Modern dentists offer quick and painless dental treatment. But often people come to the doctor when the tooth is already badly damaged, and the pain becomes unbearable. And they hear an unpleasant diagnosis – “pulpitis”. Then questions arise – what is it, how to treat it and how to prevent the occurrence of this disease.
What is it ↑
Pulpitis of the tooth is a process of inflammation in the pulp (neurovascular bundle) of a tooth. It occurs as a result of various stimuli, such as microorganisms, entering the pulp. As a rule, is a complication of caries.
Symptoms of pulpitis depend on the severity of inflammation. and whether the disease is chronic or acute.
The most characteristic signs are:
- Acute spontaneous throbbing pain.
- The pain can be given to the neck, temple, ear, and throat.
- The pain becomes stronger in the evening and at night, as well as in the supine position.
- An external examination of the tooth most often reveals a deep carious cavity.
- May smell from the mouth.
Causes of the disease ↑
There are five main causes of this disease:
- Unhealed caries.
- Inappropriate treatment.
- Damage when turning the teeth.
- Diseases of the gums.
Launched caries is the main cause of pulpitis.
In the carious cavity of the tooth, favorable conditions are created for the vital activity of the pathogenic microflora. Over time, microbes and toxins (microbial waste products) penetrate into the pulp and develop dental pulpitis.
The deeper the carious cavity, the greater the likelihood of development.
Photo: Unhealed caries is a common cause of pulpitis.
Timely treatment of caries does not guarantee one hundred percent protection against the inflammatory process under the filling, especially if the dentist acted incorrectly.
A common cause of occurrence – the wrong actions of the doctor during treatment.
For example, a dentist may accidentally leave a piece of carious tissue under the filling.
It is possible to dry the bottom of the tooth cavity with a stream of air during treatment. In this case, developing inflammation without the participation of microbes (aseptic).
In some cases, dental pulpitis can occur as a result of damage when turning the teeth.
This pulpitis is also called "pulpitis under the crown." When the doctor turns the “living” teeth under the crown, a pulp burn may occur. This is due to poor cooling or haste, inaccuracy of the doctor during the procedure.
In this case, it begins to disturb not immediately after the installation of crowns, inflammation appears gradually.
Another common cause of gum disease is parodontosis.
Bone tissue is destroyed, the root of the tooth becomes bare, and this makes it possible for pathogenic bacteria to penetrate the pulp through the glen pockets.
Parodontosis in the early stages can be detected only by taking an X-ray,
Pulpitis may occur with a jaw injury, for example, in athletes.
At the same time, a part of the tooth breaks off, the pulp becomes bare, due to which the infection easily penetrates the tooth.
Types of pulpitis:
All types of acute pulpitis are characterized by spontaneous, paroxysmal pain, which is aggravated at night.
Acute focal pulpitis is the initial stage of inflammation of the tooth pulp.
- The pain of any kind of irritant (usually cold, after the removal of the irritant, the pain does not decrease).
- The pain arises suddenly, intensifies in the evening and at night.
- The duration of painful attack – ten, twenty minutes, "bright" intervals can reach several hours
- Edema of the surrounding soft tissue with soreness of the lymph nodes.
Examination of the oral cavity of the affected tooth can reveal an extensive and deep carious cavity, as well as a large amount of softened dentin.
Acute focal pulpitis becomes acute diffuse, in which the entire coronal, and then the root pulp is involved in the inflammation.
- Prolonged painful attacks, “light” intervals are short.
- Violent, throbbing pain that adversely affects the quality of life.
- Increased pain in lying position.
This type of pulpitis is characterized by a purulent focus in the cavity of the tooth (abscess).
The disease is accompanied by a deterioration in the patient’s well-being. The pain is throbbing, constant, there are no painless gaps (as opposed to focal and diffuse).
Outwardly, it looks like a deep carious lesion in a diseased tooth. At the bottom of the cavity of the tooth appears purulent discharge, the output of which can ease the pain.
Chronic pulpitis may develop on its own, or it may be a consequence of an acute illness.
Only two factors are enough for development:
- Open cavity in tooth
- Untreated acute process.
Most often this type of chronic pulpitis occurs. Is a consequence of acute. It is characterized by pain of less intensity than in acute, a decline in edema.
The duration of the stage is up to several months, during which the process may escalate.
Patients complain about:
- Intense aching pain, possible reaction to various stimuli (temperature, chemical, mechanical). Especially strong reaction to the cold.
- Pain can occur when moving from a warm to a cold room.
- Smell from the mouth (food remains in the carious cavity rot)
- Severe destruction of a diseased tooth.
What does a tooth look like
On examination, an extensive carious cavity revealed in one place and sharply sensitive to pressure. Very large amount of affected dentin tooth. Possible change in tooth color.
This stage of chronic pulpitis has two clinical forms:
- Granulating – granulation tissue grows from the cavity of the tooth into the carious cavity).
- Polyp pulp – later stage of the disease. At the same time, the overgrown pulp tissue is covered by the oral gingival epithelium.
Photo: Polyp Pulp
- Bleeding out of a tooth while eating.
- Pain when hard food enters the tooth.
- In the carious cavity of the tooth, a growth is visible, and therefore the appearance of the tooth causes concern.
What does a tooth look like
In the carious cavity there is a lot of fabric of bright red color, which bleeds when lightly pressed. Soreness moderate.
Polyp pulp is dense, pale pink in color, there is no bleeding when pressing, bleeding is weak. The causative tooth and the area next to it are covered with bloom, because the patient spares this side when chewing. Reactions to temperature stimuli are weak.
Photo: Hypertrophic pulpitis
Else called pulp necrosis. Chronic gangrenous pulpitis is characterized by the death of pulp tissue cells. Develops with a long course.
Perhaps no complaints. With exacerbation of the disease – aching pain. May occur for no reason, with short "light" intervals. The pain increases from the hot, the cold calms her down a little.
What does a tooth look like
The deep carious cavity, the coronal part of the tooth is destroyed.
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When exacerbation of chronic pulpitis is characterized by complaints of sudden sudden attacks of pain in the region of the causative tooth or jaw.
Painful attacks can last for several hours, the "bright" intervals are short. Irritants increase pain.
On examination, a deep carious cavity is revealed, communicating with the dental cavity. When sensing (pressing) the entrance to the dental cavity, pain is observed. If there is no entrance to it, the sensing is accompanied by pain all over the bottom. Significant reaction to percussion (tapping). The mucous membrane around the tooth is not changed.
Condition after pulp removal
The diagnosis “condition after removal of the pulp” is made if the patient has a seal in the previously pulped tooth.
The tooth does not bother, channels are not opened, percussion (tapping) is painless, transitional fold in the area of this tooth without pathology.
In this type of pulpitis, the inflammatory process first covers the root pulp, then spreads to the crown. That is, unlike other types of pulpitis, it is distributed not “from above”, but “from below”.
Patients complain of pains tearing and pulsating nature. Sometimes the disease proceeds without severe pain, like a chronic process.
The treatment of such pulpitis consists in trepanning (probing) the tooth, followed by extirpation (removal) of the pulp.
For periodontal diseases
When periodontitis occurs, conditions favorable for penetration into the pulp infection.
With medium and heavy periodontitis, deep periodontal pockets appear, with a depth of half the root length or more. They contain pathogenic bacteria that can enter the pulp through the openings of the root canals in the root tips.
One way to get an infection into the pulp is to get it through the blood.
This is possible after diseases such as chickenpox, influenza, sepsis. Infection through the blood vessels enters the pulp of the tooth and causes inflammation.
Occurs more often than in adults.
This is due to the following factors:
- A large volume of pulp chamber (a thin layer of enamel and dentin),
- Less mineralized than in adults, dentin (dentinal tubules wide and short)
- Loose fibrous tissue, wide root canals and apical holes.
- The child has not fully formed the central nervous, endocrine and immune systems, which increases the likelihood of an inflammatory process and its transition to the acute stage.
Features of the course of the disease in a child
Pulpitis in children is more severe than in adults. Accurate diagnosis is more difficult, children do not tolerate the examination, they do not always correctly assess their feelings, both during the examination and before.
Pulpitis in its initial form (in the presence of even a shallow carious cavity) in children often remains imperceptible. Because of this, the parents do not immediately show the child to the doctor, and the short-term phase of acute partial inflammation may, in a short period of time, enter a common phase.
Pulpitis of temporary teeth occurs very often. Inflammation of the pulp in the overall structure of the incidence of children ranges from 35 to 50% and this number increases, and the age of the diseased is characterized by a tendency to "rejuvenate."
Early treatment in most cases allows you to save it.
If the child allows you to make an anesthetic injection, the doctor at the same visit can remove the carious foci of the baby tooth and the crown pulp.
After that, he will leave a special medicine in the cavity and mouth of the canals, disinfecting the remaining tissues, causing their mummification. This is done to prevent possible complications.
Do I need to treat it?
Many parents mistakenly believe that it is not necessary to treat this disease with temporary teeth, it will fall out anyway, it is easier to remove.
It is necessary to treat, since possible complications can lead to the damage of the bud of the future permanent tooth.
Video: treatment of pulpitis in children
Pulpitis of permanent teeth with formed roots in children proceeds in the same way as in adults. Severe pain occurs in older children and adolescents.
Diagnosis of the disease ↑
Diagnosis consists in examining the patient’s oral cavity by a specialist, identifying complaints and removing the x-ray of the patient’s tooth. Only after a complete diagnosis of the disease is necessary to treat.
The treatment is aimed primarily at removing inflammation of the pulp.
First aid and folk remedies
When providing first aid, it should be remembered that with acute partial or acute general pulpitis, thermal effect reduces pain, and with acute purulent pulpitis this effect has a cold.
If you gently remove food debris from the carious cavity, and then add a cotton ball with aspirin or other anesthetic preparations, it will help reduce pain.
Along with this, it is recommended to take painkillers such as Ketorol, Ketanov, Dexalgin, Naiz, Amidopyrine, Piminala and others.
Photo: Ketanov analgesics (left) and Dexalgin (right)
You can try to remove the pain, or at least reduce its folk remedies:
- Grate the wrist from the inside with a half of garlic and tie the same slice to the pulse area, having previously placed a thin layer of cloth or a bandage under it. On the right hand is tied, if the tooth hurts on the left side, and on the left, if on the right side.
- If there is propolis at hand, put a pea on a bad tooth, covering it with a cotton swab and hold for 15–20 minutes.
- Take a slice of salted pork fat. Clean off the salt. Put the slice on the sore spot, between the gum and cheek. Hold the slice in your mouth for 15-20 minutes until the pain subsides.
Photo: Garlic and propolis for relieving toothache
Video: toothache treatment at home
Treatment in dentistry
In dentistry, there are several ways to treat pulpitis:
- Conservative or biological. The treatment is aimed at improving the pulp with the restoration of its function. The emphasis is on its full restoration or preservation of the main functions: protective, trophic (nutrient) and plastic.
- Surgical method. This method consists in partial or complete removal of the tooth pulp. Depending on whether the nerve is preliminarily killed, and whether the whole pulp is removed, the surgical method is divided into:
- Method of vital amputation. The essence of the method consists in the simultaneous removal of coronal pulp under anesthesia without killing the nerve.
- Vital vitalization method – complete removal of the pulp under anesthesia in one step, without first killing the nerve.
- Devital amputation method. Removal of the coronal pulp with the preliminary killing of the nerve. Produced in several stages.
- Devital Extreme Method. Complete removal of pulp in several stages, with a preliminary killing of the nerve.
It happens that a tooth hurts after treatment. Panic is not worth it, since the pain that occurs after dental treatment is normal and disappears in two or three days. If the pain during this period has not passed and affect the quality of life, you should contact a specialist.
Photo: Pulpitis before and after treatment
On different types of teeth ↑
Unfortunately, pulpitis occurs on all types of teeth.
When pulpitis of the front teeth, the inflamed pulp can shine through the transparent layer of enamel, possibly giving back pain to the opposite side of the jaw.
Treat using strong painkillers. The choice of treatment should be very meticulous. Indeed, aesthetics is doubly important for the front teeth.
Three channel tooth
Three tooth roots are three pulps, respectively, three-channel pulpit is a rather difficult task for dentists.
It is possible to do without killing the nerve (vital method), but this is possible only if more than 50–60% of the tooth surface is stored.
Wisdom teeth too can comprehend such ailment. Symptoms are the same as on other teeth (acute, sharp, sometimes intolerable pain), has the same varieties.
The treatment of the wisdom tooth is similar to the treatment of other teeth and is carried out if there is good access to the tooth. But this is rare, in connection with which more often it is simply removed.
The bacteria from the affected pulp eventually penetrate the tooth and cause inflammation in the tissues surrounding its root, that is, periodontitis.
This condition requires more prolonged treatment, often the periodontitis-affected tooth is removed.