Pulpitis: symptoms, treatment, prevention
Pulpitis is an inflammation of the neurovascular bundle( pulp) of the tooth.As a rule, pulpitis is a complication of caries and develops as a result of infection of soft tissues.
Classic symptoms of pulpitis are intense pain of a pulsating nature, as well as an increased temperature sensitivity of the tooth.Sometimes there is an asymptomatic course of the disease.The course of pulpitis can be both acute and chronic.
If timely treatment of pulpitis is not carried out, serious complications are not ruled out.Often develops periodontitis, which in some cases leads to the need for extraction( removal) of the tooth.Inflammatory process can pass to surrounding tissues, thus development of abscesses, phlegmon or odontogenic mediastinitis - lesions of the mediastinum is not excluded.The most formidable complication of pulpitis is sepsis( blood poisoning), which is a life threatening condition.
Note: forced surgical extraction of the tooth with a diagnosed periodontitis can cause malocclusion and displacement of adjacent teeth.As a result, the patient begins to chew the food worse, which leads to the development of diseases of the gastrointestinal tract.Thus, some pathologies of the digestive system with a little stretch can be regarded as remote complications of pulpitis.
Why does pulpitis develop?
Inflammation in pulpitis in most cases develops as a result of infection in the pulp chamber.Bacteria can get into it in two ways - interdental( through the crown part with complicated deep caries) and retrograde( from the surrounding tissue root through the apical hole).In rare cases, the pathogenic microflora is introduced through the dentinal tubules.
In diseases that are of an infectious nature, it is possible to penetrate bacteria by a hematogenous route, i.e. with blood flow.
Iatrogenic pulpitis is a consequence of a medical error when grinding the crown with an orthopedic dentist or preparing a carious cavity.Overheating of the tooth causes a burn of the pulp, which leads to its inflammation and necrotic changes.Negative effects can also be caused by dentine drying, vibration, excessive pressure when applying the filling weight.
Important: The inflammatory response of the pulp is often reversible if it develops in the absence of significant damage to the background of drying the dentin and aspiration of odontoblasts into the dentinal tubules.
The violation of the technology of antiseptic processing, etching enamel and dentin, as well as the placement of a seal from a material containing aggressive components, without padding lead to chemical damage to soft tissues.
Note: unplanned perforation of the boron chamber during the preparation of the tooth for sealing also causes pulpitis.
Other aetiological factors include:
- abnormal abrasion of hard tissues with a violation of the formation of compensatory dentin;
- tooth trauma( fracture of the crown with dissection of the pulp chamber);
- infringement of microcirculation( at formation of petrificates and dentyle).
Classification of pulpitis
Forms of acute pulpitis:
- purulent focal;
- purulent diffuse( diffuse).
Forms of chronic pulpitis:
- is hypertrophic( proliferative);
According to the classification adopted in our country( MMSI), the condition after amputation or extirpation of pulp and exacerbation of each of the chronic forms of pulpitis is separately considered.
In the international classification, degeneration of the neurovascular bundle is also distinguished in the formation of concrements - petrificata and dentyle.These deposits consist mainly of calcium salts.Conjunctogenic pulpitis is rare.
Pathogenesis of pulpitis
Regardless of the etiology of the disease, the same structural changes occur in soft tissues - edema, microcirculation disturbance, local hypoxia and necrotic changes.
The acute form develops when infectious agents enter the pulp with the chamber closed( through its wall, thinned with a carious process).At the initial stage, the inflammation is serous, focal.If treatment is not carried out, the rapid progression of the pathological process with the appearance of a purulent discharge is almost inevitable.In the absence of outflow, it presses on the pulp, which causes the emergence of intense pain.
Chronic pulpitis is a variant of the outcome of an acute process.Most often, dentists have to deal with fibrous pulpitis.In the hypertrophic form, the pulp proliferation takes place in the carious cavity.
If gangrenous pulpitis develops, the coronal part of soft tissues undergoes necrosis, and granules form in the channels.
Some kind of triggers for exacerbation of chronic pulpitis can be stresses, common diseases( acute respiratory viral infection, influenza), as well as physical and psychoemotional stresses, leading to a decrease in overall immunity.
Symptoms of pulpitis
The leading clinical sign of an acute focal or diffuse process is very intense pain, which has the property to intensify in the evening and at night.The diffuse form is characterized by the spread of pain along the branches of the trigeminal nerve with irradiation into the temporal region, the cheekbone, the orbit or the occiput.Often the patient can not even say exactly which tooth it hurts, and the dentist has to resort to additional methods of instrumental diagnostics.With focal pulpitis, the identification of the causative tooth does not present any difficulties.
Note: most often pathology develops in the first molars( "sixes"), which are characterized by the presence of deep fissures( beards).Of the frontal group, the incisors predominate.Lower front teeth are less prone to pulpitis, because in connection with a good saliva washing, natural remineralization interferes with the development of the carious process.
Periodic pain, i.e., they sometimes spontaneously subside.They increase with the consumption of cold food or drinks.In acute purulent pulpitis, the tooth reacts to hot, and cold, on the contrary, can ease pain.
Important: with deep caries, the pain quickly disappears after removal of the temperature stimulus, and when pulpitis persists.Vertical and horizontal percussion is usually negative or weakly positive, i.e., the tooth practically does not respond to tapping( this diagnostic sign allows you to differentiate pulpitis and periodontitis).
For chronic fibrotic pulpitis, symptoms may be absent;Slight unpleasant sensations in the aching tooth are possible.
A characteristic feature of the hypertrophic form is the presence in the carious cavity of proliferation of soft tissues( the so-called fibrous polyp).
Clinical exacerbation of the chronic process has a significant similarity with the symptoms of acute pulpitis.In this case, differential diagnosis should take into account the history of the disease.
Important: , the symptoms of pulpitis of noninfectious genesis practically do not differ from the "classical" clinical manifestations of the disease.
Treatment of pulpitis
In acute serous pulpitis, conservative treatment is possible, suggesting the setting of calcium-containing medical pads during sealing and the use of bandages with antibiotics.With successful application of the biological method, a secondary dentin is formed.The technique is indicated for patients under 30 with a high level of resistance to caries, good immunity and the absence of serious chronic pathologies.
Currently, there are techniques for treating pulpitis without complete removal of the neurovascular bundle.Dentists in some cases resort to a vital amputation, which implies the extraction of pulp from the crown part only.Nerves and vessels in the channels are preserved.The method is justified if the tip of the tooth has not fully formed after its eruption.
Note: unfortunately, it is relatively rare to "grab" pulpitis at an early stage of development.This is due to the fact that most people prefer to endure the pain and drown it with analgesics for several days.Many people turn to the doctor only when the pain becomes unbearable, and the dentist has to deal with a purulent inflammation.
Treatment of acute purulent pulpitis and chronic forms of the disease includes:
- complete removal( extirpation) of inflamed soft tissues,
- mechanical extension of channels,
- their antiseptic treatment and sealing.
With devital extirpation( complete removal of the pulp after its killing) treatment is carried out in two visits.At the first stage, under local anesthesia, the doctor opens the pulp chamber and applies a special preparation that causes the death of the pulp.
More recently, an arsenous paste was used as the devitalizing composition, which was left under a temporary seal of artificial dentin for 24 hours in single-root teeth and 48 - in multi-rooted teeth.If the patient for some reason did not have the opportunity to visit the dentist on the appointed day, the bandage and the cotton ball with arsenic were recommended to be removed by yourself.Now this compound was practically abandoned due to high toxicity( there were often cases of development of toxic periodontitis).The replacement of "arsenic" was the paste, which includes an anesthetic and paraformaldehyde.It can be left for a week without the risk of complications.
Removal of pulp, channel sealing, as well as filling is performed during the second visit of the patient.
Vital extirpation( removal of the crown and root part of the altered pulp under anesthesia) allows one treatment to be performed.The patient is given a local( conductor + infiltration) anesthesia, after which the inflamed tissue is completely removed, the canals are treated and a permanent seal is put.
If there is a spread of the inflammatory process to the periodontium, the filling of the canal is postponed.It is made with a medicinal preparation with antiseptic and anti-inflammatory properties.Sealing of the canal is allowed only after complete relief of inflammation of the surrounding tooth tissue.
Important: , a possible complication of untreated pulpitis may be periostitis, popularly known as "flux".After long pains, the pulp perishes, and pus in the absence of outflow through the crown part leaves through the apical foramen and inflates the gum.Often the fistula is formed.
During the treatment, you must make at least two radiographic shots.The first one allows you to set the length, width and direction of the channels before starting work.Repeated radiography is performed after the canal is sealed( but before a permanent seal is inserted!) In order to evaluate the quality of the work.
Note: was previously sealed with predominantly phosphate cement with semi-liquid consistency.A fairly frequent complication was the removal of the filling material from the apical opening.Subsequently, around the excess cement, the top of the root formed granulomas and cysts.Currently, dentists prefer gutta-percha pins.
The tooth deprived of its own vessels and nerves has the property of changing color( darken).It is recommended to cover the depulled dental units with crowns.
Prevention of pulpitis
In the prevention of pulpitis, hygiene of the oral cavity and the timely treatment of carious lesions are of paramount importance.
Prophylaxis involves cleaning the surfaces of teeth after eating.It is recommended to remove food residues from the interdental spaces by means of dental floss( floss).
If you have pain in the tooth, you should never postpone the visit to the dentist in order to avoid the development of serious complications!
Every 6 months as a preventive measure for dental caries and pulpitis, you should visit the dentist and conduct professional cleaning of the dentition from the plaque and mineralized deposits( stones) in the room, followed by remineralization therapy and enamel coating with fluoride varnish.
Plisov Vladimir, dentist