Very often, patients at the dentist hear the diagnosis: “Pulpitis,” when we are so accustomed to hearing the familiar “caries” for everyone. Therefore, many patients are interested in what is tooth pulpitis and how does it differ from caries? This is a fairly common disease that is a consequence of dental caries. Its treatment is much more difficult, and it is much more painful.
Tooth pulpitis is an inflammatory process in the tooth pulp. The pulp is a neurovascular bundle located in the coronal part and in the root canals. The pulp contains many vessels and nerve endings. Very often, pulpitis develops as a result of complications of caries or a consequence improper treatment dentist (poor quality fillings, tooth grinding, periodontal surgery, exposure to chemicals). Retrograde pulpitis also occurs, which occurs as a result of infection through the apical foramen (photo 1). What chronic pulpitis looks like can be seen below. The photo shows the tooth before and after treatment.
Causes
There are many sources and ways of infection entering the pulp. But most often these are dentinal tubules from a deep cavity damaged by caries.
The main causes of inflammation of the dental pulp include:
- exposure to microbes that are inside the carious lesion (staphylococci, streptococci, lactobacilli), as well as their toxins and their metabolic products (photo 2);
- decay organic matter dentin;
- untreated caries, in which carious tissue remains under the filling;
- trauma, especially if accompanied by a tooth fracture (most often, trauma to the front teeth occurs in childhood);
- rough and careless treatment of a tooth with caries;
- impact chemical substances(toxic effects of filling material, phosphoric acid, irritating antiseptics);
- exposure to heat when preparing a carious tooth ( thermal burn pulp with insufficient water cooling or overdrying);
- rapid movement of teeth during orthodontic treatment;
- operations and others therapeutic effects(gingivectomy, gingivotomy, injection of drugs into periodontal pockets and their penetration into the pulp).
Infection is the primary factor in the development of pulpitis. If the pulp is exposed as a result of injury, inflammation develops in the first hours after the injury.
Dental pulpitis rarely occurs without caries, various microorganisms and their toxins. Sometimes pulpitis is diagnosed in healthy molars, which is most often explained by tooth trauma.
Pathogenesis
Pulpitis of the tooth occurs chronic and acute. For acute form This condition is typical when the infection penetrates into the pulp while the chamber is closed. At first, such pulpitis is a focus of inflammation and is called serous pulpitis. It gradually passes into the stage of purulent pulpitis and is characterized by severe pain due to the accumulation of pus in the closed pulp chamber. Chronic pulpitis is a consequence of acute pulpitis.
Chronic pulpitis is divided into:
- fibrous;
- hypertrophic;
- gangrenous.
Most often, fibrous pulpitis occurs when fibrous tissue grows. Hypertrophic pulpitis is characterized by hypertrophic growth of pulp tissue through the open cavity of a carious tooth. In the case of gangrenous pulpitis, tissue disintegration can be observed in the coronal pulp. Granulation tissue can be found in the root pulp.
Proliferative pulpitis chronic stage begins to develop from chronic fibrous pulpitis with a severely damaged crown, exposed pulp and with constant mechanical stress or infection.
Symptoms
The main symptoms of dental pulpitis include:
- severe continuous or intermittent toothache (most often at night or at changes in temperature);
- the initial stage is characterized by aching and infrequent pain;
- advanced forms are characterized by increasing pain, gradually becoming prolonged and throbbing;
- pain when tapping on the tooth.
Signs of acute pulpitis:
- severe radiating pain along the branches trigeminal nerve;
- increased toothache at night;
- frequency of toothache;
- tooth sensitivity to thermal irritants;
- unlike caries, the pain continues after the irritant is removed;
- lack of sensitivity or low sensitivity when tapping on a tooth.
IN acute stage Pulpitis, when the irritant is eliminated, the pain does not go away for another 15-20 minutes. This is the main difference between pulpitis and dental caries.
Very often, patients have difficulty pointing to a diseased tooth, as the pain spreads to the entire jaw. Acuity pain will increase during the transition from serous to purulent pulpitis. The development of the purulent process will be characterized by the appearance of pulsating, shooting and tearing pain. Gradually, pain-free intervals will shorten until they disappear completely.
The chronic form of pulpitis is characterized by:
- the appearance of pain mainly during exacerbation of the disease;
- pain when tapping on the tooth;
- fibrous pulpitis is often asymptomatic or mildly expressed (photo 3);
- with hypertrophic pulpitis, a hypertrophied polyp can be found in the area of caries;
- X-ray studies confirm that in half of the cases, pulpitis of primary teeth is accompanied by destructive changes in the periodontal tissues;
- chronic gangrenous pulpitis occurs with pain, sensitivity to hot (cold reduces pain).
Chronic pulpitis usually has acute symptoms - with periodic exacerbations. During such a period, the symptoms of chronic pulpitis will correspond to the signs of acute pulpitis. Treatment of chronic pulpitis is much more difficult than acute pulpitis.
Exacerbation of chronic pulpitis
Clinical manifestations are characterized by paroxysmal toothache of various types and the appearance of pain from external irritants spreading to adjacent teeth and tissues. Aching pain is also possible, which intensifies when biting on a tooth. Most often, such teeth already suffered from chronic pulpitis. The tooth cavity is open, and severe pain is observed when probing the pulp.
On x-ray expansion of the periodontal fissure is observed. Or bone loss in the periapical zone may be detected.
Most often, chronic pulpitis develops when the teeth were not treated on time or the root canal treatment was performed incorrectly, when the tooth is leaking (crown, filling) and the canal is obstructed. This form usually develops into another disease - periodontitis.
Diagnosis of pulpitis
Each patient's dental diseases are individual in nature. Diagnosis of pulpitis is complicated by the fact that severe throbbing pain in the tooth, which characterizes pulpitis, may be completely absent in some individuals. That's why correct diagnosis pulpitis should be based on the causes of its occurrence, determining the frequency and intensity of attacks of toothache.
To make the correct diagnosis, dentists use differential diagnosis. It lies in x-ray examination patient and information obtained from visual examination. The analysis also takes into account the patient’s stories about how long he has been bothered by pain and what its nature is (stabbing, pulling or cutting). Differential diagnosis of pulpitis allows the dentist to correctly determine what form of the disease the patient has and choose the right treatment.
Treatment
As a rule, treatment of pulpitis is carried out by removing the nerve and the pulp itself. You can remove the nerve under local anesthesia immediately at the first visit to the doctor, or put arsenic in the tooth, killing the pulp, and remove it at the second visit to the doctor. After removal, the root canals expand, after which the canals are filled.
You can see the treatment plan for pulpitis in the video
https://www.youtube.com/v/kl7wYTob8X4″>
There are 2 ways to treat pulpitis:
- Conservative. The method allows you to preserve the vitality of the pulp. It is mainly used for people young and if pulp diseases are reversible (in case of injury). Treatment is the same as for caries. The main emphasis is on thorough medical treatment of the dental cavity. For these purposes, antiseptics, antibiotics, and proteolytic enzymes are used. Do not use potent drugs, ether or alcohol.
- Surgical. Treatment is carried out by removing the inflamed pulp and filling the dental root canal with filling material (photo 4, 5). Pulp removal is performed in two ways: vital (all forms of pulpitis) using general or local anesthesia and devital (after removal of the nerve).
The choice of material for filling is made by a doctor. Today, the gutta-percha pin is considered the most popular, since it never dissolves. After the filling procedure, the patient is sent for an x-ray in order to determine how well the canals were filled. According to all rules, teeth must be sealed to the top of the canal. The last stage is installation of the seal. The higher the qualifications of the doctor, the more effective the treatment.
Prevention
Basics preventive measure against the development of pulpitis - proper oral care, regular visit dentist and timely treatment of caries.
If pulpitis is not treated, it can develop into periodontitis or necrosis. Therefore, to prevent the development of dental diseases, you should regularly visit the dentist. It is better to do this once every six months, otherwise it will be more difficult to get rid of dental problems later.
Advanced caries, neglect of hygiene oral cavity lead to the development of complications. How does tooth pulpitis develop, what is it, how is treatment carried out, and what are the consequences of ignoring the dentist’s recommendations in this case?
To understand what pulpitis is, you need to understand. This is loose and soft fibrous tissue that lies deeper than the enamel and dentin in the internal cavity of the tooth.
The pulp provides nutrition to the tooth.
The pulp can be called the “heart” of the tooth, since its entire viability depends on its condition. This happens due to the high vascularization and innervation of the pulp, the vessels and nerves of which are connected through the roots of the tooth to the main blood and nerve bundles.
Another vital component of the pulp are special cells - odontoblasts, which act as building material in the formation of the dentinal layer. There are many other components in the pulp, without which its normal functioning would be impossible:
- fibroblasts;
- microphages;
- macrophages;
- lymphocytes;
- mast (immune) cells;
- dendritic cells;
- proteins;
- enzymes.
Important! Pulpa performs four important functions: plastic, protective, trophic (transport) and sensory. Violation of any of these functions is considered a pathology requiring treatment.
Classification of pulpitis and their etiology
Scheme of development of pulpitis.
Pulpitis is an inflamed condition of the pulp tissue, which in all cases is caused by its infection. The only difference may be the route by which the pathogen enters the internal cavity: with the intradental variant, the invasion proceeds through the coronal part of the tooth, with the retrograde one - through its apical foramen (at the apexes of the roots). According to statistics, the main factor of inflammation is the bacterium streptococcus, somewhat less frequently - staphylococci and lactobacilli (anaerobic or microaerophilic).
It is long-term caries, which has destroyed the enamel and dentin underneath, that most often causes tooth pulpitis, but the actual methods of introducing pathogenic bacteria into the pulp sometimes differ. According to the nature of its course, infection of the dental pulp is usually divided into acute and chronic types. The first of them can be focal or diffuse, but it is always described as first a serous and then a purulent process. As for the chronic type, it has three subtypes:
- fibrous;
- hypertrophic;
- gangrenous.
Note! The official dental classification mentions as a separate group the acute condition of chronic pulpitis (fibrous or gangrenous), as well as the condition that occurs after partial or complete pulpectomy (pulp resection).
Now that it has become clear what it is – pulpitis, you can turn your attention to the reasons that cause it. As already said, main factor, which causes the described disease, is an infectious infection, and the main route of penetration of microbes into the pulp cavity is biological.
Complication of caries.
This means that the infection penetrates the pulp due to dental caries, including those of a secondary nature - that is, developing under the installed filling. Much less often, invasion occurs through the apical foramen at the roots of the tooth, which is a typical complication of sepsis or osteomyelitis (a purulent process occurring in the bone).
There is another group of reasons that can cause the disease, which can be characterized as physical and chemical exposure on him. The first includes a negative contact effect directly on the pulp or on the entire tooth, entailing exposure of its cavity:
- opening the pulp chamber during a dental procedure performed in a carious cavity;
- physical overheating of the pulp tissue due to treatment of caries performed without cooling the tooth (or when preparing it for installation of a crown);
- fracture of the tooth, resulting in the opening of the pulp;
- diseases that cause tooth wear due to disturbances in the formation of dentin, which leads to rapid exposure of the pulp chamber (osteoporosis, diabetes etc.);
- denticles (dentinal mineralized formations) and petrificates (focal deposits of calcium salts), which compress the pulp, causing swelling and irritation, alleviating the effects of the factors described above.
Chemical causes of pulp oppression are always the result of improper work by the dentist. Most often, this is the incorrect application of a special etching gel necessary for attaching synthetic materials to the tooth being prepared, or incomplete cleansing of it at the end of the procedure.
The use of strong antiseptic agents when treating a carious cavity can also play a negative role, as well as the toxic effect produced by some filling materials. 
Acute forms of the disease
Acute pulpitis of the diffuse type is characterized by prolonged severe pain, the pauses between which are short. The pain itself especially increases with the onset of night, intensifying due to the supine position of the sleeping person and radiating to the throat, ears or eyes, depending on where the pulpy tooth is located.
During dental examination In a carious cavity, its bottom reacts sharply to the touch of a dental probe, as well as to the thermal effects of low temperatures (air or liquid). Tapping a diseased tooth brings mild discomfort to the patient. The electrical excitability of pulp tissue is noticeably reduced in all zones, which distinguishes diffuse pulpitis from focal pulpitis.
The latter causes the patient somewhat less suffering, because attacks of pain with focal pulpitis alternate with fairly long periods of calm. Unpleasant sensations arise, for the most part, when a diseased tooth is irritated by contact or sharp temperatures, and intensify at night.
The main symptom of acute pulpitis is acute throbbing pain.
The bottom of the carious cavity is very painful during probing, while electrical excitability is increased only in the area of inflammation (when exposed to currents up to 2 μA).
Chronic pulpitis
general characteristics All types of chronic pulpitis include milder symptoms than in the acute course of the disease: the pain is not so distinct, the reaction to irritants is less frequent and lasts less long. Fibrous chronic pulpitis causes a feeling of continuous pressure and heaviness inside the affected tooth, which at the same time reacts to temperature fluctuations and physical contact with it.
Aching pain can intensify due to external irritation, and does not subside for a long time after that. Questioning the patient and diagnostics during a dental examination also reveals the following symptoms:
- sharp painful reaction to hot or cooled liquids (food), cold air;
- increased pain in the evenings and during sleep;
- irradiation of pain from the tooth to the cheek and further towards the ear and temple;
- an unpleasant odor caused by the accumulation of food debris in the carious cavity.
Advanced pulpitis can lead to serious complications.
Additional Information. In some cases, fibrous pulpitis (like other chronic types) can be almost asymptomatic, and is discovered by chance by the dentist during a dental examination.
Hypertrophic pulpitis noticeably less annoying to a sick person, except during meals, when the affected tooth experiences pressure from biting or chewing food. A characteristic feature This type of disease is characterized by bleeding of hypertrophically enlarged pulp tissue, while attacks of pain are more likely to resemble those in acute pulpitis.
Visual diagnosis of a diseased tooth will allow the doctor to notice the overgrown pulp protruding into the carious cavity inside the destroyed dental crown. Inspecting the problem area with a probe practically does not cause discomfort to the sick person.
Gangrenous pulpitis is also considered not too painful during probing or eating, but it causes considerable discomfort when the tooth comes into contact with high (less often low) temperatures. The feeling of pressure inside the tooth, when it intensifies to the point of pain, can last for a long time, and the negative sensations will be noticeably more acute if the infection has penetrated into the pulp through an unopened, thinned layer of dentin (this slows down the outflow of infected exudate).
Do you or your child have a toothache that doesn’t look much different from other teeth? Perhaps these are signs of pulpitis.
What is pulpitis?
Pulpitis – inflammatory disease dental pulp, which is neurovascular bundle tooth (or nerve, as it is also called), as well as connective tissue cells. The pulp is located under the dentin, which in turn is covered with tooth enamel. The pulp is responsible for nourishing the teeth from the inside.
Pulpitis is often a complication of another dental disease - and therefore, the main cause of pulpitis, like caries, is, for example, streptococcus. Thus, prevention of pulpitis implies protecting teeth from infection - proper care of teeth and oral cavity.
According to statistics, up to 20% of patients complaining of toothache, are the owners of pulpitis. Particularly frequent guests of the dentist are children, who usually have pulpitis of the baby tooth.
Now let's briefly look at the mechanism of development of pulpitis, which will be convenient to do using the following image:
As you can see, dear readers that at the beginning of tooth damage, plaque appears on it, which is food debris (which over time begins to rot) and various microflora, most often pathogenic.
If you do not brush your teeth, infectious microorganisms, in the course of their vital activity, produce acid, which, together with decaying food particles, begin to eat tooth enamel, which is the surface or protective layer of the tooth. Damage to tooth enamel is called caries. The more time passes without proper oral care, the faster the pathological processes of tooth destruction occur.
The third stage in the development of pulpitis is when the infection gets under the tooth enamel and the infection affects the dentin. Dentin is the hard and basic part of the tooth; in fact, it is bone. This is the last step of the infection before it reaches the pulp - the soft tissue of the tooth that lies directly under the dentin. Pass in the pulp blood vessels and nerve endings. This is precisely what causes the appearance of severe pain during pulpitis.
The fourth stage is actually pulpitis, in which the infection reaches the pulp, causing its inflammation.
The onset of pulpitis is accompanied by toothache, often pulsating in nature, increased sensitivity of the tooth to temperature changes, as well as a painful reaction of the tooth to cold or hot food/drink. Toothache due to pulpitis can spread both to several adjacent teeth and to the entire jaw, and over time even develop into a headache.
It is also worth noting that the course of pulpitis can be asymptomatic.
But still, you can independently determine the presence of pulpitis by the presence of gray enamel, frequent bleeding, dark holes or overgrown tissue in the hole from caries of a particular tooth, as well as increased sensitivity of the tooth when chewing.
The consequence of pulpitis in many cases is tooth loss, however, if this inflammatory process is not given due attention, it can spread to the jaw tissue, and then to sepsis, which is a rather dangerous complication.
Pulpitis - ICD
ICD-10: K04.0;
ICD-9: 522.0.
Symptoms of pulpitis
Toothache with pulpitis is the main symptom of this disease. By nature, the pain with pulpitis is usually pulsating in nature, often the tooth hurts so much that the patient feels as if half of his head hurts. Increased pain usually occurs at night, as well as when the affected tooth is exposed to cold or hot air or food, temperature changes, or chewing food. When tapped, the tooth is insensitive or insensitive.
Other signs of pulpitis include:
- Gray enamel of the affected tooth;
- Open tooth cavity;
- Bleeding from a tooth;
- Increased irritability.
Nonspecific symptoms include:
Complications of pulpitis
If pulpitis is not treated, it can lead to the following complications;
- Periodontitis;
- Tooth loss;
The cause of inflammation of the dental pulp is always an infection, mainly of nature - lactobacilli. As we have already said, the infection, in the process of its life activity, produces acid, which, together with food debris, destroys the integrity of tooth enamel, after which dentin, and then begins to affect the pulp itself. However, this is the entry of infection into the tooth through the crown, i.e. visible part of the tooth, but there is also another route of infection - through the apical foramen of the tooth, which is the anastomosis of the tooth root, through which blood vessels and nerve endings are connected to the tooth.
Let's consider how the integrity of the dental “chamber” is violated and infection gets into it:
- Violation of the integrity of the tooth due to incorrect actions of the doctor (poor quality filling, grinding of the tooth, surgical intervention in the jaw);
- Sinusitis, which may affect the upper teeth;
- Fracture of the crown or root of a tooth; children especially often break their front teeth;
- Increased tooth wear, which is often facilitated by the presence of diseases such as or;
- Incorrectly selected and installed braces;
Other causes of pulpitis include:
- Failure to comply with personal hygiene rules for oral care;
- Overheating of the pulp during dental treatment;
- Incorrect methods of dental treatment, including caries;
- Toxic effect of filling material on the tooth;
- Use of low-quality materials in dental treatment;
- Presence of infection in the blood.
Classification of pulpitis
The classification of pulpitis distinguishes the following types of this disease:
Acute pulpitis. Characterized by acute course inflammation with severe radiating pain, worse at night or when the tooth comes into contact with hot or cold. The acute form of pulpitis is divided into the following subtypes:
- Serous - is the initial stage of pulp inflammation, without the formation of purulent exudate;
- Focal purulent - is the second stage of pulp inflammation, in which purulent exudate is formed in the dental cavity, and the pain sometimes goes away when the tooth comes into contact with a cold substance;
- Diffuse purulent.
Chronic pulpitis. Usually it is a continuation of the development of acute pulpitis. Characterized by mild pain with frequent exacerbations. Sometimes it occurs with minimal symptoms, but pathological processes continue to destroy the tooth. The chronic form of pulpitis is divided into the following subtypes:
- Fibrous – is the initial stage of chronic pulpitis, which is characterized by the proliferation of connective tissue of the pulp, while the inflammation is almost asymptomatic;
- Hypertrophic (proliferative) – is a continuation of fibrous pulpitis, in which the pulp tissue grows through the carious cavity of the tooth, a fibrous polyp is formed;
- Gangrenous - characterized by the disintegration of pulp tissue.
There is also retrograde pulpitis, which is characterized by infection entering the pulp tissue through the apical foramen of the tooth.
Diagnosis of pulpitis
Diagnosis of pulpitis includes following methods examinations:
- Taking anamnesis;
- Visual examination of teeth;
- Questioning the patient about the nature of the pain, which is necessary for the differential diagnosis of pulpitis;
- teeth.
How to treat pulpitis? Treatment of pulpitis can be carried out by two main methods, which largely depend on the type of inflammation, so it is very important to turn to a doctor who will not only be able to accurately diagnose the disease, but also carry out the necessary therapeutic manipulations.
1. Treatment of serous pulpitis, i.e. without the presence of purulent exudate, usually involves applying a bandage or pad containing an antibacterial or alkaline agent to the pulp. These manipulations help destroy the infection, neutralize the acid produced by the infection (which actually destroys the teeth) and the formation of secondary dentin.
2. One of the popular methods of treating pulpitis of primary teeth is surgical removal pulp tissue (partially).
3. Treatment of purulent and chronic pulpitis is aimed at removing the “nerve”, sanitizing the roots of the tooth and removing the infection, after which filling is done, first of the roots of the tooth, then of the entire tooth.
The treatment of pulpitis by filling a tooth is divided into 2 methods - devital and vital extirpation(amputation).
3.1. Devital extirpation implies complete removal pulp (neurovascular bundle) of the tooth, which usually occurs in 2 visits to the dentist. This is what is being done for local anesthesia, after which the dental cavity is cleaned, into which a devitalizing paste is then placed for a week, usually a mixture of anesthetic and paraformaldehyde (previously arsenic was used for these purposes). After a week, the mixture is removed from the tooth, the tooth is cleaned of dead pulp particles and the tooth is filled.
3.2. Vital pulp amputation (pulpotomy) represents the preservation of the pulp in the area of the roots of the tooth, while its upper part, along with the parts of the tooth affected by infection (caries), is removed. After this, the bleeding stops, the tooth cavity is sanitized antibacterial agents. Afterwards, a temporary filling is placed for approximately 6 months.
After this time, the temporary filling is replaced with a permanent one. The tooth can additionally be fluoridated to further strengthen the tooth enamel. This method has the advantage that the natural structure and nutrition of the tooth is preserved.
If you use the devital method of treating pulpitis, the tooth actually becomes “dead”, because he does not receive the necessary nutrition. Therefore, in the event of repeated tooth infection, the disease will be more difficult to identify, since obvious clinical manifestations there may not be.
Traditional treatment of pulpitis, of course, does not replace the basic doctor’s procedures aimed at eliminating the inflammatory process in the pulp and filling the tooth, but it can help relieve pain and destroy infection, as well as relieve inflammation.
Important! Before use folk remedies consult your doctor.
Baking soda, hydrogen peroxide and lemon. Make a mixture of half a teaspoon, 15-20 drops of hydrogen peroxide and 5 drops. Soak a cotton swab in this product and apply it to the affected area. The product will help relieve pain and disinfect the inflamed pulp.
Propolis. Take some, roll it into a ball and place it in the carious hole of the tooth. Place a cotton swab on top for 20 minutes.
Propolis and calamus root. Mix 1 teaspoon of propolis tincture with 1 tbsp. spoon and 2 tbsp. spoons of warm boiled water. Rinse the affected tooth with this mixture and the pain will soon subside. The course of treatment is 30 days.
Horseradish tincture. Apply a cotton swab dipped in grated horseradish tincture to the affected tooth. This will help relieve pain and eliminate infection.
Onion peel. 3 tbsp. Pour a glass of boiling water over spoons of onion peel. Let the product sit for about 30-40 minutes, after which you can start rinsing your mouth with the prepared infusion.
Prevention of pulpitis
Prevention of pulpitis- This is, first of all, proper oral care and timely treatment of caries. To do this you need:
- If a hole or black plaque appears in a tooth, contact your dentist in a timely manner;
- It is advisable to visit the dentist once every six months for preventive examination teeth;
- Observe ;
- Regularly;
- Do not leave chronic diseases to chance.
Pulpitis of the tooth– an inflammatory process that occurs in the soft tissues of the tooth located inside the crown. In this disease, inflammation affects the blood vessels and nerve endings that are located 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
The tooth is an ossified papilla of the mucous membrane. Normally, a person has 28-32 permanent teeth: 8 incisors, 4 canines, 8 small molars and 8-12 large molars.Anatomically distinguished:
- tooth crown– the part protruding above the gum;
- neck of the tooth– a narrowed area with the thinnest enamel, where the crown meets the root of the tooth;
- tooth root- a part located in the alveolar process of the jaw and covered with gum.
Causes of pulpitis
Pulpitis This is the main cause of toothache. Factors causing pulp inflammation, there are various.
Symptoms of pulpitis
The variety of forms of pulpitis leads to the fact that the complaints of patients with this diagnosis can vary significantly. Pain with pulpitis is caused by increased pressure in the tooth cavity. This occurs due to the release of inflammatory exudate (blood plasma) through the walls of the capillaries. Gradually, excess fluid is pushed through the dentinal tubules, and the pain subsides for 4-5 hours.At acute form of pulpitis the following symptoms occur:
- pain continues for a long time after the irritants are removed
- spontaneous pain that is 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
- the pain is less intense and occurs periodically
- discomfort increases after eating hot or cold food
- mild spontaneous pain occurs
In advanced cases, severe complications of pulpitis: periodontitis, cyst, necrosis of the jaw.
Differential diagnosis of pulpitis
It is necessary to distinguish deep caries from chronic pulpitis, since these diseases require different treatment methods. With pulpitis, the aching pain that occurs after exposure to irritants does not go away for more than 20 minutes. If the tooth is affected by caries, then the unpleasant sensations subside after the irritant is eliminated.
To differentiate pulpitis from exacerbation chronic periodontitis It is enough to knock on the aching tooth. With periodontitis, this action will cause discomfort.
With hypertrophic pulpitis, the pain is mild, but the tooth bleeds heavily when mechanically irritated.
At fibrous pulpitis Under a thin layer of dentin in the carious cavity, the pulp is visible. Touching the probe in this place causes severe sharp pain.
When diagnosing hypertrophic pulpitis it is necessary to distinguish it from the growth of the gingival papilla. In the latter case, the overgrown papilla can be pushed back with a probe, passing it along the outer edge of the carious cavity.
At differential diagnosis pulpitis and inflammation of the trigeminal nerve, it is important to remember that with tooth pathology, pain intensifies at night. With neuralgia, on the contrary, the pain almost completely disappears at night.
Diagnosis of pulpitis
IN modern dentistry used for diagnosing pulpitis traditional methods, and modern developments.
| Diagnostic methods | Description |
| Detailed survey | The doctor collects complaints, finds out the cause, nature and intensity of pain. This greatly helps to make a correct diagnosis. |
| Oral examination | It is carried out using special dental instruments. The doctor pays attention to all teeth and early fillings, and the presence of gum inflammation. |
| Probing | Examination of the cavity of a diseased tooth using a dental probe. This manipulation allows you to accurately determine the degree of development of the disease. During probing, it is possible to establish the condition of the dentin on the bottom and walls of the carious cavity, its depth, as well as appearance pulp. An important step is to establish the connection between the carious cavity and the pulp chamber. |
| Temperature tests | A diagnostic method based on the effects of high and low temperatures on the dental pulp. With its help, it is possible to supplement the information obtained about the condition of the soft part of the tooth. |
| Electroodontodiagnosis | The method is based on the reaction of tooth pulp to electric current. The more pronounced the inflammatory changes, the higher the current strength that causes a reaction in the patient. This procedure helps to determine the depth of damage to the neurovascular bundle and identify the exact location of the inflammatory focus. The deeper it is, the stronger force current, which causes a tingling sensation. if the pulp is completely dead, the patient will only feel a slight push or touch. |
| Radiography | This method is widely used to find out the structural features of the tooth, the degree of development of the disease and the results of treatment that was carried out previously. In the case when a photograph of a molar tooth is necessary lower jaw An extraoral radiographic examination is performed. In order to obtain a picture of the remaining teeth, the intraoral method is used. |
Classification of pulpitis
After the examination, the dentist may place accurate diagnosis. Tooth pulpitis, depending on the stage and characteristics of the disease, has several forms. Acute pulpitis divided into:
- focal pulpitis
- diffuse pulpitis
Symptoms of focal pulpitis: sharp spontaneous pain that lasts from several minutes to half an hour. It may subside for 3-5 hours and sharply intensify at night. Unpleasant sensations in a diseased tooth that occur in response to exposure to irritants do not go away for a long time.
The patient can clearly indicate which tooth hurts. When probing it is noted sharp pain at one point, often in the area of the horn of the tooth pulp. In this case, the tooth cavity remains unopened.
Acute diffuse pulpitis– at this stage the inflammatory process covers the entire pulp. Prolonged attacks of severe pain occur. Periods of decreased discomfort 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. Hot heat makes the pain stronger, but cold may ease it somewhat. This indicates that the inflammation has entered the purulent stage.
Acute diffuse pulpitis can last from 2 to 14 days. Then the process enters the chronic stage.
Chronic pulpitis divided into:
- fibrous pulpitis
- hypertrophic pulpitis
- gangrenous pulpitis
- retrograde pulpitis
When examined by a dentist, a deep carious cavity is discovered. It can connect to the pulp chamber. The pulp of the tooth is sharply painful and bleeds. There is no unpleasant sensation when tapping on a tooth.
Chronic hypertrophic pulpitis– a form of development of the disease in which the carious cavity connects with the tooth cavity. In this case, the pulp grows and forms a process - a polyp, which fills all the free space. The patient experiences pain when chewing, and bleeding from the tooth is often noted. These sensations replace the severe pain that occurs in acute period diseases.
Chronic gangrenous pulpitis– develops against the background of chronic fibrous pulpitis, after a putrefactive infection. It is noted putrid smell from the mouth, prolonged aching pain from irritants, which is especially intensified after eating hot food. 
Often a diseased tooth has a deep and extensive carious cavity, inside of which you can see dirty gray pulp. Her sensitivity is upper layers usually reduced. This is due to the fact that with gangrenous pulpitis, the nerve fibers atrophy.
Chronic retrograde pulpitis – a chronic form, which is characterized by the formation of periodontal pockets. They occupy a significant part of the root. This is where the source of infection is located. Bacteria spread through root canals and cause inflammation of the soft tissues of the tooth. Wherein bone The root is resorbed, which is clearly visible on the x-ray.
Treatment of pulpitis
Each form of dental pulpitis has its own treatment characteristics. All dental procedures for the treatment of acute or chronic pulpitis are preceded by local anesthesia and removal of all tissue affected by caries. And an x-ray is always the final stage treatment of tooth pulpitis. This is necessary to monitor the effectiveness of the treatment.| Method | Description |
| Conservative or biological methods of treating pulpitis: With this method of treatment, the tooth pulp is completely preserved and restored. | |
| Medicinal and anti-inflammatory pastes | “Calcidont”, “Life”, “Dical” have a strong anti-inflammatory effect. They are laid at the bottom of the cavity cleared of caries. |
| Proteolytic enzymes | They have anti-edematous, necrolytic, anti-inflammatory effects, stimulate tissue regeneration. |
| Preparations based on calcium hydroxide | They are applied to the bottom of a cleaned cavity near the pulp and stimulate the formation of dentin, prevent pathogenic microorganisms from entering the dental pulp, and have an anti-inflammatory effect. |
| Physiotherapeutic treatment | Procedures aimed at treating inflammation in the dental pulp (laser treatment, depophoresis, UHF) |
| Installing a temporary filling | The tooth cavity is closed for 2-5 days to observe the reaction of the pulp. |
| Installation of a permanent filling | The doctor chooses which material is best suited for filling the tooth. |
| Surgical or surgical techniques treatment of pulpitis: consist of partial or complete removal of the pulp and filling the root canal and tooth cavity with filling material. | |
| Vital amputation method | Partial pulp removal. The crown part is removed, but the root part remains viable and continues to nourish the tooth. The procedure is performed under conduction anesthesia. Often used to treat pulpitis of primary teeth in children. It is used in people under 40 years of age with acute focal pulpitis and chronic fibrous pulpitis in multi-rooted teeth, where the boundary between the coronal and root pulp is clearly defined. |
| Devital amputation method | Complete pulp removal. Subsequently, the root canal and tooth cavity are filled. This method allows you to cure tooth pulpitis in one visit to the dental office. However, after this the tooth remains without nutrition. In some cases, it is necessary to place a crown. |
| Combined method of treating pulpitis | Combines complete removal of pulp from canals with good patency and mummification of pulp in difficult-to-pass canals. Used for acute diffuse, chronic fibrous and hypertrophic pulpitis. |
In different cases of pulpitis, the price of treatment will vary significantly. The cost of complete treatment of dental pulpitis depends not only on the choice of clinic. Surgical methods for treating pulpitis with subsequent filling will cost from 2000 rubles. The cost of treatment using the biological method is from 4,000 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
Pulpitis– it’s not just tooth pain! If this disease is not treated, there is a risk of complications of pulpitis: acute and chronic periodontitis, pulp necrosis, periapical abscess. The spread of infection through the bloodstream can lead to the development of purulent sinusitis, meningitis, brain abscess and peripharyngeal abscess. It is impossible to cure pulpitis at home! It is possible to get rid of toothache only temporarily. Therefore, it is very important to promptly consult a dentist for qualified medical care.
Prevention of pulpitis
Prevention of pulpitis in primary and molar teeth involves proper oral care. high-quality teeth cleaning and selection of suitable toothpaste and toothbrush. This is one of the most important stages in preventing the disease.
Timely treatment caries is the main measure for the prevention of pulpitis.
It is necessary to visit the dental office at least 2 times a year.
These simple steps will keep your teeth healthy and your smile beautiful.
Why does a tooth hurt after pulpitis?
Don't panic if your tooth hurts after pulpitis. Doctors consider it normal that discomfort lasts from several hours to 2-3 days after visiting the dentist. To alleviate the condition during this period, you can take painkillers (Nise, Ibufen). If the tooth is treated correctly, then after 3 days the pain will gradually disappear.Pulpitis is a disease of the pulp caused by inflammation. Due to the fact that it contains a nerve ending, this process is accompanied by a strong acute pain, which can be either continuous or periodically stopping.
In most cases, acute or chronic pulpitis is formed as a result of 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 incorrectly performed procedures by a low-skilled dentist. For example, such complications often occur due to:
- Use of low-quality filling materials during the treatment of caries;
- Incorrect grinding of the tooth required for subsequent prosthetics;
- Errors during surgical interventions in the treatment of periodontitis;
- The 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 various influences physical nature on the teeth. As practice shows, the appearance of a disease is usually 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, is microorganisms penetrating the neurovascular bundle. In particular, the development of the disease is caused by the growth and development of streptococci, lactobacilli or staphylococci, therefore the best means of preventing the growth of such microbes is strict adherence to the rules of oral hygiene.
Kinds
Pulpitis, as well as any other diseases, can have the most different shape. According to their location, they can be:
- Crowns;
- Root;
- Total.
In addition, diseases are divided according to the nature of their course, and occur in the following forms:
- Acute;
- Chronic;
- Chronic with exacerbations.
The most common is acute form of pulpitis. It develops near the carious cavity and leads to serous inflammation. Subsequently, the disease progresses through 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, pulp destruction becomes more severe and treatment becomes more difficult.
Chronic pulpitis differ from acute ones in that they do not appear simultaneously, but periodically, which is associated with the constant entry of bacteria into soft tissues tooth They often appear as a result of the development of an acute form, but they can also develop on their own. As for complications that can develop against the background of the disease, these include apical periodontitis. Therefore, at the first symptoms of pulpitis, we recommend that you do not delay visiting the dentist, but seek qualified medical help as soon as possible.
Classification
Additionally, pulpitis can also be classified according to morphological characteristics. In such a situation, the classification assumes the following forms:
- Gangrenous pulpitis. The formation of this variation of the disease begins with an acute form, which leads to the death of part of the pulp. The remaining area suffers from serous inflammation, accompanied by the formation and increase in the amount of granulation tissue, which has a limiting effect on the dead areas.
- Hypertrophic pulpitis accompanied by the appearance of a granulation cavity. This form of the disease is chronic, accordingly, inflammatory processes occur over a long period of time. The granulation cavity gradually replaces dental cavity and the carious one communicating with it, which can be judged by the softness of the formation and its slight bleeding.
- Fibrous pulpitis- This special shape a disease characterized by the presence of a significant amount of collagen fibers and plasma cells in the oral cavity.
Given such a variety of forms of the same disease, it is not surprising that its symptoms can manifest themselves in different ways.
Symptoms
As we have already noted, the main sign of the appearance of pulpitis can be the presence of continuous or intermittent pain, which often intensifies at night. In addition, a change in temperature, which is typical for most patients, can also become a symptom of the development of the disease.
On initial stage Pulpitis pain is quite weak and is rather aching in nature. And the longer a visit to the dentist is postponed, the more advanced the disease becomes, and the more serious the discomfort. Over time, the pain becomes throbbing and prolonged, preventing the person from leading a normal lifestyle.
All of the above is characteristic of the acute form of pulpitis, while in the case of chronic pain does not appear constantly, but only during exacerbations. Also, a symptom of a chronic and purulent form of pulpitis can be pain, 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 pain of a spreading nature, transmitted from the affected tooth to neighboring ones. These sensations do not appear constantly, but with a certain frequency, becoming more frequent at night. A diseased tooth becomes extremely sensitive to any kind of irritant, and even the elimination of these irritating factors does not lead to a decrease in pain.
The course of chronic fibrous pulpitis differs practically complete absence any signs, and only periodically occurring unpleasant sensations of a non-symptomatic nature can indicate its presence. Because of this, this form of the disease is most often not diagnosed by the patient independently, which leads to the development of hypertrophic chronic form accompanied by destructive changes, arising in the periodontal tissues.
For gangrenous form Pulpitis also manifests severe pain with rather unusual irritants. For example, a tooth may begin to become aware of itself under the influence of warm food, and calm down from the cold. In most cases, the unpleasant sensations do not last long and quickly disappear on their own, just as they appeared.
In any case, the appearance of toothaches, regardless of their form, indicates the development of pulpitis. Therefore, contact dental clinic worth even if they were episodic in nature.
How is pulpitis treated?
It is immediately worth noting what serious illness There is no treatment for pulpitis 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 treating the inflamed pulp rather than physically removing it. IN in this case the full viability of the neurovascular bundle is maintained, for which the doctor uses all kinds of antiseptics, antibiotics and other drugs. In 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 resorted to for pulpitis formed as a result of trauma.
The surgical method is used by dentists much more often due to its complete effectiveness. This technology involves removing the inflamed pulp, after which the dentist treats the tooth canals, which involves disinfecting them and filling them with a special filling material. The only exception is wisdom tooth pulpitis, which, due to the peculiarities of the location of the canals in such a tooth, is usually not treated. The surgical treatment method has two types:
- Vital. It is distinguished by its versatility, which allows the use of treatment for any form of disease development. Pulp removal is performed during one visit to the dentist's office, under general or local anesthesia.
- Devital. This form is more gentle, since it involves the doctor removing an already dead nerve, destroyed under the influence of a special drug placed in the carious cavity. This pulp removal occurs in several stages, which is due to the impossibility of instantly killing the nerve.
It should be noted that it is much easier to cure 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 monitor the condition of your teeth, preventing the very development of this disease.
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 baby teeth and the low immunity of the growing body. Due to the fact that the neurovascular bundle in such teeth is quite poorly developed, the disease is diagnosed already at late stages, when it remains only possible surgical method treatment.
As in the case of adults, the dentist removes the affected pulp, but does this exclusively in the radicular part, since baby teeth do not have formed roots. Therefore, after removing the soft tissue of the upper part, the doctor applies a special medicine to the bottom of the cavity, which has disinfecting properties that prevent the spread of infection. As a result, a new, completely healthy one grows in place of the healed tooth.
A significant factor is that incorrect or not timely 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 regularly visit the dentist's office to diagnose the current condition of the oral cavity.
Treatment of pulpitis during pregnancy
Since the pregnancy process is accompanied by serious fluctuations hormonal levels, during this process, 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 inflammation will be more harmful than medical intervention.
All healing procedures to remove pulpitis in pregnant women should limit themselves to minimal use medical supplies, including painkillers. The main goal facing the dentist is to eliminate inflammation and pain, while treatment is usually completed after the baby is born.
