Mar 06, 2018
Pulpitis is classified into acute( including focal and diffuse), chronic( fibrotic, hypertrophic and gangrenous) and chronic in the stage of exacerbation.
As for the symptomatology, the leading sign of any of these types of pulpitis is pain. In acute pulpitis, it occurs spontaneously and has the nature of seizures. If the measures are not taken in time, the process begins to progress and affect the branches of the trigeminal nerve.
Attacks of pain, usually occur at night. If the pulpitis has passed into the chronic form, the pain arises more often under the influence of some stimulus. However, unlike caries, it does not subside after removing the hindrance, but continues for some time.
Pulpitis pain occurs as a result of exudate pressure on the dental nerves. With acute pulpitis, the cavity of the tooth is usually closed, so the outflow of exudate is impossible, and therefore there are attacks of pain. When a sufficient amount of exudate accumulates, it exits under pressure through the dentinal tubules. As a result, the swelling of the tissues of the pulp decreases, and the pain stops temporarily. With a chronic form, the tooth cavity is open, so the exudate pressure does not reach the force capable of causing a painful attack.
As a rule, in any form of pulpitis, excluding retrograde, there is a large carious cavity. With chronic pulpitis, the doctor's tool easily penetrates into it. The patient's tooth is sensitive to cold, warm, sour and sweet. If you knock on it, there will be pain. In acute pulpitis, changes in the X-ray pattern are characteristic for the granulating or fibrous form of periodontitis.
In acute focal serous pulpitis there are sharp paroxysmal pains that last 20-30 minutes and are localized only in 1 tooth. The so-called light periods last from 5 to 6 hours.
At night, pain is more intense than during the day. In addition, the attack can provoke both mechanical and any other stimulus - thermal, chemical, etc. When examining the tooth, a large carious cavity is visible, the touch to the bottom of which is very painful. Under the influence of cold water, pain also arises, which then slowly disappears. Tapping on the tooth is almost painless, the mucosa around it is not inflamed.
In the case of acute diffuse serous-purulent pulpitis, sharp paroxysmal pains arise, giving off in the jaw, ear, or temple( along the trigeminal nerve).Attacks can last from 3 to 5 hours with intervals of 30-40 minutes. They can provoke any stimulus, and at night the pains are especially painful. Usually in this state a person on the 2-3rd day always turns to the doctor, as the intensity of unpleasant sensations gradually increases. When examining a damaged tooth, a vast and very painful carious cavity is visible.
In acute diffuse purulent pulpitis, spontaneous pains are vomiting, pulsating in nature, almost continuous and rendered to the jaw. Attacks follow one after another, light periods are very short, the heat only intensifies unpleasant sensations. Slightly soothe cold compresses. Body temperature increases to 38 ° C.When you go to a doctor usually it turns out that the pain has been going on for several days. The fact is that at the beginning of the disease the attacks are rather short, but the pain gradually builds up and can completely deprive the person of working capacity. When examining the tooth, a deep and very painful carious cavity is visible. When the doctor starts probing the tooth, the probe can penetrate into his cavity. At the same time, a drop of pus appears, and the patient feels relieved. An x-ray image shows a fuzzy structure of bone tissue in the base of the root of the tooth.
Pains with simple chronic pulpitis are flaccid and aching, concentrated in the area of 1 tooth and occur after exposure to temperature or food intake. From time to time there are spontaneous pains that go away on their own within 1-2 days.
The examination shows a deep carious cavity filled with food remnants and necrotic dentin. When the doctor examines the tooth with a probe and it enters the cavity, there is a sharp pain, and the pulp begins to bleed. Pain is caused by cold food, however, tapping on the crown is usually painless.
Granulomatous chronic pulpitis is quite rare: it usually occurs in young people when the crown is severely damaged. At the same time, a soft tissue growth appears in the tooth, which prevents eating and completely closes the jaw. Occasionally, under the influence of chemical or tactile stimuli, flaccid pain occurs. The onset of granulomatous chronic pulpitis is the destruction of the tooth for many months, after which spontaneous or caused by various irritants arise pain. After that there is a growth of soft tissue, which gradually increases in size and when it touches it bleeds.
In this case, the crown of the tooth is largely destroyed, and the carious defect is a vast cavity with a tumor-like proliferation of a soft tissue that has a red color. The patient tooth sluggishly reacts to a cold and a rapping, the mucous membrane of the gum is calm. On the roentgenogram there are often signs of fibrous periodontitis.
Partial gangrenous pulpitis is characterized by a feeling of pain from hot and "awkwardness" in the tooth, as well as an unpleasant odor from the mouth. In chronic form there is a feeling of raspiraniya in the tooth, less often - short-term pain. He becomes sensitive to cold and hot. With an external examination, a deep carious cavity is visible, filled with remnants of dark-colored dentin and emitting a gangrenous odor. The tooth itself becomes dull, acquires a grayish shade, its cavity is opened and filled with the remains of decomposed dentin, which is the cause of the unpleasant odor. When the doctor begins to probe such a cavity, pain does not arise. It appears only when the probe touches the mouth of the canals. In this case, the tooth begins to bleed. He is not sensitive to the cold, but reacts very strongly to tapping and is hot.
Exacerbations of chronic pulpitis cause sharp paroxysmal pains in the area of the tooth or jaw. They can last for hours, rest periods are very short, and any stimulus only increases pain. Usually, such exacerbations occur several times before a person consults a doctor.
The fact is that pain in chronic pulpitis periodically disappear, leaving only pain from various stimuli. An exacerbation, as a rule, provokes catarrhal diseases. When examining the tooth, you see a vast carious cavity, which communicates with the cavity of the tooth. His sounding is very painful. In addition, it is sensitive to cold. Pain also occurs when tapping on it.
Clinical manifestations of retrograde pulpitis are almost identical to the symptoms of acute purulent pulpitis and differ only in the absence of a carious cavity and more intense pain sensations. The latter are explained by the lack of the possibility of outflow of exudate, since with this form of the disease there is no carious defect, therefore the tooth canals are isolated.
Pulpitis - inflammation of the tooth pulp, tooth pulp. As a rule, it is a complication of caries, when hard tooth tissues are destroyed so deeply that microorganisms, inevitably located in the carious cavity, cause inflammation of the pulp. In rare cases, pulpitis can be the result of hematogenous drift of bacteria( with a common disease) or penetration through the root orifice and the root canal of the root of the tooth, or be a consequence of a tooth trauma. More rarely, the cause of pulpitis can be mechanical or medicamental effects on the pulp in the treatment of deep caries.
Unfortunately, pulpitis can arise from improper or inadequate actions of the doctor( for example, poor quality filling, lack of so-called "lining" in it, excessive preparation, orthopedic structures, etc.).
Acute paroxysmal pain;With the development of the process, the intervals between the attacks of pain decrease. In acute pulpitis, the pain is diffuse, non-localized and intensified at night. Often the pain radiates along the branches of the trigeminal nerve. With the transition of the serous form of pulpitis into purulent pain intensifies, acquiring a pulsating character. The intensity of pain is so significant that patients lose their ability to work, especially in occupations that require special attention( drivers, machinists, etc.).Recognition of acute pulpitis is facilitated by the presence in the tooth of a deep carious cavity. With retrograde pulpitis, when there is no cavity, the diagnosis is difficult and requires special techniques that are owned by dentists.
Pain in pulpitis can resemble attacks of neuralgia of the trigeminal nerve. Unlike acute pulpitis, pain in neuralgia is more likely to occur during conversation, eating, touching the skin of the face, the mucous membrane of the mouth cavity;at night, usually there is no pain, seizures are more short-lived and are accompanied by vegetative reactions: redness of the face, salivation, etc.
Treatment of pulpitis is performed by a dentist and is reduced in the initial stage to the removal of inflammation of the pulp and tooth filling. At later stages of development of pulpitis after a special effect on the pulp it is removed, the channels of the tooth root, pulp cavity and carious cavity after mechanical and antiseptic treatment are filled with filling material.
Treatment of pulpitis requires preliminary anesthesia. The usual pain relievers are good only in the first stage of the disease. Unfortunately, many patients turn to the doctor very late, when the painkillers already stop doing the right thing, and the process is finally started and moved from the acute stage to the chronic one. Serous pulpitis can be cured with the proper method of treatment( containing calcium healing pads for seals, antibiotic dressings, etc.).It is also possible to partially remove the pulp - the removal of the nerve. In the treatment of acute purulent and chronic pulpitis, the canal is depulled and sealed.
For the removal of inflamed pulp, the procedure of deviation is used, which often uses arsenic or other substances that cause necrosis and mummification of all elements of the pulp, including nerve endings. When using arsenic, the pain can disappear after a few hours, and the procedure for removing the nerve and painless treatment of the cavity can be carried out after 1-2 days. After removing the pulp from the tooth cavity and the dental canals, fill the roots with a special filling material.
Given the possibility of acute pain during pulpitis, in certain situations( in the absence of a dentist), urgent help should be given to such patients. Analgin, amidopyrine and their combinations rarely have an effect. An accessible and simple method of assisting in such cases is as follows: the carious cavity of the causative tooth is as far as possible free of food debris. At the bottom of her place a small cotton ball moistened in a solution consisting of a drop of carbolic acid( 1: 1000) and dissolved in it 1-2 crystals of dicaine, novocaine or sovcine. The tampon should be squeezed to remove excess solution. On top of the tampon, insert a cotton ball moistened in a colloid. Usually the pain disappears after 20-30 minutes and does not resume for several hours. During this time the patient must appear for treatment to a dentist. What use of folk remedies in this disease look here.
As already noted, the main cause of pulpitis is a complication of caries, therefore the main preventive measure is the timely treatment of caries. To do this, you must train yourself to visit the dentist regularly for the purpose of preventive examinations. Then all dental diseases will be cured at the earliest stages, which is much more pleasant and cheaper!