Chronic pulpitis – This is a chronic inflammation of the dental pulp. It can be either the outcome of acute inflammation (acute pulpitis) or develop independently. Many factors influence whether the inflammation will initially be acute or chronic. This is our own immunity, capable or incapable of a violent response in response to an irritant. And the properties of this stimulus: its strength, exposure time.

There can be many causes of chronic pulpitis:

- caries (the most common). It is known that the pulp reacts even to a shallow carious cavity. But these changes can only be detected at the microscopic level. And if the cavity is deep, then its microorganisms, along with their toxins, are able to penetrate through the dentinal tubules and dentinal fluid into the pulp chamber. And ultimately cause inflammation of the pulp.

- marginal periodontal diseases. In the case of these diseases, the dentogingival attachment is destroyed. As a result, plaque microorganisms have the opportunity to settle on the tooth root. And from there, through the lateral canals or the apical foramen, you can directly reach the pulp.

- injury. Acute - for acute, chronic - for chronic pulpitis. Chronic tooth trauma is most often its overload. It occurs due to malocclusion, oversized fillings, or orthodontic apparatus. In response to such exposure, various pathological changes may appear in the pulp, including chronic inflammation.

— iatrogenic factors. It is no secret that different stages of dental treatment can provoke such a response from the pulp. During preparation, this is overheating, vibration, and accidental opening of the pulp chamber. When filling with modern composites, there is a violation of the etching regime, adhesive technique, and exposure to light from a polymerization lamp. Carrying out professional hygiene, for example, using high-frequency ultrasound, can also cause inflammation of the dental pulp.

- idiopathic (unclear) causes. When there is no visible local reason for the development of pulpitis. In other words, out of the blue.

Chronic pulpitis clinic

Chronic inflammation of the pulp differs from acute inflammation by the appearance of the third phase of inflammation - proliferation. Thanks to this stage, inflammation is limited and its intensity decreases. Because of this, the chronic pulpitis clinic has its own characteristics:

— the process is very lengthy, can take from several weeks to several years;

- pain in response to stimuli is not severe. And it is not too different from that with deep caries. And if the cavity - the cause of pulpitis - is located in some hard-to-reach place (for example, on the proximal surface), then the patient may not be bothered at all. Pain is provoked by different factors, which ones depend on the form of chronic pulpitis.

Chronic forms of pulpitis

There are several chronic forms of pulpitis. And, as often happens, their names differ in different classifications. The most used classifications of chronic pulpitis are ICD-10 and E.M. Gofung.

Chronic pulpitis according to Gofung:

Chronic pulpitis: 1) simple;

2) hypertrophic;

3) gangrenous.

Chronic pulpitis according to ICD-10:

K04. Diseases of the pulp and periapical tissues.

K04.0. Pulpitis.

K04.03. Chronic pulpitis.

K04.04. Chronic ulcerative pulpitis.

K04.05. Chronic hyperplastic pulpitis.

K04.1. Pulp necrosis.

These names are simply related, with the exception of chronic ulcerative pulpitis(ICD-10). Gofung has no analogue.

You can also find such a name for chronic (simple) pulpitis as “chronic fibrous” (by analogy with chronic fibrous periodontitis). This name originally appeared in the classification of KMI (Kyiv Medical University) and is still used in the literature.

To more conveniently describe each form of chronic pulpitis, you can use the following diagram:

Results main research methods:

1. Survey
2. Inspection
3. Probing
4. Percussion
5. Palpation

Results additional research methods:

1. Electroodontodiagnosis (EDD)
2. X-ray

Chronic fibrous pulpitis

Chronic fibrous pulpitis, also known as chronic simple/chronic pulpitis:

1. Survey

During the interview, we find out what worries our patient tooth pain. Her description:

• occurs in response to irritants - temperature (too cold or hot, sudden change in external temperature), chemical (sweet), mechanical (from food, toothpicks).
• aching, does not go away for a long time after the impact of the cause of the pain has stopped.

According to these symptoms, you can conduct another study - a thermal test. The reaction to it in case of chronic simple pulpitis will be positive.

But! There may be no pain at all, then they talk about asymptomatic pulpitis.

Our patient can also tell you that the tooth hurt before. The cause of the pain could be caries, the complication of which was inflammation of the pulp. Or acute pulpitis, which has become chronic.

1. Inspection

Of course, the patient’s appearance does not cause concern. Only the desired tooth attracts attention, namely the deep carious cavity in it (if pulpitis is a complication of caries), which may also be under a filling. The tooth cavity is most often not opened. If you open it during preparation, the inflamed pulp bleeds and hurts.

1. Probing

The bottom of the carious cavity is painful at one point - the projection of the closest part of the pulp. !Difference from deep caries: the entire bottom there is sensitive, all of its peripulpar dentin.

1. Percussion is painless.
2. Palpation of the transitional fold in the area of ​​the apex of the tooth root is also painless.

There are no reasons for the appearance of pain during percussion and palpation: inflammation occurs only in the cavity of the tooth. And the surrounding tissues are not involved in it (yet).

1. EDI – 40-60 microamps. But it can also give a false result, the indicators are normal (2-6 µA).
2. X-ray is a carious cavity if it is the one that caused inflammation of the pulp. There are no changes in the periapical tissues. But with increased reactivity of the body, there may be, for example, an expansion of the periodontal gap.

Chronic ulcerative pulpitis

Chronic ulcerative pulpitis is very similar to chronic simple pulpitis. Common complaints will be the results of additional studies, percussion and palpation. But there are also differences (during inspection and probing):

Unlike chronic simple pulpitis

• there is a communication with the tooth cavity.
• The pulp at the site of communication has a characteristic appearance: an ulcerative surface that may be covered with a layer of necrotic plaque.
• the reaction to probing is painful or slightly painful, the pulp bleeds.

Chronic hypertrophic pulpitis

Chronic hypertrophic pulpitis, also known as chronic hyperplastic pulpitis (CHP), most often develops if the tooth crown is severely destroyed + the cervical edge of the tooth is one of the walls of the carious cavity. This creates conditions for the inflamed hypertrophied pulp to grow there. Young age is also an important, but not the primary condition. The fact is that the higher the reactivity of the body, the higher the probability of such active growth of pulp elements.

1. Survey. To the complaints of aching pain, as with chronic simple pulpitis, several more are added:

• growth of “wild meat” in the tooth or in its place;
• its bleeding, pain, especially when eating, when it is injured by antagonist teeth and food.

1. Inspection.

We see a carious cavity filled to a greater or lesser extent with soft tissue. It may vary in color and consistency. It depends on the degree of its maturation. Young tissue will be bright pink, even red, soft, similar to granulation tissue. More mature tissue, the so-called “pulp polyp,” is tumor-like, pale pink, and dense.

1. Probing.

Also different, for the same reason. Immature tissue bleeds easily and is painful. Probing the formed tissue does not lead to bleeding and is slightly painful.

4, 5. Percussion and palpation are painless.

1. EDI – 20-40 µA.
2. X-ray - no changes.

Another distinctive feature of this chronic pulpitis is a negative thermal test: the tooth does not respond to temperature stimuli.

Chronic gangrenous pulpitis

Chronic gangrenous pulpitis (pulp necrosis) is the death of pulp cells. The cause of this outcome may be inflammation or injury.

1. Survey

Our patient is bothered by aching pain from various irritants. He is exhausted, because after eliminating the influence of these irritants, the pain does not go away, it goes away slowly. The pain is especially pronounced in response to heat. It hurts both from hot tea and from a sudden change in temperature (for example, entering your warm apartment from a frosty street). He can remember what hurt worse in the past. Some “lucky” people may not be bothered by pain at all. Or maybe the complaint is about something else - bad breath.

Patients may also be concerned about discolored teeth. This is especially true if the causative tooth is located in the frontal region. Tooth enamel with pulp necrosis becomes gray. This complaint may even be the only one if the death of the pulp occurred as a result of injury. It would be a good idea to ask about it during the survey.

1. Inspection

The gray color of the tooth enamel, a deep carious cavity, and a large connection with the tooth cavity are visible to the naked eye. The pulp is dirty, dark, in the form of a pulp, with a fetid odor. In the coronal part it can completely disintegrate.

In the case of pulpitis from trauma, the tooth looks intact, only the darker color of the enamel gives it away. The pulp in this case has the appearance of a dry strand, and not a shapeless mass. This is because the cause of its death is not microorganisms with their toxins, but poor circulation.

1. Probing

The pulp becomes necrotic, and along with it the nerve endings die. Only in distant areas of the pulp (its mouth or, even further, in the root canals) does pain and bleeding persist.

This probing feature helps distinguish pulp necrosis from other similar conditions. For example:

• The pulp in chronic ulcerative pulpitis has a similar appearance. However! its sensitivity is still preserved in the coronal part.
• Chronic apical periodontitis is quite another. In such a tooth there is nothing left of the pulp, and any endodontic instrument will not cause any discomfort.

1. Percussion can already be painful, but periodontitis is nothing at all.
2. Palpation of the transitional fold is still painless.
3. EDI – up to 90 µA (almost complete disintegration of the pulp).
4. X-ray: expansion of the periodontal fissure and destruction of bone in the apical area are possible if the infection has already affected the adjacent periapical tissues in addition to the pulp.

Exacerbation of chronic pulpitis

The clinic for exacerbation of chronic pulpitis is the same as for an acute condition, acute pulpitis. The exception is information that the patient can tell. The fact that the tooth has been bothering me for a long time has already hurt as much as it hurts now. Or report some factor that could provoke an exacerbation of a sluggish process (hypothermia or a photofill of a tooth in which pulp inflammation was not suspected). More information about the clinic of exacerbation of chronic pulpitis can be found in the article “ Acute pulpitis».

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The article was written by O.V. Titenkova. Please, when copying material, do not forget to provide a link to the current page.

Chronic Pulpitis updated: February 24, 2018 by: Valeria Zelinskaya

Chronic hypertrophic pulpitis is characterized by its own developmental features, clinical picture and diagnostic methods

(pulp polyp) is a form of pulp inflammation in which proliferation phenomena predominate. According to the international classification, ICD-10 has the code K04.05.

Symptoms of chronic hypertrophic pulpitis

What should be distinguished from chronic hypertrophic pulpitis?

This form of pulpitis should be differentiated from the growth of the gums in the presence of a class 2 cavity, as well as from the growth of granulation tissue from the periodontium through the destroyed bifurcation (trifurcation) of the roots into the carious cavity of the tooth. Remember that only a qualified dentist can correctly distinguish between these diseases and make the correct diagnosis. We will only indicate some signs that will help distinguish these diseases:

1. Type of lesion. The overgrown gingival papilla can be pushed back by running a probe along the edge of the tooth crown.
   The growth of granulation tissue from the periodontium can only be determined by a doctor, because This will require the use of special techniques.

Treatment

First, infiltration or conduction anesthesia is administered to numb the tooth. Then the pulp polyp is removed and all destroyed dentin and enamel are carefully removed, a small amount of arsenic paste is added to the communication with the pulp and a temporary dressing of aqueous dentin is applied. After 24-48 hours, the temporary filling is removed along with the arsenic paste, and the roof of the cavity is removed using a boron. Then the coronal and root pulp is removed. They pass and form the correct conical shape of the root canal. Then it is filled, and then, using a photopolymer, the anatomical shape of the tooth and its functional usefulness are restored. You can read more detailed information in the article "".

Forecast

Patients suffering from such an ailment as chronic hypertrophic pulpitis often turn to dentists. It represents the stage of pulpitis, at which the connection of the carious cavity with the pulp chamber occurs. Under the influence of the pathological process, the pulp tissue grows, and a polyp appears, which occupies the entire tooth cavity.

When pulpitis progresses to the chronic stage, the unbearable pain characteristic of the acute stage of the disease disappears, and other unpleasant sensations appear instead. A person cannot chew food normally because chewing is accompanied by pain. Blood may ooze from the cavity while eating and brushing your teeth.

Attention! Chronic hypertrophic pulpitis is also called pulp polyp. The disease is an inflammation of the neurovascular bundle of the tooth, in which proliferation phenomena are observed.

According to the international classification of diseases ICD-10, pathology is designated by code K04.05.
Dentists distinguish two forms of this disease. The granulating form is characterized by the growth of granulation tissue located in the pulp chamber into the carious cavity. The pulp polyp is accompanied by the formation of oral gingival epithelium on its surface. This stage of the disease occurs later.
The cause of the disease is the transition of acute pulpitis to the chronic phase. In some cases, there is no acute course of the disease, but the chronic form develops immediately.
A person suffering from chronic pulpitis complains of pain and bloody discharge from the tooth when exposed to it. He feels how granulations protrude from the carious cavity.
Carrying out an examination, the dentist observes the following picture: red pulp tissue is visible in the carious cavity; touching it with a probe causes slight pain. If a polyp has formed, it will have a light pink color and a dense consistency. Probing it does not cause bleeding or severe pain.

Pulpitis is an inflammation of the internal tissues of the tooth - the pulp, which is located inside the dental canal and contains the nerve, blood vessels, connective tissue cells and provides nutrition to the hard tissues of the tooth from the inside.

Since the patient cannot chew on the side where the problem tooth is located, a lot of soft plaque accumulates in this area. The tooth reacts weakly to increases or decreases in temperature. The x-ray shows that there are no changes in the periapical tissues.
When making a diagnosis, the doctor must be able to distinguish chronic hypertrophic pulpitis from the growth of the gingival papilla and overgrown granulations from perforations in the bottom of the tooth cavity.

Symptoms

• Painful sensations. Various irritating factors can provoke pain. In some cases, there is no pain, but blood may ooze from the tooth. The patient cannot chew food on this side.
• Specific appearance of the tooth. At this stage of the disease, the crown of the tooth is almost completely destroyed, and pulp tissue protrudes from the carious cavity. If a polyp has formed, it looks like a pale pink tumor. Since a person has to use only the healthy side of the jaw while eating, heavy plaque begins to accumulate around the diseased tooth.
• Bad breath. Due to the pain, the patient cannot brush his teeth normally, and this leads to the appearance of a bad odor. However, it should be remembered that this symptom is not specific and is also observed with other ailments.

One of the symptoms of chronic hypertrophic pulpitis is bad breath, which occurs due to the lack of ability to properly care for the oral cavity.

The doctor must distinguish chronic pulpitis from gingival overgrowth, if a class II cavity is detected, as well as from the overgrowth of granulation tissue from the periodontium through the destroyed root branching zone.

Types of chronic hypertrophic pulpitis

There are two types of the disease:

1. The appearance of granulations. In this case, granulation tissue begins to grow from the pulp chamber into the carious cavity. This happens because the body seeks to fill the empty space in the tooth and triggers a compensatory mechanism.
2. Polyp of the neurovascular bundle. A polyp develops as the disease progresses to a deeper stage. At this stage, there is a strong ingrowth of gingival epithelial cells into granulations that have grown from the pulp chamber.

In this image, the granulation degree of chronic pulpitis, the pulp begins to grow from the pulp chamber into the carious cavity.

Clinical picture of the disease

Important! The disease is characterized by aching pain that appears when pieces of hard food get on the tooth, as well as when eating hot and cold. In the carious cavity, overgrown pulp tissue is visible, which looks like meat. When mechanically applied, blood begins to ooze out of it.

Patients often tell the doctor that they used to experience quite severe spontaneous pain, and then it went away on its own. This may indicate that pulpitis has entered the chronic stage.
On examination, the dentist reveals a large carious cavity containing soft, bleeding granulations. Probing these granulations does not cause severe pain. When the probe touches the pulp itself, acute pain appears. Having examined the polyp, you can see that its stalk grows from the pulp chamber.
When the disease is at an early stage, the sprouted tissue has a bright red hue. If the disease is advanced, the polyp acquires a light pink color, corresponding to the natural shade of the oral mucosa. Tapping the tooth and palpating the soft tissue around it does not cause pain.

Additional diagnostic methods

Electroodontodiagnostics is a method of dental research based on determining the threshold excitation of pain and tactile receptors of the dental pulp when an electric current passes through it.

The dentist may conduct several additional tests to confirm the diagnosis.

• Thermal test. In chronic hypertrophic pulpitis, the thermal test is usually negative, that is, the tooth does not respond to thermal stimuli.
• Radiography. The x-ray shows that the carious cavity is connected to the pulp chamber, and the periapical tissues are not affected.
• Electroodontodiagnostics. The study shows that the electrical excitability of the neurovascular bundle is below normal (less than 40 μA).

Similarities and differences with other diseases

Chronic hypertrophic pulpitis has some similarities with such pathologies as the proliferation of the gingival margin and the growth of granulation tissue from the periodontium in the upper part of the tooth or from the root bifurcation zone, so the doctor must conduct a thorough examination to correctly diagnose.

Chronic hypertrophic pulpitis has similar features to such pathologies as the growth of the gingival margin and the growth of granulation tissue from the periodontium in the upper part of the tooth.

To differentiate chronic hypertrophic pulpitis from overgrowth of the gum edge, you need to examine the affected tooth with a probe. Under the granulations there is a carious cavity with softened dentin, but it is not connected to the pulp chamber.
When granulations grow not from the pulp chamber, but from the periapical tissues, the tooth does not respond with pain to deep probing. This sign is the main difference, since when probing the polyp the patient experiences acute pain. When examining granulations that have grown through a bifurcation with a probe, it is possible to identify a defect in hard tissue in the root branching zone. This is clearly visible on an x-ray.

Treatment methods

Attention! Chronic hypertrophic pulpitis can only be cured surgically. There are two methods: partial and complete pulp amputation.

The doctor chooses the most appropriate option depending on the course of the disease and the degree of pulp damage. The operation to remove the neurovascular bundle is performed under local anesthesia, as it is very painful.
Partial pulp amputation involves excision of only its coronal part. If the pulp is completely affected, it is necessary to remove not only the upper part, but also the root part.

The photo shows the appearance of the removed tooth pulp.

Complete pulp amputation

In this case, the operation is carried out in two stages: first, the coronal part of the neurovascular bundle is removed, and then the root part.
After excision of the pulp tissue, it is necessary to stop the bleeding so as not to provoke the development of complications. After the bleeding has stopped, the doctor disinfects the canal with an antiseptic, rinses it with water, dries it thoroughly and begins filling.

Important! Often, after complete amputation of the neurovascular bundle in a tooth that has several roots, canal obstruction may occur. In this case, medicinal electrophoresis with a solution of calcium iodide is used for treatment.

The doctor must check all root canals to make sure there is no inflammation. If at least one root canal is not treated, periodontitis may develop.

Complete depulpation takes place in several stages: opening the carious crown, cleaning the cavity. pulp removal, canal filling, crown restoration.

Partial pulp amputation

After removing the coronal part of the neurovascular bundle, the dentist treats the tooth cavity with an antiseptic and stops the bleeding.

Attention! The root part of the pulp, which remains intact, is covered with a pad of special dental paste, and a temporary filling is placed on top of it. The patient wears this filling for a week, and then comes back to see the doctor.

If the healing process proceeds normally, the dentist removes the temporary filling and installs a permanent one in its place.
To avoid complications after treatment of chronic hypertrophic pulpitis, the patient should undergo a dental examination at least once a year.
Chronic hypertrophic pulpitis must be treated in a timely manner and prevent its transition to advanced forms. Otherwise, the treatment will be long and difficult, and there is no guarantee that the affected tooth can be saved.

Hypertrophic pulpitis is a rare dental disease. It often happens that patients are first bothered by severe pain in the tooth, which then passes, and then bad breath and minor aching pain appear along with bleeding gums when chewing food, as well as while brushing their teeth. In this case, protruding neoplasms are felt in the tooth cavity.

The causes of hypertrophic pulpitis are, first of all, severe tooth destruction due to deep caries or trauma, as a result of which infection penetrates into the open pulp. Infection can enter the pulp chamber as a result of poor-quality treatment of a tooth affected by caries. Since this destructive process takes a long time, the pulp becomes inflamed and soft tissue grows in it with the formation of a polyp, therefore hypertrophic pulpitis has another name - pulp polyp.

In clinical practice, chronic hypertrophic pulpitis is distinguished in two forms:

• granulating, i.e. when granulation tissue located in the pulp grows into a tooth cavity affected by caries;
• polyp, a more severe stage of the disease, i.e. when the gingival papilla grows on top of the pulp. In this case, the gingival tissues grow together with the sprouted granulations, and at the slightest irritation the pulp begins to bleed.

Very often, children and adolescents suffer from this disease due to insufficient quality oral care.

How is the disease diagnosed?

Since chronic hypertrophic pulpitis in its external manifestations is similar to some soft tissue pathologies associated with the growth of the gingival margin and granulation tissue, the doctor must have experience and the necessary qualifications to make a correct diagnosis.

During a visual examination by a dentist, he sees a rather deep cavity affected by caries, in which there are soft granulation formations that release blood when pressed. When the probe touches the tumors, the patient does not experience severe pain, but if the probe is inserted deeper into the pulp chamber, acute pain occurs.

At the initial stage, the granulation tissue is bright red, and in a more advanced form, the color of the polyp changes to light pink. The polyp has a dense structure, and when the area of ​​the diseased tooth is exposed, the patient, as a rule, does not feel pain, although acute pain occurs when probing the polyp itself. Since patients, as a rule, begin to brush their teeth less often due to pain, a soft plaque forms in the area of ​​the diseased tooth, which is also detected during a visual examination. The x-ray shows the absence of a septum between the dental cavity and carious (periodontal) cavity.

In order to make an accurate diagnosis, the doctor may additionally prescribe the following examinations:

• thermal test, i.e. when a diseased tooth is exposed to thermal irritants. If the patient has chronic hypertrophic pulpitis, then the tooth does not react to irritants;
• a photograph taken using an x-ray, which reveals the connection of the pulp chamber with the cavity affected by caries;
• electroodontodiagnostics, in this case the threshold sensitivity of the pulp is determined when an electric current is passed through it.

How is hypertrophic pulpitis treated?

To treat hypertrophic pulpitis, the affected pulp is partially or completely removed through surgery. Due to the painfulness of the procedure, the patient is given local or general anesthesia.

If the pulp is partially removed, then its upper, coronal part is cut off. In order to remove all neoplasms in the pulp, it is necessary that they die; for this purpose, an arsenic-based paste is used, which is covered with a temporary filling for several days. Then the dead tissue is excised, the bleeding is stopped, the cavity is treated with antiseptic solutions to form root canals, which are subject to further filling with photopolymer materials. Before installing a permanent filling, the patient wears a temporary filling for a week, under which a special medical pad is applied.

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In the case of complete removal of the neurovascular bundle, the pulp is first partially removed, its upper part, and then completely, including the root part. Next, after stopping the bleeding, the cavity is treated with antiseptic and the channels are prepared for filling. In case of obstruction of the root canals, electrophoresis with drugs is used. At this stage, it is very important to properly treat all the canals of the molar tooth, so as not to cause inflammation in the future and, as a result, lead the tooth to periodontitis. The treated root canals are filled.

With timely and high-quality treatment hypertrophic pulpitis does not cause further complications, the patient stops pain and bleeding, and the restored tooth will again be able to perform its daily functionality associated with aesthetics and complete chewing of food. If you start treatment for this disease, you may face further complications, such as periodontitis, the treatment of which will be longer and more difficult.

Prevention measures.

In order to prevent the development of hypertrophic pulpitis, you need to be conscientious about maintaining high-quality oral hygiene and dental care; in addition, it is important to eat well and properly, i.e. consume as many healthy foods as possible, rich in minerals and vitamins, and, if possible, exclude unhealthy foods from the diet: candies, sweets and other carbohydrate foods. It is important to monitor the condition of your teeth; for this you need to conduct an independent examination, and if you identify unpleasant symptoms and pain during chewing food, visit the dentist as soon as possible.

Chronic pulpitis in dentistry is called inflammation that occurs in the pulp (soft tissue component) of the tooth. The abnormal process eventually leads to pathological changes in its structure. Pulpitis affects mainly patients aged 20 to 50 years, while most clinical cases are fibrous or gangrenous forms of inflammation, less than 1% of patients suffer from a pathology such as chronic hypertrophic pulpitis.

Causes and mechanism of disease development

The occurrence of chronic hypertrophic pulpitis is associated with the formation of granulations in the lesion, resorption of dentin and its subsequent replacement with osteodentin. In the granulating form of the pathological process, granulation extends beyond the pulp into the carious cavity. If the patient suffers from polypous GP, during diagnosis mushroom-shaped soft tissue growths covered with numerous ulcers are discovered.

HP can be a consequence of “local” dental problems or develop against the background of more serious systemic diseases. Exacerbation of hypertrophic pulpitis (hereinafter referred to as HP) without medical intervention leads to gangrene of the pulp. Chronic inflammation can be an independent pathology or a consequence (complication) of another disease.

In dentistry, it is generally accepted that the chronization of the inflammatory process occurs no earlier than 12 weeks from the beginning of the acute phase, and is due to the incomplete elimination of “provocative” factors. HP, like any inflammatory process, is primarily caused by “attacks” of pathogens and their metabolic products (toxins). They enter the tooth pulp with the blood flow and lymph through the dentinal tubules.

The trigger mechanisms for the development of chronic hypertrophic pulpitis include:

• deep caries (including poorly treated ones);
• tooth trauma (the pulp is exposed, the integrity of the neurovascular bundle is damaged);
• periodontitis;
• acute pulpitis;
• increased tooth wear.

Important! Symptoms of HP may be a complication of other local inflammatory processes in the paranasal sinuses or oral cavity (due to the retrograde penetration of pathogens - pathogenic bacteria - into the pulp).

Signs of GP

Pain syndrome in most cases does not accompany the course of chronic HP. The main complaints of patients are related to the fact that foreign tissue grows in the tooth, which is injured under functional load (during eating), and also constantly bleeds. Only sometimes is there a slight pain caused by pressure on the tooth.

The course of polypous or granulating forms of HP is not associated with attacks of intense pain in the affected tooth

The color of the overgrown tissue in the granulation form of GP is bright red, even with light probing there is slight pain. Polyps, in turn, have a pale pink tint, have a dense consistency, do not bleed, and upon palpation or percussion either do not hurt at all or “respond” with minor discomfort.

Diagnostics

The dentist, first of all, is interested in the nature of the pain in the damaged tooth (if any) and establishes its connection with visible causes. An objective examination involves examining the “damaged” tooth and probing its hypertrophied soft tissues. With HP, there is always a significantly deepened carious cavity connected to the pulp chamber. On probing, the soft tissue formation is painful and bleeds.

Depending on the form of the pathological process, polyposis or granulation tissue may protrude from the carious cavity.

X-ray examination of a damaged tooth can reveal changes in the form of an increase in the periodontal gap or detect areas with sparse bone tissue. Chronic HP is differentiated from deep caries, acute pulpitis or exacerbation of the chronic form of periodontitis. In addition, differential diagnosis of GP is carried out with the growth of the gingival papilla.

Similar manifestations: the presence of a carious cavity filled with overgrown tissue; upon probing, the hypertrophied pulp bleeds and slightly “responds” with pain (only if it is not a polyp). The list of differences between these pathological changes includes the following symptoms:

• The overgrown gum papilla can be “displaced” from the carious cavity using a dental instrument or a cotton swab; its connection with the interdental gum is revealed. The hypertrophied pulp, in turn, grows from the opening of the dental crown.
• An X-ray for GP shows the connection between dental and carious cavities.

GP of granulation form is also distinguished from overgrown granulations when the bottom of the tooth cavity is damaged. In both cases, the carious lesion is filled with granulation tissue; when probing it, local bleeding occurs. In this case, chronic GP is associated with acute pain during probing; the level of perforation is localized below the neck of the tooth, and in the case of GP it is located significantly above it.

Granulating or polypous GP, if left untreated, leads to gangrene (death) of the pulp

Solving the problem

Treatment of hypertrophic pulpitis, first of all, involves relieving attacks of pain (if any), as well as combating the local inflammatory process. The list of tasks that the dentist must solve also includes the prevention of damage to periodontal tissue and restoration of the anatomical integrity and functions of the damaged tooth.

GP involves vital extirpation of the dental pulp. The operation is performed under local anesthesia; necrotization of the soft tissue formation is not performed. After surgical intervention, the doctor mechanically and with the help of medicinal compounds processes and fills the tooth canals, and at the last stage of treatment restores the dental crown.

Prevention and prognosis

A correctly selected timely treatment strategy for chronic HP allows you to preserve the tooth for many years without causing damage to its functionality. Advanced forms of the disease can result in a whole range of serious dental complications for the patient with unpredictable developments. The best prevention of HP in both children and adult patients is the treatment of caries and other dental diseases.

In addition, doctors strongly do not recommend enduring intense pain in a tooth for a long time, but immediately seek qualified medical help. Regular visits to the dentist’s office, good daily oral hygiene, and periodic professional plaque removal help prevent pulpitis of any form.