside which you can see a dirty-gray pulp. Its sensitivity in the upper layers is usually reduced. This is due to the fact that with gangrenous pulpitis, the nerve fibers atrophy.

Chronic retrograde pulpitis - chronic form, which is characterized by the formation of periodontal pockets. They occupy a significant part of the root. That is where the source of the infection is located. Bacteria spread through the root canals and cause inflammation of the soft tissues of the tooth. In this case, the bone tissue of the root resolves, which is clearly visible on the x-ray.

Pulpitis treatment

In various cases of pulpitis, the price of treatment will vary significantly. The cost of complete treatment of tooth pulpitis depends not only on the choice of clinic. Surgical methods of treatment of pulpitis with subsequent filling will cost from 2000 rubles. The cost of treatment with a biological method is from 4000 rubles. The amount will be influenced by many factors: the number of roots in the tooth, the form and stage of the disease, the quality of dental materials.

Complications of pulpitis

Prevention of pulpitis

It is necessary to visit the dental office at least 2 times a year.
These simple measures will keep your teeth healthy and the beauty of your smile.

Why does a tooth hurt after pulpitis?

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 intermittent.
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 during 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 impossibility of restoring 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 performs the treatment of 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 gentle, 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.

Dentists often have to deal with patients who come to an appointment with advanced caries that has turned into pulpitis. Many people delay the visit to the doctor until the last, while the tooth affected by caries continues to deteriorate. They cite lack of time, money, or are simply afraid of treatment. But the disease does not disappear anywhere, and as a result pulpitis develops. Some patients are so irresponsible about their health that even after the development of pulpitis they continue to hesitate to visit the clinic, trying to get rid of the pain in the tooth on their own.

Important! Pulpitis is a serious disease that requires prompt treatment. However, even it is not the limit of the destruction of the diseased tooth. Untreated pulpitis causes the risk of periodontitis, which requires more serious treatment. If measures are not taken in time, tooth extraction may be necessary, which leads to displacement of the dentition and malocclusion. After that, the patient can no longer chew food with sufficient quality, and this is fraught with the development of gastrointestinal diseases.

Attention! Even before the advent of such a branch of medicine as dentistry, people knew that exposure to the deep tissues of the tooth causes terrible pain. This was widely used during the Inquisition. For torture, the inquisitors used a mechanical device similar to a drill. With its help, they crushed and reamed the victim's teeth, getting to sensitive soft tissues. Such an impact caused unbearable pain to a person, causing loss of consciousness. When a person lost consciousness, he was returned to consciousness and continued to be tortured, repeating the execution over and over again. After a few days of such torture, the unfortunate man died from a painful shock.

Pulpitis is a dental disease characterized by inflammation of the nerve bundle (pulp), which is affected by external or internal factors. The pulp is a soft tissue dotted with nerves and blood vessels. That is why it is so sensitive, and its inflammation or mechanical damage causes severe pain.

The dental pulp is loose, fibrous connective tissue that fills the cavity of the tooth. It consists of a cellular part, a ground substance, fibers, vessels, and nerves.

This is due to the fact that the inflamed pulp swells, increases in size and presses on the nerve endings.

Attention! In the acute course of the disease, the pulp is covered from above with carious tissue, and in the case of chronic pulpitis, it is open and visible in the opening of the cavity. The chronic form of the disease is not accompanied by such severe pain as the acute form. Pain sensations are aching in nature, intensifying when a chemical or thermal irritant enters the pulp.

When a person eats, food particles enter the open carious cavity. If they are not removed from there, they clog the hole, begin to decompose and irritate the pulp, causing pain. The most difficult thing is to remove the remains of solid food (pieces of vegetables, nuts or seeds) from the cavity.

How pulpitis develops

The main cause of the disease is neglected caries. The carious cavity expands and deepens, allowing bacteria to freely enter the soft tissues of the tooth. The penetration of infection can be direct and indirect. When the pulp is open, microorganisms have direct access to it. When the pulp is covered, bacteria enter through the dentinal tubules.

This figure shows all the stages of development of pulpitis, which show how, as a result of damage to the outer and middle shells of the tooth, inflammation occurs and the destruction of its nervous system.

Doctors identify two ways for infection to enter the pulp: through the crown of the tooth and through the top of the root. The first method is a complication of deep caries. With the second method of infection, it is customary to talk about retrograde pulpitis. In some infectious diseases of the body, the inflammatory process can affect the maxillofacial region. In this case, infection and inflammation of the pulp can begin. If the foci of inflammation are located near the teeth, there is a risk of developing pulpitis. Such foci are often the maxillary sinuses. For example, if a person develops sinusitis, the infection can spread to a tooth. Patients suffering from sinusitis often go to the doctor with complaints of toothache. When the periodontal pocket becomes infected - the gap between the root of the tooth and the gum - the infection can rush to the apex of the root, causing pulpitis.
Very often, the disease appears due to improper treatment or doctor's mistakes. If the doctor does not follow the technology of preparation and filling of a tooth damaged by caries, this can lead to the development of pulpitis. The most common mistakes doctors make are:

• overheating of tooth tissues during preparation;
• accidental damage to the pulp chamber with the installation of a permanent seal;
• violation of the technique of grinding the tooth under the crown.

As a result of improper treatment, the patient begins to experience pain, and the dentist has to redo his work.

Important! There are different forms of pulpitis, the most rare of which are traumatic and calculus pulpitis. Traumatic pulpitis appears as a result of a fall or impact. The most vulnerable are the front teeth, which are easily injured in this way. Traumatic pulpitis is non-infectious, but its symptoms are completely similar to the usual form of the disease that develops as a result of inflammation of the pulp. Concremental pulpitis develops under the influence of salt deposits (denticles and petrificates) that accumulate on the teeth. These deposits press on the soft tissue and irritate the nerve endings, causing inflammation.

Acute and chronic forms of the disease

Pulpitis, like any disease, has three stages: acute, chronic, and also the stage of exacerbation. As a rule, acute pulpitis appears first, which, if untreated, flows into chronic. The chronic form of the disease is accompanied by periodic exacerbations. Sometimes the disease does not have an acute stage, but a chronic, sluggish form immediately develops. Some patients do not have exacerbations of a chronic disease, and it gradually, imperceptibly for a person, passes into periodontitis. These processes are associated with the individual characteristics of the organism of each person.
The pathogenesis of the disease is directly related to its cause. The main reasons are: infection, trauma, as well as the irritating effect of the material from which the seal is made. However, all inflammatory processes, regardless of their etymology, have many similarities. Thus, pulpitis triggers a number of structural changes in the tooth: the pulp swells, blood circulation is disturbed, the cells no longer receive enough oxygen, the process of removing toxins becomes more difficult, and necrotic areas form in the tooth.

Acute pulpitis is an inflammatory process that affects the pulp chamber, crown and root canals. It is diagnosed after an instrumental examination of the oral cavity, radiography of the tooth, electroodontodiagnostics, and is treated promptly - with the help of amputation of the tooth pulp.

Acute pulpitis is of two types: focal and diffuse. In one and the other case, pain sensations appear both when exposed to a diseased tooth, and without it. The stimulus that provokes the resumption of pain can be any. Usually it is sour, sweet, spicy or cold food. Attacks of pain are interspersed with short periods of calm, the pain intensifies at night.

Attention! In the focal form of the disease, the pain has a specific localization, and the patient clearly knows exactly where it hurts. In the diffuse form, the pain does not have a clear localization, therefore it can radiate to the ear, eye, temple, cheekbone, jaw, head or occipital region. This phenomenon is observed due to irritation of the trigeminal nerve. If this happens, the doctor conducts additional diagnostics to find the location of the pain.

How does pulpitis develop in different groups of teeth?

Every tooth can be subject to pulpitis, but some of them are more vulnerable. At risk are the "sixes" or first molars. They are located in an unprotected area, and their fissures (natural depressions) are deep and closed. "Sixes" are the first permanent teeth that erupt in children as early as the age of six. Therefore, caries often affects them in the first place. Parents often do not pay attention to the appearance of stains on these teeth in a child. As long as the tooth does not hurt, the child does not complain, so it is very easy to miss the initial stage of caries. But if children's teeth are not treated, caries can quickly turn into pulpitis.
If the disease affects the front teeth, then these are usually the central and lateral incisors.

The development of pulpitis begins with the penetration of carious infection into the deep layers of the tooth, there is a color change in the tooth and carious destruction of enamel and dentin. Pain occurs as a result of inflammation of the pulp tissue.

Canine teeth are the most resistant to caries due to their structure. The front lower teeth are less susceptible to caries and, as a result, to pulpitis. A large amount of saliva accumulates in this zone, which serves as a natural protective factor against microorganisms and acids that destroy teeth. It contains minerals (calcium, phosphorus), which are necessary for the restoration of enamel.
However, another trouble awaits the lower teeth: most often it is on these teeth that tartar is deposited. The reason for this is the same saliva containing minerals that easily turn into dental deposits.

Why is pulpitis dangerous?

The disease is dangerous by the development of complications. The main reason for this is the delay in treatment and the use of a large number of painkillers. Attempts to wait out the pain or cure the tooth with painkillers lead to the loss of precious time and trigger the mechanism for the development of complications. The most likely complication is periodontitis - inflammation of the tissues adjacent to the root. Allocate periodontitis in acute and chronic form. Acute periodontitis is characterized by severe throbbing pain, fever, swelling of tissues adjacent to the tooth, and a feeling of fullness. During treatment, the doctor opens the tooth, releasing a large amount of foul-smelling pus.
Another sign of chronic periodontitis is the appearance of fistulas on the gums - channels for the removal of pus. Pus accumulates and periodically comes out through this hole, bringing temporary relief to a person.

Periodontitis is a disease that occurs when the apex of the tooth root becomes inflamed. It develops in the absence of timely treatment of tooth pulpitis or as a result of poor-quality root canal filling.

Chronic periodontitis, in which cysts develop, is very dangerous and difficult to treat. The tissues around the root grow and form granulomas (sacs filled with pus). When a tooth is removed, these cysts are clearly visible. They hang from the roots and are red or bluish in color. Patients who have seen them remember this unpleasant sight for a long time.
The above complications are not yet the most dangerous. Pulpitis and periodontitis lead to tooth loss, but this is far from the worst thing that can happen to a patient. In the absence of adequate treatment, the risk of developing even more formidable diseases increases, which lead not only to tooth loss, but also to serious health problems, and in advanced cases even to death. These include complications such as periostitis, abscess, cellulitis, osteomyelitis and sepsis.
Periostitis is a disease in which the inflammatory process affects the periosteum. Pus penetrates under it and causes inflammation. The patient has a high temperature, general weakness, the gums swell, changing the shape of the face. Experiencing severe suffering, the patient often regrets that he did not go to the doctor in time and did not cure the pulpitis.
Osteomyelitis is a dangerous disease, which is the dissolution of the jaw bone. If osteomyelitis is left untreated for a long time, the jawbone becomes very fragile and may break. Such cases occur when a patient with advanced osteomyelitis finally turns to the dentist. During medical manipulations, a fracture or breaking off of part of the jawbone can occur.
Abscess and phlegmon are purulent inflammations, which are serious complications of pulpitis. An abscess is a local purulent inflammation, and a phlegmon is diffuse. They develop when the infection reaches the vital vessels and nerves and can result in the death of the patient.
Sepsis is the infection of the blood with poisonous decay products of infected tissues. Infected blood spreads throughout the body. The result could be death.
From all of the above, it can be seen what serious problems can be caused by a seemingly harmless caries that has turned into pulpitis. To protect yourself from these serious diseases, it is necessary to treat caries and pulpitis in a timely manner, without waiting for the development of complications. The sooner treatment is started, the fewer problems can be avoided.

How to recognize pulpitis by symptoms?

In order to avoid serious health problems, it is important to recognize pulpitis in a timely manner and consult a doctor. The disease has pronounced symptoms that allow you to easily diagnose it yourself.
The main sign of pulpitis, which distinguishes it from caries, is acute spontaneous pain.

Acute pulpitis is pain that is provoked by various stimuli (sour, sweet, spicy or cold food). Attacks of pain either subside, then resume again, and in the evening the pain intensifies many times over.

With caries, pain occurs only upon contact with an irritant. Symptoms of acute periodontitis are unbearable pain that does not even allow touching the tooth, fever and poor health of the patient.
Chronic pulpitis is more difficult to diagnose. If the carious cavity is open and soft tissue is visible in it, this indicates hypertrophic pulpitis. And if food, getting into the cavity, causes prolonged aching pain, we can talk about gangrenous or fibrous pulpitis.

Important! The symptoms of chronic periodontitis are similar to the symptoms of chronic pulpitis, only with periodontitis, fistulas form on the gums, the gum itself swells, and pus periodically oozes from under it.

Methods of treatment and preventive measures

After the diagnosis is made, the dentist decides how the treatment will be carried out. Pulpitis can be treated in three ways: save the nerve, partially remove it, and carry out a complete removal of the pulp. Of these three methods, doctors most often use the latter. Preservation of the pulp is often accompanied by complications, and partial removal is used when, due to the complex structure of the dental canal, it is impossible to treat it completely.
High-quality treatment involves careful processing of root canals and their sealing. During the treatment, the doctor treats the canals with special needle-like instruments (files), then rinses them with a disinfectant, and then seals them. For filling, special hardening materials are used. The treatment is carried out under local anesthesia.
In most cases, pulpitis cannot be cured in one visit to the doctor. The patient may need to visit the dentist 2-4 times. This happens when the doctor places a temporary filling containing arsenic, an antiseptic or a drug in the root canal. The patient wears such a filling for several days.
If the treatment is carried out correctly, the patient should not have any pain. Sometimes there are post-filling pains that appear when chewing or pressing on the tooth, but they disappear within a few days.
The main way to prevent pulpitis is the timely treatment of caries. And it is best to observe oral hygiene in order to protect yourself from caries. Key measures to prevent dental problems:

• brushing your teeth in the morning and evening, as well as every time after eating;
• cleansing the interdental spaces with dental floss (floss);
• restriction of sweet foods;
• passing preventive examination at the dentist twice a year;
• removal of tartar;
• remineralization and fluoridation of tooth enamel.

© ALDECAstudio / Fotolia

What is pulp

The pulp consists of connective tissue, which is rich in blood vessels and nerves, its coronal part is a rather loose structure and follows the contours of the tooth with peculiar processes in the region of its tubercles.

The structure of the root part is more dense. The pulp acts as a powerful protective barrier against all kinds of bacterial infections, but this function weakens under various negative influences.

Causes of pulpitis

Approximately 20% of patients in dental clinics are diagnosed with inflammation of the pulp - pulpitis. This disease occurs mainly as a result of bacterial infection, usually by coccal microorganisms (staphylococci, streptococci, etc.). Infection comes from the carious cavity.

Pulpitis can occur with various mechanical influences, as a result of toxic poisoning due to poor quality filling material, when a dental crown is broken off, as well as in the treatment of deep caries ( with the destruction of the carious bottom).

Inflammation can be caused by periodontitis. In this case, the infection of the tooth root occurs with pathogenic microflora contained in periodontal pockets.

As a result of unprofessional actions of a dentist when treating a carious cavity (insufficient water cooling, too high drilling speed), a thermal burn of the pulp may occur; excessive drying of the contact surface with the filling material can lead to an aseptic (non-bacterial) form of the disease.

With incomplete removal of the affected tissues, caries destroys the tooth under the filling, which over time also leads to the described disease.

© Aleksei Lazukov / Fotolia

Forms and symptoms of pulpitis

There are two main forms of the disease, which have similar symptoms (signs) with varying degrees of severity.

Acute pulpitis

The patient suddenly has acute pain attacks. Basically they do not depend on external irritating factors and most often occur at night.

Individuals may have seizures provoked by temperature fluctuations(usually from cold, but sometimes from hot food). Moreover, acute pain disappears approximately 15 minutes after the cessation of the irritating effect.

Often the pain that occurs is not localized in the region of the diseased tooth, but spreads to the entire jaw, which makes it difficult to diagnose.

If left untreated, the serous form can turn into a purulent stage. The pains intensify and acquire a “shooting” character, the intervals of rest decrease (sometimes to zero).

The severity of the disease depends on the type of microorganism that caused inflammation, as well as on the strength of the immune response, which decreases with age.

Chronic pulpitis

As a rule, it develops after the completion of the acute stage, but it can also occur on its own. Depending on the severity, the following forms are distinguished:

• fibrous(simple). Pain appears only under the influence of mechanical or chemical stimuli, as well as with sudden temperature changes;
• polyferative(hypertrophic). The cavity of the tooth is open and bleeding, when food gets there, pain occurs;
• gangrenous chronic.

© Zsolt Bota Finna / Fotolia

A person feels fullness in the tooth, sometimes there is pain when eating hot food. On the right is a photo that clearly shows what chronic tooth pulpitis is.

Under the influence of adverse factors, an exacerbation of the disease can occur. In this case, the pain intensifies and is often spontaneous.

Treatment

A neglected disease leads not only to a complete defeat of the pulp, but also to the occurrence of inflammation in the surrounding tissues (periosteum, periodontal tissues and gums). Therefore, it is important to seek medical help as soon as possible.

Conservative treatment

A conservative (biological) method is indicated for young people (under 30 years old) who do not have other diseases, if no more than two days have passed since the onset of pain. With this treatment, the pulp retains its viability.

Dentist:

• performs anesthesia;
• opens the cavity of the tooth;
• removes inflamed tissue;
• lays a special healing ointment;
• puts a permanent or temporary filling.

In the second case, the final filling is carried out in a few days (subject to positive dynamics).

Surgical treatment

© Sandor Kacso / Fotolia

There are two methods of surgical treatment. In the first, amputation, the coronal part of the pulp is removed. Indications for use: chronic fibrous or acute serous pulpitis. With the extirpation method, the entire pulp of the tooth is removed. Indications: all types of diseases, especially advanced forms (purulent, gangrenous).

Amputation method

The dentist performs the following actions:

• conducts anesthesia;
• opens the cavity of the tooth;
• removes the coronal part of the pulp;
• flushes the treated cavity with special solutions;
• lays a healing ointment;
• puts a filling.

Extirpation method

When implementing this method of treatment, two options are possible: the use of anesthesia ( vital extirpation) and necrotization of the dental pulp with special means ( devital extirpation). Basically, vital extirpation is used, since the treatment is carried out in one session.

In both cases, the dentist:

• completely removes the pulp;
• treats root canals and rinses them with special solutions;
• carries out sealing of channels;
• final filling of the tooth.

wisdom tooth pulpitis

Wisdom teeth are more susceptible to this disease. The factors causing inflammation, symptoms and treatments do not differ from those described above. In most cases, wisdom teeth are located incorrectly, and access to them is extremely difficult. Therefore, dentists usually suggest these teeth are not treated, but removed.

Pulpitis of milk teeth. Its symptoms and treatment

© Wavebreakmedia Micro / Fotolia

Pulpitis in children is diagnosed more often than in adults. This is due to the fact that the pulp and surrounding tissues have not fully formed. In addition, children's immunity is imperfect and cannot fully fulfill its function of protecting the body from infections.

Inflammation that is not cured in time is fraught with very serious problems: the tissues of the oral cavity surrounding the tooth are involved in the pathological process.

In most cases, pulpitis in children is asymptomatic. Parents need to pay more attention to this problem, visit the pediatric dentist regularly(Prophylactic examinations should be carried out every six months).

Just like in adults, the main cause of the disease is caries that has not been cured in a timely manner. Inflammation can occur from mechanical injuries, improper treatment (thermal overheating during the treatment of a carious cavity), toxic effects (installation of poor-quality fillings), and a cold infection.

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Here: - an effective recipe for the treatment of flux at home with aloe is offered.

Here is a general description of the main forms of pulpitis of milk teeth:

hypertrophic

In this form (which is very rare), the tooth is completely destroyed, the pulp grows and bleeds when probing. When eating, the child may feel slight pain.

Gangrenous

The pain is almost not felt (even when opening the cavity). The tooth darkens. Lymph nodes usually increase in size.

Chronic

This form is characterized by constant aching pains, which are aggravated by the presence of irritating factors. There may be swelling of soft tissues, lymph nodes increase. With exacerbations, the symptoms intensify. The child feels a general malaise, body temperature may rise.

Treatment is carried out by the same methods as in adults: with a conservative (biological) method, the viability of the pulp is preserved, with a surgical one, either complete or partial depulpation is performed (extirpation or amputation method).

What are the features of pulpitis of milk teeth - we learn from the following video:

Treatment with folk remedies

The ideal case is to visit a dentist on the first day after the onset of symptoms of the disease. For temporary pain relief (up to three days), alternative methods can be used.

It makes no sense in this article to duplicate a huge number of recipes for healing potions: if you wish, you can easily find them on the Internet. The main thing is to remember: this disease can not be cured by folk remedies.

To relieve toothache, various products of plant or animal origin are used: sage, calendula, willow bark, ginger, bay leaf, mint, eucalyptus, pine resin, beets, garlic, lard, propolis ... Well, the most favorite method among the people is - mouthwash with baking soda.

Price of tooth pulpitis treatment

© Dmitry Guzhanin / Fotolia

It is impossible to give an unambiguous answer to the question - how much does it cost to cure tooth pulpitis. The price of medical services depends on many factors: the pricing policy of the clinic, the cost of filling materials, the structure of the tooth.

For example, the treatment of pulpitis of a three-channel tooth (without including the price of the filling itself) can result in an amount of 3 to 4 thousand rubles, a "simple" tooth - about 500 rubles. Installing a seal can cost from 500 to 1-2 thousand rubles.

Any citizen of the Russian Federation with a medical insurance policy has the right to apply to a state dental clinic for free medical care.

Conclusion. Once again about the need for timely treatment

A neglected disease can lead not only to tooth loss. Inflammatory processes can affect the surrounding tissues of the oral cavity with very unpleasant consequences for a person. A properly treated tooth can last for many decades without causing discomfort.

It is necessary to mention the financial side of the matter. In case of loss of a tooth, it is necessary to install its prosthesis, the cost of which can be tens of thousands of rubles. So the choice is yours.

As a summary, let's watch the video and find out, this time visually, how the pulpitis of the tooth is treated:

If you find an error, please highlight a piece of text and click Ctrl+Enter.

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 important 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.