• Pulpitis: photos, symptoms, causes, treatment

    Pulpit of the tooth is one of the most unpleasant complications of caries, causing severe pain and awe-inspiring an unavoidable visit to the dentist.

    What is the cause of this trouble, and what are the main ways to deal with it?

    Causes of

    Why the pulpitis of the tooth develops, and what is it? According to most textbooks on therapeutic dentistry, the main cause of pulpitis is the complications that arise in the tooth with deep caries. However, in practice, several more specific causal factors should be identified.

    1. 1) Deep caries. Since the origin and progress of caries in the oral cavity is due to the action of a conditionally pathogenic microflora, the walls of the carious defect are abundantly saturated with microbes. Toxic products of their vital activity for a long time affect the pulp through decalcified, dentinic tubules, which are more permeable than in a healthy tooth. This effect leads to a response - to inflammation.
    2. 2) Errors in the treatment of deep caries.
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    4. 3) Accidental dissection of the tooth cavity during preparation. With a deep cavity excision of non-viable tissues can be made in dangerous proximity to the pulp. Even if the latter is not exposed, an extremely thin layer of dentin may not be able to protect the pulp from external influences, including infection, high and low temperatures, etc. While remaining unnoticed, such areas of the carious cavity contribute to inflammation of the pulp in the next few hoursor a day after treatment.
    5. 4) Errors in the choice of filling material or a violation of the technology of caries treatment. Applying a seal with deep caries from an irritating material without an insulating pad can lead to pulpitis. The same negative result can be obtained with an incorrect acid pickling when working with composite materials or a violation of the photopolymer exposure technology. As a result, the residual monomer can exert the same irritant effect on the pulp, as well as toxins in deep caries.
    Caries is not the only cause of pulpitis. However, all other variants of the appearance of inflammation of the pulp are much more rare.

    Among them are:

    • infection of pulp when drifting microflora into the cavity of the tooth with blood flow in the presence of a significant source of infection.
    • penetration of microflora into the pulp through the destroyed periodontium, for example, with a deep pathological dentogingival pocket.
    • trauma of the tooth, which caused the violation of her blood supply.

    Morphology of development of pulpitis

    When pulpitis occurs in soft tissues, a series of various pathological changes occur, causing a variety of patient complaints.

    Long before the appearance of the first unpleasant sensations of the patient, in a limited area of ​​the pulp, close to the carious focus, the lumen of the blood capillaries increases and the permeability of their walls increases. The content of cells responsible for immunity increases.

    In addition, the surface layer of pulp containing odontoblasts begins to intensively reduce the lumen of the dentinal tubules and deposit the replacement dentin on the inner surface of the tooth cavity. There is an activation of the struggle of the pulp for survival, which the tooth gradually and steadily loses, yielding to the rapid onslaught of carious destruction.

    As the swelling in the tissues of the pulp rises inside the tooth, the pressure increases, resulting in irritation of numerous sensitive nerve endings, which leads to pain. When the pressure reaches its maximum, the exudate rushes into the dentinal tubules and the pain temporarily subsides.

    However, since the pathological process does not stop, the amount of exudate increases again. The speed of its formation increases, so the duration of pain attacks increases, and the phases of improvement in well-being are shortened. In the process of inflammation, all new areas of the pulp are involved, pulpitis from the limited becomes diffuse.

    In some areas of inflamed pulp, small and scattered areas of purulent decomposition first appear, which gradually increase, merge into a single purulent mass. The further fate of the tooth, if its treatment has not yet begun at the previous stage of serous inflammation, can proceed according to the following scenarios:

    1. 1) A doctor helps - removes inflammation with special drugs or removes the nerve and seals the tooth.
    2. 2) Pus can find an outlet through a carious defect. The pressure subsides, the pain subsides, and the inflammation passes into a chronic form. Pulp fabrics undergo characteristic changes - they are transformed into fibrous tissue or subjected to gangrenous decomposition.
    3. 3) Pus breaks into periodontium, leading to the appearance of acute periodontitis.

    Symptoms of pulpitis

    Among the many varieties of pulpites, the Goffung scheme has the most practical value. Pulpit tooth, and its main symptoms can be determined based on the following classification:

    1. 1) Acute serous pulpitis( focal and diffuse).Complaints of pain in the tooth, having a paroxysmal character. The pain is greatly increased from hot.
    2. 2) Acute purulent pulpitis. The pain is greatly increased, light intervals are practically absent. Often the intensity of pain is significantly reduced from the cold, which was the reason for isolating the "bottle symptom" - patients are often forced to take cold water in their mouths and appear in the doctor's office with a bottle in their hands.
    3. 3) Chronic simple pulpitis. Since all forms of chronic pulpitis usually occur against the background of the opening of the tooth cavity, a significant increase in pressure inside the tooth is impossible, the exudate has the possibility of unimpeded outflow. In addition, partial or complete disturbance of the structure of the pulp leads to a violation of its sensitivity. All this does not allow the emergence of severe toothache. Painful sensations occur after eating or from significant temperature irritation.
    4. 4) Chronic hypertrophic pulpitis. The tissues of the pulp retain their structure, the connective tissue dominates and grows in it. Partially increased in volume, the pulp penetrates beyond the natural cavity of the tooth, often filling the whole carious opening. When a food tooth becomes damaged or another strong stimulus is exposed, a slight aching pain of a short duration appears.
    5. 5) Chronic gangrenous pulpitis. If the resistance of the body is reduced, the pulp is subjected to diffuse decay. To a greater extent, this applies to its coronal part, which turns into a homogeneous homogeneous mass. In the root canals, the nerve can still be in a state of simple chronic inflammation with a degeneration into fibrous tissue for a long time. Therefore, pain sensations are rare, mild, and occur either when the carious defect is sealed tightly with food residues, or from a hot defect.

    Diagnosis of pulpitis

    Usually the diagnosis is not difficult, this is facilitated by clear complaints of the patient and visible significant changes in the tooth. Great help is provided by the history, objective examination and measurement of the reaction to electrical stimulation( electroodontodiagnostics).

    Radiography in pulpitis is not always informative, as it does not show changes in the structure of the pulp, and periodontitis with this disease has practically no significant structural changes.

    Errors can occur in assessing transitional states, for example, from deep caries to pulpitis. Underestimation of the real severity of the pathology can lead to inadequate treatment and the occurrence of undesirable complications.

    It is also important not to skip the transition of inflammation to the abdominal tissues, so as not to treat pulpitis in acute or chronic periodontitis.

    Treatment of pulpitis

    Principally in the treatment of pulpitis several directions are distinguished.

    Biological or conservative. If we consider the essence of the initial stage of pulpitis, then it differs little from inflammation in other tissues of the body, not removed by the surgeon only because of the onset of edema.

    The task of the biomethod is to remove inflammation in the tissues of the pulp before irreversible structural disturbances occur. After preparation of the carious cavity, a paste with anti-inflammatory preparations restoring the capillary circulation and eliminating other manifestations of pulpitis is applied to the tooth.

    With the onset of irreversible changes in the pulp, surgical treatment is used - partial or complete removal of the pulp( extirpation and amputation).

    Removal of pulp can be done "as is" or after the preliminary destruction of its structure, devitalization. Thus, the treatment of pulpitis is divided into the vital and devital directions.

    Methods for the treatment of pulpitis: advantages and disadvantages of

    There are five main methods that are effective in the treatment of tooth pulpitis. Below you will be able to assess their main advantages, as well as learn about the shortcomings of each particular method, thereby choosing the right one for yourself.

    1. Biological( conservative) - the main differences of the method - the cavity of the tooth is not opened, the medicine is temporarily applied to the bottom of the carious cavity. Advantages and disadvantages - while maintaining the vitality of the tooth, its remineralizing function is not undermined, it is able to resist the beginning of the development of a new carious process. If treatment is started with a delay, it does not give a positive result.
    2. Vital amputation - the main differences of the method - after preparation of the carious cavity only the coronal part of the pulp with preservation of the root is removed. Advantages and disadvantages - it avoids infection of the periodontal disease. However, with the further disintegration of pulp more often than with other methods, requires repeated treatment.
    3. Vital extirpation - the main differences of the method - complete removal of the entire pulp with subsequent sealing of the root canals. The most common method of treatment. Advantages and disadvantages - there are no complications from devitalizing drugs. Disadvantage - there is a need for quality passage and processing of the root canals: no significant curvature of the roots, branching or obstruction of the channels, etc.
    4. Devital amputation - the main differences of the method - all devital methods are preferred when it is impossible to treat the tooth with anesthesia( for example, with an allergy to anesthetics). Partial removal of the pulp is performed with the obstruction of the root canals followed by conservation( mummification) of the remaining tissues in the canals. Advantages and disadvantages are the simplicity of the technology of treatment, the absence of the need for complex work in the end channels. Minus - incomplete mummification and continuation of pulp disintegration possible;tooth staining from the inside, etc.
    5. Devital extirpation - the main differences of the method - the nerve is removed completely after applying paste on the basis of arsenic or other preparation. The canals are sealed by technology that prevents the re-development of microflora in the lumen of the root canal. Values ​​and disadvantages - anesthesia is not required. The pulp is extracted airless, which somewhat simplifies the treatment of the root canal. Minus - often work without anesthesia becomes very painful. With devitalization, complications from the toxic effect of the drug on the periodontal tissue are possible.
    Thus, pulpitis is a complex disease of the entire tooth, requiring urgent qualified treatment. Prognosis, with the right approach, a favorable, treated tooth is able to serve for many years without causing any complaints.

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