Tooth pulpitis is deep caries that has reached the root of the tooth and destroys it. This disease is common and one in five residents will encounter it during their lifetime. Pulpitis comes in many forms and types. Only a dentist can determine the presence of a lesion and outline a treatment plan. If you do not start acting in time and do not get rid of the inflammation, you can lose a tooth, without the possibility of recovery.
Pulpitis – causes
Inflammation of the pulp is explained by the penetration of microbes into the soft tissue of the tooth during the development of deep caries. They can penetrate indirectly – through the dentinal tubules, or directly – to the opened pulp. There are many reasons for the appearance of pulpitis, but one of the main ones is a retrograde infection. It is able to penetrate into the canals of the tooth with the help of holes formed during caries. The infection does not come from nowhere. It develops in the presence of chronic diseases of the oral cavity.
There are a number of reasons why tooth pulpitis develops due to the ingress of bacteria into it:
- Cariogenic. In the presence of caries, microorganisms enter the nerve canals through the existing openings. The protective hard layer of the tooth becomes thinner and microcracks form, through which bacteria easily penetrate into the pulp chamber, which is the beginning of tooth pulpitis.
- Periodontal. Another reason is surgery. This may be a dissection of the gums or its excision.
- Hematogenous. With this route of transfer, the infection is introduced into the pulp through the blood vessels and through the lymph. The tooth looks intact from the outside, but the pulp is already amenable to change.
There are reasons why the presence of bacteria is not important:
- Injury to the tooth of any etiology. This may be a fracture, improper turning of the tooth, a crown and a fragment of its part, non-professional treatment.
- Damage to the tissues surrounding the tooth.
- The effect of ultrasound of different frequencies on the tooth.
- Impact on the tooth of chemical materials used in filling. Also, tooth pulpitis can occur due to the temperature regime during turning or treatment.
Forms of pulpitis
There are three main forms of pulpitis:
- Sharp form. It includes: diffuse, focal pulpitis and traumatic.
- Chronic. Representatives of this species are: gangrenous, fibrous and hypertrophic pulpitis. This group also includes all types of exacerbation of a chronic process.
Inflammation of the pulp – symptoms
Inflammation of the pulp of the tooth is characterized by the presence of pain in the affected area. If we are talking about a chronic disease, then the pain here will manifest itself only during the period of exacerbation. If the pulpitis is acute, then the pain, as a rule, is very strong and does not subside. In both cases, the pain becomes worse as the night falls.
But along with pain, there are other characteristic symptoms:
- carious enamel gray or black;
- bleeding gums;
- high body temperature (the body’s reaction to exacerbation);
- insomnia and headache.
Acute pulpitis is an inflammatory process that has reached the pulp (root) and affected the nerve endings of the tooth. Pulpitis, the symptoms of which are acute, appears equally in both men and women. Children are less susceptible to it, they often have a neglected chronic form that occurs with a less pronounced manifestation of symptoms.
The acute form of the disease is divided into 3 types:
- Focal pulpitis – This is the initial stage of pulp damage. The main development factor is microorganisms penetrating into the soft tissues of the tooth through caries. Often, the disease occurs due to the unscrupulous work of the dentist, who introduces bacteria into the dental chamber. There they begin to multiply actively. If the process takes place in a closed dental chamber, then at the initial stages it can be easily eliminated. But if the tooth is open, infection of neighboring teeth is inevitable. Only surgical intervention is recommended here.
- Diffuse pulpitis – a rapidly developing disease of the teeth, a complication of the focal form. With it, inflammation penetrates into the root of the tooth and gives off a strong, piercing pain in the head. Often the patient cannot determine which tooth hurts, the pain erodes to the affected half of the jaw. Only a dentist can determine a diseased tooth by tapping and washing the tooth enamel.
- Traumatic appearance – occurs due to damage to the tooth in various ways. This may be pulpitis, the root canal treatment of which was carried out carelessly, and injured the pulp with a dental instrument. This may be a fragment of a part of the tooth that exposed the pulp, or due to the opening of the horn of the pulp during the treatment of caries. In all three cases, the first symptom is a sharp pain when touching the tooth, as well as a reaction to cold and hot. Don’t put off going to the dentist.
Pulpitis pain can also be chronic. In this case, inflammation exists for a long time, during which the tooth undergoes significant changes. In the chronic form, the pain appears during the period of exacerbation, at other times the person does not feel discomfort. The disease can be diagnosed by physical examination and X-ray examination.
There are three types of chronic pulpitis:
- fibrous pulpitis – characterized by the growth of connective tissue in the cavity of the tooth, which has a fibrous structure. Symptoms are characterized by the presence of constant heaviness in the tooth, aching pain, the reaction of the pulp to thermal, mechanical and chemical changes. Diagnosis is made by examination and radiography.
- Gangrenous pulpitis – a late stage of the disease, in which the pulp tissue dies due to the introduction of pathogenic bacteria into it and softening of hard tissues. As a rule, with this course of the disease, the infection penetrates through the carious pit formed in the cavity of the tooth. In the course of the disease, the color of the tooth changes from yellow-gray to dark brown. There is a sharp putrid smell from the mouth, pain manifests itself when pieces of food enter the cavity.
- Hypertrophic pulpitis – a kind of neglected form, formed as a result of the penetration of carious bacteria into the pulp cavity. A distinctive feature is the formation of a polyp. Symptoms are not expressed, therefore, the disease can be detected only at a routine examination by a dentist. The only visible symptom is the bleeding of the tooth, due to the growth of granulation tissue in it.
Diagnosis of pulpitis
Methods for diagnosing inflammation of the dental pulp are determined by the following steps:
- The dentist conducts a survey and detects the presence of pain. He learns about their duration, intensity and draws up a picture of the disease.
- The next step is inspection. On examination with the help of glass and instrument, the presence of caries is revealed. Teeth that have any damage are tapped and blown. Also, the dentist can take temperature samples (exposure to the affected tooth of low and high temperatures) and conduct probing (to determine the degree of development of the disease).
- Electroodontodiagnostics or x-rays are performed. In the first case, a current is passed through the nerve, revealing its viability. And in the second – determine the lesions.
Tooth pulpitis – what it is, how to treat the disease and what methods exist today, we will analyze below. It is important to know that in the initial stages of pulpitis is curable with the preservation of the dental nerve. If a person comes to the appointment with the initial development of the disease, the tooth is opened and the state of the pulp is assessed. Further, if the condition is satisfactory, it is wrapped with a bandage impregnated with calcium hydroxide and closed with a temporary filling. If after a couple of days the inflammation subsides, the doctor puts a permanent filling.
Tooth pulpitis – how to relieve pain?
Pulpitis of the tooth, the treatment of which is planned in the near future, requires emergency relief of pain:
- Painkillers. To eliminate the pain syndrome, you can take drugs that stop the pain. These are: Nimesulide, Pentalgin, Ketonal.
- Anti-inflammatory agents: Nurofen, Diclofenac. They will relieve pain and have an anti-inflammatory effect before a dentist appointment.
- Antimicrobial drugs: Metrogil-denta, Betadine. They have a local antimicrobial effect. Indicated for use with painkillers.
Pulpitis treatment methods
There are two very effective treatments:
- Treatment of pulpitis with a biological method. In this case, the nerve endings of the tooth are preserved in their original form. The pulp is covered with a cloth containing a calcium hydroxide solution and left to rest for a couple of days under a temporary filling. Next, an examination is carried out with an x-ray and, if the method has given results, the tooth is covered with a permanent material. The method is effective in the acute phase of the disease and with a highly qualified doctor.
- Surgical method. The essence of the method is to remove the pulp from the dental cavity. Treatment of pulpitis by the method of vital extirpation is applied using anesthesia. With this method, the carious area is first removed, then the cavity is treated with an antiseptic solution. The nerve is then removed and the tooth is sealed. The method is not recommended for people who are allergic to anesthetics. If the vital method is contraindicated for a person, the devital method is used. In this case, toxic substances act on the pulp. They are placed in the tooth for 24-48 hours. During this time, the pulp tissue dies and is easily removed at the next examination. After the tooth is sealed.
Treatment of pulpitis – stages
How dentists treat pulpitis in stages:
- Interview. The doctor should identify important points by questioning the patient.
- Inspection. The dentist examines the oral cavity for damaged teeth. Each tooth is tapped, blown and inspected.
- X-ray. If necessary, the affected tooth is examined on an x-ray and then a decision is made regarding its treatment.
- Cleansing the cavity from caries. The tooth is cleaned and the canals are opened.
- Canal cleaning and pulp removal. With the help of tools, the pulp is removed and the canals of the tooth are cleaned.
- Sealing. A filling is placed on the tooth and ground down.
Wisdom tooth pulpitis: treat or remove?
Inflammation of the dental pulp, the treatment of which is inevitable, raises the question for many – is it worth treating? There is an opinion that wisdom teeth do not participate in the chewing process and are generally useless teeth. They are more prone to carious processes, this is explained by the overlapping of the surface of the tooth with the gum, which prevents it from being cleansed of bacteria. To remove or not, only the dentist can decide.
There are a number of cases where deletion is undesirable:
- Correct position in the dentition and participation in chewing.
- Planning for dentures. Wisdom teeth are very strong and are often used as the basis for a prosthesis.
- Tooth decay occurs due to caries. In this case, the tooth cavity is cleared of harmful bacteria and the tooth is saved.
Toothache after pulpitis treatment
Treatment of pulpitis without removing the nerve is a long and complicated process, both for the patient and for the doctor. After the procedure, the tooth may be painful for some time. This is considered the norm for devital extirpation. But if the nerve was removed during the treatment, the pain afterwards may indicate the grossest errors of the doctor when extracting the pulp. To calm down, it is worth taking an x-ray and making sure that part of the instrument has not remained in the canal and the entire area has been removed.
Prevention of pulpitis
A disease called pulpitis, the symptoms and treatment of which is familiar to almost every second inhabitant of the country, makes it very difficult to live. It is difficult to treat it and it is better to prevent the development of the disease:
- It is important to always treat caries on time.
- Regularly visit a dentist.
- Brush your teeth 2 times a day.
- Follow a healthy lifestyle. Then it will be possible to forget about dental pulpitis once and for all.