Modern dentistry offers fast, high quality and painless dental treatment. However, people who already have a badly damaged tooth and unbearable pain often come to a dentist’s appointment. Such patients can hear from the doctor an unpleasant diagnosis - pulpitis.
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Pulpitis: what is it?
Pulp is a nerve and vascular bundle of a tooth. When microorganisms (streptococci, staphylococci, lactobacilli) and their toxins penetrate into it, an inflammatory process occurs called pulpitis.
Pulpitis often occurs as complication of caries. It should be remembered that in itself caries does not pass and, if not treated, this complication occurs. About thirty percent of patients turn to the dentist with pulpitis, which is much more difficult to treat.
Causes of disease
The five main causes of pulpitis:
- Unhealed caries.
- Gum disease
- Damage to the tooth during turning.
- Inappropriate treatment.
- Injuries.
Unhealed caries.
Running caries is the main cause of pulp inflammation. In the cavity of a tooth damaged by caries, favorable conditions are created for the pathogenic microflora. Over time, microbes and their toxins enter the pulp, which causes the development of dental pulpitis (photos can be seen in the article). The likelihood of developing the disease depends on the depth of the cavity.
Gum disease.
This is one of the most common causes of pulpitis. In case of gum diseases, the root of the tooth is exposed and the bone tissue is destroyed. Through periodontal pockets, pathogenic bacteria enter the pulp and cause inflammation.
Damage to the tooth during turning.
When turning a “live” tooth under the crown due to poor cooling, the doctor’s haste or inaccuracy, a burn of the pulp can occur. As a result, the tooth is damaged and some time after the installation of crowns, inflammation appears.
Inappropriate treatment.
Incorrect actions of the dentist in the treatment of a tooth are a common cause of pulpitis.
Even treatment of caries was held in a timely manner, it is not an absolute guarantee of protection against the inflammatory process under the seal. Especially if the doctor acted incorrectly. For example, a dentist may accidentally leave a piece of carious tissue under the filling.
Injuries.
Inflammation of the pulp can occur with trauma to the tooth or jaw. As part of the tooth breaks off, and the pulp becomes bare, the infection penetrates inside. And, if the injury is not eliminated in time, after some time pulpitis may develop.
Symptoms of pulpitis
Pulpitis is divided according to the duration of the disease. They are acute and chronic.
Signs of acute pulpitis
- Strong pain, which spreads over the entire half of the head, on which there is a bad tooth. The pain, having a throbbing and tearing character, can periodically subside and recur. In the evening and at night it increases.
- Bad tooth sensitive to many irritants. And, even after the removal of the stimulus, the pain does not disappear, but, on the contrary, increases.
- The pain intensifies and increases under the action of the hot, and from the cold the attack may subside.
- With advanced forms of the disease, the intervals between attacks of pain are reduced and become longer.
Classification of acute pulpitis
- Focal. This is the initial stage of the disease. At this stage, the inflammatory process is localized in the upper part of the tooth. Pain is felt only in one tooth, appears under the influence of irritants and lasts from ten to twenty minutes.
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Purulent inflammation of the pulp results from the lack of treatment for diffuse pulpitis. The patient is worried about the incessant pain, which is aggravated by thermal effects. Body temperature rises. - Diffuse . In the absence of qualified assistance at the initial stage of the disease, after a few days, the second stage of pulpitis develops. The inflammatory process moves to the root area. Pain arises spontaneously and lasts for several hours. At night, they intensify. The pain may be in the back of the head, ear or temple. This stage lasts from two days to two weeks.
In addition to the above forms of pulpitis, in separate groups endure diseases of these types:
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Traumatic. This form of the disease is non-infectious. Its development was provoked by a traumatic, toxic or drug effect on the tooth. Symptoms of the disease, as in the acute form of pulp inflammation. - Retrograde. Severe symptoms has not. There is no pain, and external signs. Diagnosed only by radiographs. When running form disease symptoms retrograde pulpitis is similar to the symptoms of acute purulent inflammation of the pulp.
- Three channel. In this form of the disease, the inflammatory process takes place in the tooth, which has three channels (in the teeth of the chewing group).
Symptoms of chronic pulpitis
This form of the disease arises after an unsuccessful treatment of caries or, if the acute form was not treated, and the patient suffered pain. Chronic pulpitis is divided into subtypes:
- Fibrous.
- Hypertrophic.
- Gangrenous.
With fibrous pulpitis reduced severity of symptoms. Sometimes patients complain of weak pain from solid or hot food.
With hypertrophic in the form of the disease, the dental cavity replaces the granulation, which also fills the carious cavity. Patients may complain of bad breath, pain when touching the tooth and bleeding. On the radiograph there are no significant changes in the bone tissue of the apex of the root.
With gangrenous pulpitis the tooth has a sharp, putrid odor from the mouth, the pulp is covered with yellow-gray bloom, the tooth is destroyed.
During exacerbation, chronic pulpitis has the same symptoms as acute. In any form of the disease, the body temperature does not rise and the general condition of the body is not disturbed.
Symptoms of pulpitis may be similar to the symptoms of other dental diseases. For example, on neuralgia trigeminal nerve or periodontitis. Therefore, self-diagnosis and self-treatment are unacceptable. On your own, you can only take a pain pill and go to the dentist, who will prescribe an adequate treatment.
Pulpitis can be recognized by external signs:
- The tooth is mobile.
- The enamel is gray.
- The gums are red and bleeding.
- In the area of the diseased tooth - edema.
- Formed fistulous passage.
On the X-ray picture, the inflammatory process of the pulp is not visible, since it does not cause changes in the solid tissues. An indirect sign of pulpitis in the picture is a deep carious cavity, communicating with the tooth. The diagnosis is made on the basis of clinical data, the results of pulp sensing and determination of electrical excitability.
Complications of pulpitis
Lack of proper treatment can lead to periodontitisin which the infection leaves the borders of the tooth and damages deeper gum tissue. The consequence of periodontitis is bone destruction. If its chronic form is formed, then cysts, granulomas, and other various diseases that are difficult to treat can occur.The tooth will have to be removed, otherwise there is a possibility of the infection spreading with the blood flow throughout the body.
Sometimes a complication may occur after the treatment of pulpitis of the teeth.
- The channel is not fully sealed.
- Material for sealing was taken out of the border of the root.
- The doctor did not notice or cure the channel.
- The walls were perforated.
- During treatment, there was insufficient antiseptic.
Treatment methods
- Biological. With this method of treatment, the nerve is not removed, the tooth remains alive. The inflammatory process is treated with anti-inflammatory, calcium-containing and anti-allergic drugs. Physiotherapy is performed. Carious cavity closed seal.
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Devitalny. With this method, tools are used that kill the nerve (for example, arsenic). In the place of damage, such agents are found several days before the complete killing of the pulp. - Vital. The pulp and all damaged tissues are removed under the action of anesthesia. The channel is processed, the cavity walls are cleaned, and antiseptic washing is carried out.
- Surgical. With this method of treatment, the pulp is removed completely, the canals are sealed. This option includes several stages and is used for different forms of pulpitis.
Mild forms of the disease are treated with modern methods (for example, laser). In chronic form of pulpitis, antibiotics should be used.
With the timely treatment of pulpitis the nerve is preservednecessary to ensure the functioning of the tooth and normal nutrition. Therefore, when the first symptoms characteristic of the disease, you should immediately consult a doctor. And since pulpitis is primarily a complication of caries, from time to time you should go for prophylactic examinations to the dentist.
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