To understand the problem, you need to recall the structure of the tooth: the enamel, the strength is slightly inferior to the diamond, and dentin lies a gentle and friable epithelium of the tooth – pulp. It is penetrated by blood vessels, lymphatic and nerve fibers. The objective of pulp is to provide nutrition the hard tissues of the tooth.
What is pulpitis
Normal polarna camera completely sealed. But as soon as it is depressurized, the “heart” of the tooth is completely helpless in the face of pathogens. Developing inflammatory reaction, which dentists call “pulp”, and patients”nerve inflammation”.
Due to the presence in the pulp of the nerve endings, tooth pain in this disease, indeed, unbearable. And knew, even during the Inquisition. One of the most common tortures at the time – using tools to crumble the tooth enamel and affect the soft tissue of the tooth. In the result, subject lost consciousness and then died of shock.
Forms of pulpitis
In 1989 in the Institute named after N.. Semashko proposed the classification of diseases used by the dentists still. It highlights the acute and chronic pulpitis. Often initially the patient is experiencing an acute stage, but without treatment, the inflammation becomes chronic, which often makes itself felt painful exacerbations.
Much less frequently the situation is reversed when the patient does not complain of severe pain, and the disease develops sluggish, and immediately in the chronic form. Both acute and chronic pulpitis, has its own subtypes. To diagnose them correctly is very important as it is the kind of disease will depend on the treatment strategy.
Most often occurs as a complication of deep caries. Is characterized by severe, throbbing pain that is worse at night. Acute pulpitis occurs in 2 forms: focal and diffuse.
Focal pulpitis is the initial stage of the disease, which lasts no more than 1-2 days. During this period the patient complains of sharp shooting pain that can occur as when exposed to the tooth, and without it. The attack lasts a short time: 10-30 minutes. Then unpleasant sensations recede, but return again in a few hours. At this stage the pain is clearly localized and the patient can clearly indicate which tooth hurts.
Diffuse pulpitis. If in the first 48 hours to see a doctor, the pain will start to give in the cheeks, neck or whiskey. Attacks now last longer: 30-40 minutes, and the spaces between them are reduced. On the doctor’s patient with diffuse pulpitis can not tell exactly which tooth is causing the pain.
At this stage, the inflammation has already covered the entire coronal part of the pulp, and affected root. If the process passed into the suppurative stage, pain is constant. To briefly relieve it cold, but hot meals and drinks, on the contrary, will increase the discomfort. Not uncommon in this period and the increase in body temperature. Diffuse pulpitis lasts from 2 days to 2 weeks and then the disease becomes chronic.
Interesting! Acute pulpitis is generally not found in children. This is due to the peculiar structure of children’s teeth. But men and women suffer from this disease equally.
To diagnose chronic form of the disease is much more complicated than acute. But it in overwhelming majority of cases dealing with dentists. Duration of inflammatory process of soft tissues during the chronic course of the disease ranges from 2 weeks to several years.
The pain is not so obvious, is dulled, although not entirely. Cold and hot foods increase the discomfort, so patients try to minimize loading the aching tooth. The dentin and enamel are gradually destroyed, and the pulp may start to bleed. In one of the periods of the exacerbations, the patient still comes to the dental clinic, then the doctor will diagnose one of the many forms of chronic pulpitis.
Fibrous pulpitis. Often hidden flows, without causing the person severe anxiety. But in the dentist chair in the sick tooth revealed a deep carious cavity which is not connected with the cavity of the tooth, but is very sensitive to the touch. The fibrous form of pulpitis is often a logical continuation of the acute stage, and develops as a result of running caries.
Gangrenous pulpitis or pulp necrosis provoke infectious agents. In this disease nerve fibers of the pulp are dying, and she is gray. The patient complains of increased pain and putrid breath. The dentist, upon inspection of the watches extensive carious cavity. At this stage it only remains to state an unpleasant fact: the crown part of the tooth is completely destroyed.
Hypertrophic pulpitis. A cavity is already connected with the cavity of the tooth, the young connective tissue it expands, forming a polyp, which will soon fill the space. When you press a polyp bleeds, but the rest of the time does not cause the patient any discomfort.
Exacerbation of chronic pulpitis. The final stage of the disease that combines the signs of sharp and chronic forms. The patient complained of hours-long bouts of unbearable pain, which subside for a few minutes. When pressed on the tooth the pain intensifies, and watching the dentist extensive destruction of bone tissue of the tooth.
According to statistics, the most common form of chronic fibrous pulpitis is. In second place is gangrenous. And very rarely of hypertrophic type of disease.
Depending on the shape and the extent of the disease, pulpitis will manifest itself in different ways. But to smell a rat on the common signs of the disease.
- increased sensitivity to hot and cold food;
- change the color of the enamel;
- redness and inflammation of the gums;
- bad breath.
But the main symptom of pulpitis is an acute throbbing pain. Initially, she is concentrated in one point, but eventually spreads to the entire jawbone, gives the ear, throat, temple or neck. Particularly severely affected patient in the evening and at night.
When different forms of the disease the pain will be different:
- focal pulpitis delivers a strong discomfort. The pain is severe but short-lived and precisely localized;
- diffuse loss of impersonating an increased pain in the supine position;
- the fibrous pulp can cause pain the teeth at the exit from a warm house to the cold outside;
- when gangrenous pulpitis especially unbearable is making the hot food.
Important! Sometimes the pulpitis takes place completely asymptomatic, gradually moving in periodontitis and periostitis. In such advanced cases the risk of losing a tooth is huge. It is therefore important to undergo routine medical examinations.
First thing the dentist if you suspect pulpitis of the tooth, ask the patient many questions: when did the first attack, how long it lasted, if pain increases at night and that helps to alleviate the pain. All of these points to be advised by a doctor not out of idle curiosity, but because each form of disease has its own symptoms.
Then will follow a thorough oral examination which involves probing, palpation and percussion (percussion) of the tooth. Because accurately identify the culprit of the pain is often difficult, dentists are widely used in temperature test. During which the tooth is exposed to carbon dioxide (-700C) or dichlordifluormethane (-400C). After the restoration of the sensitivity test again, and if from cold the pain subsides, the doctor can confidently speak about the beginning of the process of dying pulp.
Interesting! According to statistics, among all the diagnosed chronic pulpitis is 60%. And only 4 people out of 10 come to the dentist in the acute phase of the disease.
How to treat pulpitis
After the diagnosis, the dentist makes a treatment plan, whose main task is to eliminate the inflammation. If the process is not too extensive, the dentist may try to repair the nerve. This method of treatment is called conservative or biological. If the disease is detected at an advanced stage, we will focus on the surgical treatment: partial (amputation) or complete (extirpation), the removal of the pulp.
Unfortunately, in 90% of cases of chronic pulpitis – irreversible disease. With the sprouting of blood vessels and necrosis began to talk about the full restoration of the tooth is no longer necessary. And the only way out of the dentist – the removal of the nerve. Therefore, our physicians once again urge: do not delay treatment while you have all the chances to save the tooth!
Alas, it is available only in the case when the patient came to the clinic immediately after felt a strong pain. At this stage, the doctor will reveal the pulp, process it with antiseptic and put a dressing with calcium hydroxide. Then the patient will put a temporary filling and after treatment will be changed to permanent.
Biological method is not too popular among dentists. It requires the doctor’s qualifications and the medical talent that allows to consider in the treatment of many nuances, and once risked, to save the patient’s healthy tooth. In the course of conservative treatment it is very important to monitor the status of the pulp through x-rays.
Amputation is a partial removal of the pulp, namely, the coronal part. The root portion is retained. Actual this treatment only for teeth with 2 or more roots, which are easy to separate the individual elements of the nerve bundle.
Amputation may be 2 types.
- Vital. In this case, the patient immediately remove the portion of the nerve. Conduct manipulation under anesthesia. Vital amputation is used only in patients under 45 years with a healthy periodontium.
- Devital amputation involves the mortification of the pulp with demetalizarea paste. And then the nerve is removed from the coronal portion of the tooth and in the root cavity of the mummified his resorcinol-formalin.
Devital amputation at the time helped dentists, if you get to the desired area of the pulp was impossible. Today, the method is gradually disappearing, as the flexible titanium and Nickel tools allow you to treat even in curved canals.
The most common method of treatment that allows dentists to completely eliminate the risk of re-inflammation of the soft tissues of the tooth. In the same way as amputation, the method of surgical treatment can be vital and devital.
Vital extirpation or pulpectomy is done under anesthesia, and constitutes the complete removal of the soft tissues of the tooth. Treatment of pulpitis in this case is limited to the only clinic, which is very convenient for the patient.
In the course of treatment doctor:
- removes dental tissue affected by caries;
- handle the tooth with antiseptic;
- remove the pulp;
- sealing the cavity.
Unfortunately, vital extirpation is not available to patients with Allergy to anesthetics. They will have to visit the dentist twice. The first time the doctor will put on the aching tooth toxic composition, and close the cavity with a temporary filling. At the second appointment the dentist will painlessly remove the pulp, clean the canals and put a permanent seal. This type of treatment is called devital hysterectomy.
Important! Very often after imposition of arsenic patients are not in a hurry to the dentist. The pain subsided, the carious cavity is closed with a temporary filling, and then you can wait. In fact, this is a huge mistake! Over time, arsenic will gradually poison the body, which can lead to very sad consequences. Therefore, to complete the treatment within a specified physician time.
The stages of treatment of pulpitis
In the surgical treatment of pulpitis, the patient will have to undergo 5 stages of treatment.
- The removal of the decayed tissue. The doctor will clean the tooth, will open and will expose the pulp chamber. If you remove the nerve cannot be made into the cavity of the tooth will be invested arsenic, and placed a temporary seal. The next visit will be in 2-3 days if the patient can come as soon or in 2 weeks.
- Removal of the pulp. For this purpose there is a special tool – pulpectomies.
- The implementation of x-ray. His task is to give the doctor full information about the length and shape of the channels.
- Cleaning of channels. High-quality implementation of this phase of treatment allows to eliminate repeated inflammation.
- The seal installation. In some cases, the dentist will insist on performing this procedure in 2 stages: at the first visit, the doctor will seal the canals, and the second time the crown part of the tooth.
Sometimes at treatment of pulpitis additionally appointed reception of anti-inflammatory drugs.
Pulpitis in children
Time to identify pulpitis at the child very difficult. First, due to the fact that the pulp of the milk tooth are not sensitive. And its inflammation does not cause kids a lot of pain. In addition, children rarely give the doctor calmly examine himself, and do not know how to accurately convey their feelings from the actions of the doctor.
Nevertheless, among all children’s dental diseases, the proportion of pulpitis is 35-50%. And at the same time every year, patients are becoming younger. You can often hear the opinion that the pulpit in a child treated is not necessary, because very soon, in place of the milk teeth will be permanent.
But dentists are convinced that it is equally dangerous and complete disregard for the problems, and the mindless destruction of the affected baby tooth, which is often pressure from parents. The fact that in case of complications may be affected by the germ of the future permanent tooth. Therefore, pulpitis in primary teeth should only be treated!
The scheme of actions of the doctor in this case is:
- The kid is taking anesthetic injection.
- Remove the carious lesions and the pulp from the coronal portion of the tooth.
- In the opened cavity of the channels administered the drug, mummifying the remaining tissue.
- Is filling the canals, then the tooth.
The course of pulpitis of permanent teeth in adolescents does not differ from adult symptoms. And the cure for it is also used in biological and surgical techniques.
If you long to put off going to the dentist, the inflammation of the soft tissues of the tooth will eventually spread beyond the root canal. And when the patient gets to the clinic, the doctor diagnoses not already pulpitis and periodontitis, or even worse, periostitis – inflammation of Kolokolnya tissues of the jaw.
Other complications of untreated pulpitis include:
- osteomyelitis – inflammation of bone marrow purulent character;
- phlegmon of the face – a breakthrough of pus in the facial soft tissue.
- General blood poisoning;
- amyloidosis is the failure of internal organs, caused by poisoning of the body decay products.
Fear of dentist can bring the person before the disability, and sometimes to death. And that’s no exaggeration! In 30% of cases sepsis, which is a complication of pulpitis, is fatal.