Most people seek emergency treatment from a dentist for the simple reason that they did not pay enough attention to caries, considering it to be a kind of “annoying misunderstanding” that could wait until there was free time for his treatment. As a result, the most common cause of acute pain is not caries, but pulpitis, which is associated with damage to the soft tissue inside the tooth. And often the symptoms of pulpitis continue to be confused with caries, hoping to once again wait or drown out the pain with painkillers.
But the defeat of the pulp chamber of the tooth is still far from the limit. The result of excessive “long-suffering” is often the transition of pulpitis to the more difficult for treatment of the disease – periodontitis. Often the outcome of the complications of pulpitis is the removal of a tooth, after which the neighboring teeth can shift, a violation of the bite, normal chewing of food, and sometimes – diseases of the stomach and intestines.
The photo below shows a tooth in which deep caries led to the development of pulpitis:
Many people know firsthand about the possible appearance of the so-called flux (periostitis). But few people know that the flux on the gum often appears after long pulpic pains and is the result of the nerve dying out in the dental canal with the formation of pus, which simply has no place to go out, and therefore it goes towards the root of the tooth, inflating the gum.
Over time, flux can turn into a fistula (see photo):
What is pulpitis, what are the causes of its occurrence, how it can threaten human health, and what types of this pathology are – all of this will be discussed further.
About the pain that can occur when exposed to the nerve of the tooth, they knew long before the advent of modern dentistry. At the time of the Inquisition, the first primitive hand tools (something like dental machines) were used for torture, which allowed the crumbling of enamel and dentin during rotation and reaching the soft tissues inside the tooth, thereby causing their irritation and destruction.
Of course, everything was done in order to cause unbearable pain in the subject, and it came down to loss of consciousness and pain shock. Then the sufferer was brought to life in order to continue the effect on the pulp. Sometimes torture lasted more than one day, and the person died from traumatic shock.
So what is pulpit?
Pulpitis is an inflammatory reaction of the pulp tissue (dental nerve) that occurs in response to an irritating factor, external or internal. Pulp is a soft tissue penetrated by vessels and nerves. There are a lot of nerve cells inside it, which is why toothache is considered one of the strongest.
Photos of tooth pulp:
Why, when pulpitis occurs so much pain?
Due to the fact that the inflammatory reaction has a phase of edema, during the increase in pulp size, nerve cells are squeezed with the development of severe intolerable pain. In acute forms of pulpitis, the pulp is covered with a thin layer of carious tissues, and in chronic forms, when the pain is not so pronounced, most often the bottom of the carious cavity communicates with the pulp chamber. In such cases, the pain is aching in nature and becomes pronounced only when irritants get into the hollow of the tooth (hot, sharp), or due to complete blockage of the opening over the pulp with something (seeds, nuts, apples).
As a result of swelling and compression of the entire connective tissue bundle, gradual necrosis (death) of the “nerve” occurs.
With one form of chronic pulpitis, only the coronal part of the tissue dies, and in the canals it partially remains alive.
Causes of pulpitis
The most common cause (etiology) of pulpitis is deep caries. In the process of deepening the cavity, there is a direct or indirect penetration of microbes into the pulp tissue. With direct access, the infection falls directly on the exposed pulp, and indirectly through dentinal tubules penetrating the thickness of the dentin.
In dentistry, there are several ways to infect the pulp and the occurrence of pulpitis:
- through the crown of the tooth (caries complication)
- through the hole of the root apex with the manifestation of retrograde pulpitis.
Retrograde form of pulpitis is rare because of its specific developmental mechanism (pathogenesis). Causes of retrograde pulpitis are:
- Hematogenous (through the blood) infection of the tooth pulp with common infectious diseases (influenza, rubella, etc.), when the infection spreads to the maxillofacial region.
- When the infection spreads from infectious foci close to the roots of the tooth, which most often becomes the maxillary sinus with sinus.
- Through an infected periodontal pocket (the space between the root and the gum), when, due to a violation of the periodontal attachment, the infection rushes to the apex of the tooth root, causing pulpitis.
Also one of the most common causes of the development of pulpitis are mistakes of the doctor or his incorrect actions. Most often this is due to overheating of the tooth during its processing (preparation), accidental opening of the pulp chamber, followed by the imposition of a permanent seal, as well as improper turning of the tooth under the crown with non-compliance with the technique and without the manufacture of protective caps after the procedure. A pulping tooth begins to manifest itself immediately or after a medical error, often forcing the doctor to redo all the work anew.
One of the rarest pulpitis are traumatic and calculitis pulpitis. Trauma upon impact, injury, or fall is most often characteristic of the front teeth: it is in such cases that pulpitis has a non-infectious origin. The symptoms of pulpitis of the front teeth arising from this do not differ in any way from the “classical” variants of the development of pathology.
When calculi pulpitis in the dental nerve there are violations due to dentikley and petrification – sediments, consisting of salts (mainly calcium compounds). These calcified stones compress the delicate tissue of the pulp, causing the development of pulpitis.
The following picture schematically shows the classic version of the development of pulpitis – after deep caries:
Acute and chronic disease
Pulpit tooth, as a disease, can have several currents: acute, chronic and in the acute stage. Most often, first formed acute pulpitis, and then – chronic. At some point in time, the chronic form goes into an exacerbation stage.
However, such a scheme does not apply to all cases: it also happens that the tooth is not sharply sore, and the pathology immediately turns into a sluggish chronic form. Often, a person does not even have exacerbations, when the chronic form of pulpitis smoothly changes into another more complicated disease for the treatment – periodontitis.
The pathogenesis (development) of pulpitis is directly related to the etiology (cause) of its occurrence and may have its own specifics, but any inflammatory tissue reaction has much in common. Regardless of what causes pulpitis (infection, trauma, or toxic effects on the “nerve” of the filling material), serious structural changes occur inside the pulp tissue:
- pulp edema;
- impaired blood flow;
- oxygen starvation of cells;
- the difficulty of the removal of toxins;
- phenomena of necrosis (necrosis).
Among acute pulpitis emit focal and diffuse. In both cases, pulping tooth hurts not only spontaneously without irritants, but also in the presence of them (sweet, cold and
Difference of acute diffuse pulpitis from focal is the spread of pain along the branches of the trigeminal nerve: the pain can be given to the temple, ear, infraorbital region, the back of the head, cheekbone, etc. In such cases, the person can not accurately specify the doctor causing the suffering of the tooth, and have to use additional diagnostic tools.
In case of focal pulpitis, pain is localized in one particular tooth, and the patient is able to point precisely at it.
The consequences of irreversible disturbances in the dental pulp can be chronic forms of pulpitis: fibrous, gangrenous and hypertrophic. The names themselves speak for themselves:
- in fibrous pulpitis, inflamed nerve tissue degenerates into fibrous tissue;
- with gangrenous – there is gangrene or necrosis of the coronal or partially the root tissue inside the tooth;
- in hypertrophic pulpitis, hypertrophy (proliferation) of soft tissue occurs, which can often occupy the entire carious cavity – the so-called “wild meat”.
Chronic pulpitis usually manifests itself only with aching pains and weak sensitivity from stimuli (especially hot). Pain may have an individual duration, often repeated over several months with varying regularity.
As a rule, certain triggers (stress, hypothermia, flu, etc.) lead to a decrease in the body’s defenses with the development of an exacerbation of chronic pulpitis, when the entire history of acute pain recurs, bringing new suffering.
“I don’t like to go to the doctors at all, so I waited. Terribly sick tooth for several days, had to swallow pills, and then, about a miracle, the tooth stopped hurting! I even thought – well, it must be the same, really everything has resolved, and now the doctor does not have to be recorded. And then after a week I felt some kind of thing on the gum above the diseased tooth, such as an ulcer and the taste of it was so nasty. Purely intuitively guessed that this pus comes out. In general, I could not manage without a doctor – everything was drilled out to me, channels were cleaned, the tooth was already dead. ”
Options for the development of pulpitis in different groups of teeth
Pulpitis can develop on any tooth, but there are certain groups of teeth that are most often prone to such a lesion. The first place in terms of frequency of occurrence is occupied by the first molars or, otherwise, the sixth teeth, which appear among the first (at the age of 6) and are in the most unprotected zone, often having deep and closed fissures (pits). When a child’s spots appear on these areas, the parents do not immediately understand what it is, but as the process deepens every day the moment approaches when the child begins to complain of strong spontaneous pain in the tooth – this is pulpitis.
From the front teeth, pulpitis most often develops on the central and lateral incisors. Fangs are least prone to caries due to their massiveness and structural features.
The lower front teeth, as a rule, are the least susceptible to the development of caries and in the future – pulpitis due to the high degree of their saliva washability. Since saliva is a kind of “liquid enamel”, it is precisely in this group of teeth that the lost mineral components (calcium, phosphorus) return faster.
However, one should not forget that despite this “luck” of the lower front teeth in terms of the risks of developing caries complications (pulpitis and periodontitis), the lower teeth are more prone to depositing dental calculus on them just because of the same highly mineralized saliva ( see the example in the photo).
The most dangerous complications of pulpitis
The most dangerous complications of pulpitis occur on the background of long-term patience of pain or regular use of painkillers. Most often, pulpitis develops acute or chronic periodontitis – inflammation of the tissues around the root.
In the acute form of periodontitis, in most cases, people go to a dental clinic for the reason that there are very strong throbbing pains, and it is simply impossible to touch the tooth, sometimes even the tongue. Often at the same time the body temperature rises and there is a feeling that the tooth seems to have “grown”. If a doctor is approached at this stage of the process, then after the treatment of the tooth and penetration into the area where the pulp should be located, an abundant pus with an unpleasant odor comes out of the channel.
In chronic forms of periodontitis the most unpleasant are the formations on the gum – fistula. These are the channels that depart from the inflamed root of the tooth and from which periodically there is a foul-smelling pus that makes it easier for a person to suffer for the time being.
The most difficult to treat and dangerous to health is chronic periodontitis associated with the so-called cysts. Some people are well aware of the possible growth of tissues around the root in the form of granulomas and cysts, since they saw this picture after the removal of their tooth. These “purulent pouches” on the removed teeth hang from the roots, having a color ranging from red to bluish color. This picture leaves no one indifferent and is remembered for a long time.
For more information about the formation of a cyst on the root of a tooth, its danger to health and possible complications during removal, see a separate article.
If you thought that this horror ends, you will have to disappoint. The above-mentioned complications of pulpitis were “peaceful” themselves, which most often lead only to tooth loss, but there are diseases that affect the general human health: periostitis, osteomyelitis, abscess, phlegmon, sepsis.
Periostitis is an inflammation of the periosteum of the jaw against the background of the spread of pus under it. As a result, the state of health worsens, the temperature rises to high values, the shape of the face may change, there is a feeling of spreading in the gums near the patient’s tooth. Often, after these severe conditions, a person more than once regrets that he did not treat relatively innocent pulpitis in time.
Osteomyelitis is the melting or dissolution of the bone, when the purulent process covers the jaw spaces so much that, in addition to the diseased tooth, the teeth adjacent to it begin to loose.
With the long-term development of osteomyelitis, a person may seek the help of a dentist-surgeon to eliminate the source of infection, but the result of the removal of a diseased tooth can become a piece of jaw or fracture with it. Since in the process of progression of osteomyelitis, the bone becomes less durable due to its “dissolution”, even a small effort often leads to its injuries of varying severity.
Abscess (limited purulent inflammation) and phlegmon (diffuse purulent inflammation) are diseases that develop against the background of complications of pulpitis and often lead to death. They are associated with active germination of the source of infection in the space between the muscles, where the vital formations (vessels, nerves) are located.
In the photo below – phlegmon:
Sepsis is the contamination of the blood with toxic products of infection, leading to intoxication of the body, disruption of its protective forces and, ultimately, sometimes death.
How to independently recognize pulpitis
In order to prevent serious complications in time, it is useful to be able to independently recognize pulpitis at its very first symptoms. Diagnosing yourself is not so difficult.
In the event of the occurrence of dental pain, one should first of all understand their nature: in case of caries, there is no acute spontaneous pain, it appears only from external stimuli. With acute pulpitis and its aggravation there are both of these signs. And in case of acute periodontitis, the tooth is most often not allowed to touch at all, the state of health may deteriorate, the hotter dramatically increases the already unbearable throbbing pain.
Chronic pulpitis is more difficult to detect, but with the possibility of inspecting the cavity, it becomes easier to recognize pulpitis. If the carious cavity is occupied by some kind of soft tissue, then most likely chronic hypertrophic pulpitis develops. If a long aching pain occurs when food gets into the tooth, then the likelihood of an open nerve is high, as with fibrous or gangrenous pulpitis.
Chronic periodontitis has much in common with chronic pulpitis, but only with chronic forms of periodontitis can there be fistulae on the gum near the diseased tooth. Only with periodontitis, the gum near the tooth can swell up, hurt, and pus is often released from under it.
Despite the possibility of self-diagnosis, the final diagnosis can only be made by a dentist, after conducting a set of diagnostic measures (examination, palpation, percussion, thermometry, EDI, X-ray).
The photo below shows the visiograph for radiography:
Treatment and prevention of pulpitis
After determining the pulpitis, the doctor draws up a plan for his treatment. There are 3 approaches to the treatment of pulpitis: with the preservation of the entire nerve, with its partial removal, with the complete extraction of the pulp from the system of equine canals.
The first way to preserve the entire pulp in a viable state does not currently find popularity due to frequent complications, so doctors usually prefer the latter option. Partial removal of the pulp is also used, but only when it is not possible to go through the entire canal due to its complex structure or the presence of foreign bodies in it.
The main importance in the full treatment of pulpitis is a good drug treatment of the canals and their filling to the physiological apex (apex). For this, anesthesia is done, the canals are processed with special tools like needles (files), washed with antiseptic solutions and sealed with hardening pastes with gutta-percha pins or without them.
Often the treatment of pulpitis takes from 1-2 to 3-4 visits. This is due to the approach to treatment, with or without the use of pastes for necrotization of the “nerve” (arsenic or not containing arsenic), with the production of special antiseptics or drugs for additional disinfection of the channels, calculated for several days.
For more information about the interesting nuances of the treatment of pulpitis, see the article Modern methods of treatment of pulpitis.
Normally, after treatment of pulpitis, there should be no pain. With limitations, post-filling pain is allowed after treatment for no more than 5-7 days, which manifests only discomfort when biting on a tooth (especially solid food).
In order to prevent the development of pulpitis, timely treatment of caries occurring on the tooth is important. This is a minimum program. With regard to the maximum program, you should start prevention before the occurrence of caries, and follow the recommendations aimed at strengthening the teeth and their protection:
- To carry out cleaning with toothbrushes and toothpastes of all available surfaces of the teeth every time after eating;
- To clean the zones of gaps between the teeth with floss (threads);
- Do not abuse the sweet;
- Perform professional hygiene 1 time in half a year (cleaning of plaque and stone);
- To carry out remineralizing therapy and deep fluoridation of all teeth in consultation with the dentist.
Implementation of these recommendations will not only allow you to never feel the full horror of pulpit pain, but also protect your teeth from the development of caries.