Do you or your child have a toothache that doesn’t look much different from other teeth? Perhaps these are signs of pulpitis.

What is pulpitis?

Pulpitis– an inflammatory disease of the dental pulp, which is the neurovascular bundle of the tooth (or nerve, as it is also called), as well as connective tissue cells. The pulp is located under dentin, which in turn is covered with tooth enamel. The pulp is responsible for nourishing the teeth from the inside.

Pulpitis is often a complication of another dental disease - and therefore, the main cause of pulpitis, like caries, is, for example, streptococcus. Thus, prevention of pulpitis implies protecting teeth from infection - proper care of teeth and oral cavity.

According to statistics, up to 20% of patients complaining of toothache have pulpitis. Particularly frequent guests of the dentist are children, who usually have pulpitis of the baby tooth.

Now let's briefly look at the mechanism of development of pulpitis, which will be convenient to do using the following image:

As you can see, dear readers, at the beginning of tooth damage, plaque appears on it, which is food debris (which over time begins to rot) and various microflora, most often pathogenic.

If you do not brush your teeth, infectious microorganisms, in the course of their vital activity, produce acid, which, together with decaying food particles, begin to eat tooth enamel, which is the surface or protective layer of the tooth. Damage to tooth enamel is called caries. The more time passes without proper oral care, the faster the pathological processes of tooth destruction occur.

The third stage in the development of pulpitis is when the infection gets under the tooth enamel and the infection affects the dentin. Dentin is the hard and basic part of the tooth; in fact, it is bone. This is the last step of the infection before it reaches the pulp - the soft tissue of the tooth that lies directly under the dentin. The pulp contains blood vessels and nerve endings. This is precisely what causes the appearance of severe pain during pulpitis.

The fourth stage is actually pulpitis, in which the infection reaches the pulp, causing its inflammation.

The onset of pulpitis is accompanied by toothache, often pulsating in nature, increased sensitivity of the tooth to temperature changes, as well as a painful reaction of the tooth to cold or hot food/drink. Toothache due to pulpitis can spread both to several adjacent teeth and to the entire jaw, and over time even develop into a headache.

It is also worth noting that the course of pulpitis can be asymptomatic.

But still, you can independently determine the presence of pulpitis by the presence of gray enamel, frequent bleeding, dark holes or overgrown tissue in the hole from caries of a particular tooth, as well as increased sensitivity of the tooth when chewing.

The consequence of pulpitis in many cases is tooth loss, however, if this inflammatory process is not given due attention, it can spread to the jaw tissue, and then to sepsis, which is a rather dangerous complication.

Pulpitis - ICD

ICD-10: K04.0;
ICD-9: 522.0.

Symptoms of pulpitis

Toothache with pulpitis is the main symptom of this disease. By nature, the pain with pulpitis is usually pulsating in nature, often the tooth hurts so much that the patient feels as if half of his head hurts. Increased pain usually occurs at night, as well as when the affected tooth is exposed to cold or hot air or food, temperature changes, or chewing food. When tapped, the tooth is insensitive or insensitive.

Other signs of pulpitis include:

• Gray enamel of the affected tooth;
• Open tooth cavity;
• Bleeding from a tooth;
• Increased irritability.

Nonspecific symptoms include:

Complications of pulpitis

If pulpitis is not treated, it can lead to the following complications;

• Periodontitis;
• Tooth loss;

The cause of inflammation of the dental pulp is always an infection, mainly of nature - lactobacilli. As we have already said, the infection, in the process of its life activity, produces acid, which, together with food debris, destroys the integrity of the tooth enamel, after which the dentin, and then begins to affect the pulp itself. However, this is the entry of infection into the tooth through the crown, i.e. visible part of the tooth, but there is also another route of infection - through the apical foramen of the tooth, which is the anastomosis of the tooth root, through which blood vessels and nerve endings are connected to the tooth.

Let's consider how the integrity of the dental “chamber” is violated and infection gets into it:

• Violation of the integrity of the tooth due to incorrect actions of the doctor (poor quality filling, grinding of the tooth, surgical intervention in the jaw);
• Sinusitis, which may affect the upper teeth;
• Fracture of the crown or root of a tooth; children especially often break their front teeth;
• Increased tooth wear, which is often facilitated by the presence of diseases such as or;
• Incorrectly selected and installed braces;

Other causes of pulpitis include:

• Failure to comply with personal hygiene rules for oral care;
• Overheating of the pulp during dental treatment;
• Incorrect methods of dental treatment, including caries;
• Toxic effect of filling material on the tooth;
• Use of low-quality materials in dental treatment;
• Presence of infection in the blood.

Classification of pulpitis

The classification of pulpitis distinguishes the following types of this disease:

Acute pulpitis. It is characterized by an acute course of inflammation with severe radiating pain, worsening at night or when the tooth comes into contact with hot or cold. The acute form of pulpitis is divided into the following subtypes:

• Serous - is the initial stage of pulp inflammation, without the formation of purulent exudate;
• Focal purulent - is the second stage of pulp inflammation, in which purulent exudate is formed in the dental cavity, and the pain sometimes goes away when the tooth comes into contact with a cold substance;
• Diffuse purulent.

Chronic pulpitis. Usually it is a continuation of the development of acute pulpitis. Characterized by mild pain with frequent exacerbations. Sometimes it occurs with minimal symptoms, but pathological processes continue to destroy the tooth. The chronic form of pulpitis is divided into the following subtypes:

• Fibrous – is the initial stage of chronic pulpitis, which is characterized by the proliferation of connective tissue of the pulp, while the inflammation is almost asymptomatic;
• Hypertrophic (proliferative) – is a continuation of fibrous pulpitis, in which the pulp tissue grows through the carious cavity of the tooth, a fibrous polyp is formed;
• Gangrenous - characterized by the disintegration of pulp tissue.

There is also retrograde pulpitis, which is characterized by infection entering the pulp tissue through the apical foramen of the tooth.

Diagnosis of pulpitis

Diagnosis of pulpitis includes the following examination methods:

• Taking anamnesis;
• Visual examination of teeth;
• Questioning the patient about the nature of the pain, which is necessary for the differential diagnosis of pulpitis;
• teeth.

How to treat pulpitis? Treatment of pulpitis can be carried out by two main methods, which largely depend on the type of inflammation, so it is very important to turn to a doctor who will not only be able to accurately diagnose the disease, but also carry out the necessary therapeutic manipulations.

1. Treatment of serous pulpitis, i.e. without the presence of purulent exudate, usually involves applying a bandage or pad containing an antibacterial or alkaline agent to the pulp. These manipulations help destroy the infection, neutralize the acid produced by the infection (which actually destroys the teeth) and the formation of secondary dentin.

2. One of the popular methods of treating pulpitis of primary teeth is surgical removal of the pulp tissue (partially).

3. Treatment of purulent and chronic pulpitis is aimed at removing the “nerve”, sanitizing the roots of the tooth and removing the infection, after which filling is done, first of the roots of the tooth, then of the entire tooth.

The treatment of pulpitis itself by filling a tooth is divided into 2 methods - devital and vital extirpation (amputation).

3.1. Devital extirpation implies the complete removal of the pulp (neurovascular bundle) of the tooth, which usually occurs in 2 visits to the dentist. To do this, local anesthesia is administered, after which the dental cavity is cleaned, into which a devitalizing paste is then placed for a week, usually a mixture of anesthetic and paraformaldehyde (previously arsenic was used for these purposes). After a week, the mixture is removed from the tooth, the tooth is cleaned of dead pulp particles and the tooth is filled.

3.2. Vital pulp amputation (pulpotomy) represents the preservation of the pulp in the area of ​​​​the roots of the tooth, while its upper part, along with the parts of the tooth affected by infection (caries), is removed. After this, the bleeding stops, the tooth cavity is sanitized with antibacterial agents. Afterwards, a temporary filling is placed for approximately 6 months.

After this time, the temporary filling is replaced with a permanent one. The tooth can additionally be fluoridated to further strengthen the tooth enamel. This method has the advantage that the natural structure and nutrition of the tooth is preserved.

If you use the devital method of treating pulpitis, the tooth actually becomes “dead”, because he does not receive the necessary nutrition. Therefore, in case of repeated tooth infection, the disease will be more difficult to detect, since there may not be obvious clinical manifestations.

Traditional treatment of pulpitis, of course, does not replace the basic doctor’s procedures aimed at eliminating the inflammatory process in the pulp and filling the tooth, but it can help relieve pain and destroy infection, as well as relieve inflammation.

Important! Before using folk remedies, consult your doctor.

Baking soda, hydrogen peroxide and lemon. Make a mixture of half a teaspoon, 15-20 drops of hydrogen peroxide and 5 drops. Soak a cotton swab in this product and apply it to the affected area. The product will help relieve pain and disinfect the inflamed pulp.

Propolis. Take some, roll it into a ball and place it in the carious hole of the tooth. Place a cotton swab on top for 20 minutes.

Propolis and calamus root. Mix 1 teaspoon of propolis tincture with 1 tbsp. spoon and 2 tbsp. spoons of warm boiled water. Rinse the affected tooth with this mixture and the pain will soon subside. The course of treatment is 30 days.

Horseradish tincture. Apply a cotton swab dipped in grated horseradish tincture to the affected tooth. This will help relieve pain and eliminate infection.

Onion peel. 3 tbsp. Pour a glass of boiling water over spoons of onion peel. Let the product sit for about 30-40 minutes, after which you can start rinsing your mouth with the prepared infusion.

Prevention of pulpitis

Prevention of pulpitis- This is, first of all, proper oral care and timely treatment of caries. To do this you need:

• If a hole or black plaque appears in a tooth, contact your dentist in a timely manner;
• It is advisable to visit the dentist once every six months for a preventive dental examination;
• Observe ;
• Regularly;
• Do not leave chronic diseases to chance.

Pulpitis is an inflammation that occurs in the neurovascular bundle of the tooth, which is often defined as a nerve. Pulpitis, the symptoms of which consist of severe pain (intermittent or continuous), is essentially a consequence of previously neglected caries by the patient. It is after this that the diseased tooth is destroyed so badly that the infection freely enters the very root of the tooth, affecting the nerve.

General description

In addition to the complication that follows caries, pulpitis also often occurs due to the incorrectness of certain actions on the part of the doctor. In particular, these include the use of low-quality fillings and improper grinding of the tooth carried out for the subsequent installation of orthopedic structures. It could also be incorrectly performed surgical interventions affecting the periodontium or the negative effects caused by certain chemicals. Medical practice, in addition, indicates the relevance of cases of retrograde pulpitis, in which infection occurs through the apical foramen.

In general, the reasons that lead to inflammation of the pulp are more than diverse, and it can be triggered by acute or chronic irritations.

Mostly pulpitis is the result of a combined effect from microbes that are located deep in carious lesions. In particular, these may be streptococci, lactobacilli or staphylococci, as well as their toxins, waste products and dentin decay products.

As for the routes of penetration and sources of infection entering the pulp, they are also different - in addition to the path in the form of dentinal tubules through a carious cavity, infection can also provoke pulpitis due to injury (especially of the type that is combined with a tooth fracture). A fairly common occurrence among children is trauma that occurs in the area of ​​the front teeth. In this case, even the breaking off of even part of the tooth without opening its cavity makes infection possible. In the same case, if the injury leads to exposure of the pulp, the inflammatory process forms within the next few hours from its moment. Accordingly, infection is the leading factor provoking the formation of pulpitis.

As we have already noted, with rough or careless treatment of a carious cavity, exposure and subsequent infection of the pulp also becomes possible, which occurs in combination with the inflammatory process. It should be noted that pulpitis in extremely rare cases forms without dental caries.

Main forms of pulpitis

The following forms of pulpitis are distinguished:

• In accordance with the characteristics characteristic of a particular localization:
• Coronal pulpitis;
• Total pulpitis;
• Root pulpitis.
• In accordance with the nature of the disease:
• Acute pulpitis;
• Chronic pulpitis;
• Chronic pulpitis with exacerbation.

The acute form of pulpitis forms in close proximity to the carious cavity in the form of a focal lesion, after which serous inflammation occurs (that is, serous pulpitis). As a result of this process, one can notice the severity of vascular hyperemia in the microcircular bed, as well as the formation of serous edema in combination with a slight accumulation of leukocytes. In addition, mild degenerative changes are formed in the nerve fibers. The duration of this stage of the course of pulpitis is about several hours, after which the severity of the migration of neutrophils is noted along with dystrophic changes in the nerve fibers of the pulp, which are caused by the breakdown of myelin. Subsequently, the disease develops into a diffuse form of pulpitis or purulent focal pulpitis.

Focal purulent pulpitis is limited in nature of its formation; in addition, it is also characterized by filling in the form of purulent exudate with the formation of an abscess after it. Diffuse purulent pulpitis can occur not only with filling the coronal part of the pulp, but also with filling its root part (phlegmon). The pulp has a grayish color, and there is severe damage to all its structural elements.

The communication of the pulp cavity with a carious cavity in combination with the penetration of anaerobic flora can lead to the formation of pulp gangrene. As a result of this process, it takes the form of a gray-black mass with a putrid odor, as a result of which any of its structure is lost. The pulp may also have a granular appearance, and it contains microbes in combination with fatty acid crystals. Due to the transition of the inflammatory process to the root pulp, apical periodontitis begins to develop. The duration of the acute form of pulpitis in general is about 3 to 5 days.

The development of chronic pulpitis occurs as an independent form, but it can also develop against the background of acute pulpitis.

Morphological characteristics determine the following division of pulpitis:

• Gangrenous pulpitis. Its development begins with an acute form, in particular, its occurrence is accompanied by partial death of the pulp. The part of the pulp that has been preserved has serous inflammation with the characteristic formation of granulation tissue, due to which the dead masses are limited.
• Hypertrophic (granulating) pulpitis. For this type of pulpitis, it is important to comply with the chronic nature of inflammation. The granulation cavity replaces the dental cavity, in some cases also filling the carious cavity, which, in turn, communicates with the dental cavity. This course is also characteristic of a pulp polyp, which is characterized by the softness of the formation and its easy bleeding.
• Fibrous pulpitis. In this case, we are talking about a process in which most of the tooth cavity has many collagen fibers and plasma cells, as well as cellular infiltrates based on lymphocytes.

Pulpitis: symptoms

Pulpitis in general is characterized, as we have already noted, by continuous or intermittent tooth pain, which is especially acute at night. In addition, there is also a change in temperature.

The initial stage of pulpitis is characterized by infrequent aching pain, while its more advanced forms occur with a gradual increase in painful sensations, and over time they only worsen, becoming pulsating and prolonged. The chronic form of pulpitis, as a rule, occurs with pain only when it worsens. Also, for the chronic form of pulpitis, along with its purulent form, a characteristic phenomenon is pain, which occurs even in the case of slight tapping in the area of ​​the affected tooth.

At acute focal, and also when diffuse In pulpitis, the main symptoms are reduced to very severe pain of a radiating nature (that is, spreading) along the branches of the trigeminal nerve. Increased pain, again, is noted at night, but in general they are characterized by their own periodicity. The affected tooth is extremely sensitive to the irritants affecting it, and even eliminating the irritant does not help reduce the pain or its disappearance. When tapping (percussion), there is a lack of tooth sensitivity or slight sensitivity.

Flow chronic fibrous pulpitis characterized by the absence in most cases of any symptoms, in some cases the occurrence of minor discomfort is noted.

Hypertrophic chronic pulpitis, as a rule, it develops against the background of the fibrous form in those situations in which the crown has been largely destroyed, and the pulp is exposed and is constantly exposed to mechanical irritation and infection in general. When a tooth is tapped, sensitivity may be noted, but this symptom is not the leading and constant one when considering this disease. The radiograph determines the absence of significant changes in the area of ​​​​the bone tissue of the root apexes.

X-ray examination of pulpitis in primary teeth indicates in more than 55% of cases the presence of destructive changes occurring in the periodontal tissues.

Gangrenous chronic pulpitis can occur with severe pain, the tooth is extremely sensitive to hot influences on it, while cold, on the contrary, has a calming effect on the pain.

As for exacerbations that are relevant for chronic pulpitis, they are characterized by paroxysmal pain that occurs in the tooth, and this pain occurs spontaneously - that is, without the influence of any irritating factors on the tooth. Long-lasting pain is also possible, arising under the influence of external stimuli with active irradiation along the branches of the trigeminal nerve. Most often, in this case, the tooth cavity is open, and pain occurs when attempting to probe the pulp.

Regarding the complications that pulpitis can entail, it can be noted that the lack of proper treatment, as well as inadequate treatment of the root canal system or lack of tightness during tooth restoration can lead to periodontitis.

Treatment of pulpitis

• Conservative method . In this case, the viability of the pulp is preserved. The method is especially effective in use for young people, but it is used only in the reversibility of pulp disease (for example, with traumatic pulpitis). Treatment is carried out in a similar way to the treatment of caries, with particular attention paid to medicinal treatment of the affected cavity. Antibiotics, antiseptics, and proteolytic enzymes are used for this. The exception is drugs with enhanced action, including ether and alcohol.
• Surgical method. This treatment method involves removing the inflamed pulp. Using filling material, the root canal of the tooth is filled. One of two methods can be used to remove pulp:
• Vital method. The implementation of this method is possible for any form of pulpitis. For removal, local or general anesthesia is used.
• Devital method. To use this method in pulp removal, it is necessary to first kill the nerve.

Early treatment of pulpitis makes it possible to preserve the nerve, which is necessary to ensure normal nutrition and vital activity of the tooth, and therefore, when the first symptoms characteristic of pulpitis appear, you should immediately contact a dentist.

According to statistics, in almost every fifth person who goes to the dentist, the doctor discovers pulpitis. This is approximately 15-25% of all dental patients. Accordingly, pulpitis is a fairly common dental disease. So what is it?

What is pulpitis

Pulpitis is an inflammation of the pulp or internal structures of the tooth, or rather its nerve ganglion, which occurs when an infection penetrates into the tooth through the destroyed layer of dentin.

Why does pulpitis occur?

Usually the most common cause of pulpitis is another disease that is not treated in time. This could be, for example, caries (especially deep ones). Or such a disease could be periodontitis. Sometimes pulpitis occurs after a tooth injury or after improper treatment or dental prosthetics, when such procedures are performed by a non-professional, resulting in tooth damage.

A damaged tooth is more susceptible to infection, which causes inflammation and, as a consequence, pain.

The most common cause of pulpitis is a late visit to the dentist. Therefore, you should not delay your visit to the dentist - even the slightest damage to your teeth, small stains or chips deserve the closest attention of a doctor. Otherwise, you will get a complicated disease and extra financial costs.

How does pulpitis arise and develop?

If pulpitis is caused by a mechanical impact on the tooth (damage to the tooth), it develops quite quickly, since the pulp is already exposed and the infection arises quickly. If pulpitis is a consequence of caries, its development may be longer. However, the longer it develops, the worse the consequences of pulpitis.

When the soft tissues of the tooth (pulp) are exposed to infection for a long time, they are destroyed, and therefore can no longer perform their function, and it may be necessary to completely remove these tissues. This process is commonly known to us as nerve removal.

Speaking about the patient’s sensations, it should be noted that pulpitis is almost always accompanied by pain. The farther, the stronger, and then the jaw.

Depending on the course of pulpitis, it can be:

• spicy;
• chronic;
• chronic with exacerbations.

In this case, acute pulpitis can become purulent, in which case a purulent process occurs in the affected area of ​​the pulp, sometimes with an abscess. In general, acute pulpitis lasts 3-5 days, after which it develops either into a more severe form (purulent) or into a chronic form. If pulpitis is not treated, the tooth tissues become dead, after which the inflammation process can penetrate into neighboring teeth, causing periodontitis.

According to the place of development they distinguish:

• root pulpitis - accordingly, it occurs in the root part of the tooth;
• coronal pulpitis – arises and develops in the coronal pulp zone;
• total pulpitis – affects the entire pulp.

Symptoms of pulpitis

The main symptoms of pulpitis include:

• sharp, tearing or aching pain in the area of ​​the affected tooth, as well as in the entire jaw, occurring mainly in the evening and at night, and often not stopping at all;
• presence of damage in the tooth (so-called “holes”, chips);
• sometimes - an increase in temperature;

Diagnosis of pulpitis

Often, in order to diagnose pulpitis, the doctor only needs its clinical manifestations. In this case, the main diagnostic methods will be interviewing the patient about the nature and frequency of pain, examining the oral cavity in general and the diseased tooth in particular, and palpation.

One of the additional diagnostic methods is EDI or electroodontodiagnosis - testing the response of the pulp to small current discharges. During this diagnostic method, the doctor uses a special device with which he conducts this test.

However, this may not be enough to make an accurate diagnosis. In such cases, they usually resort to the most effective method of diagnosing pulpitis - an x-ray. It very accurately displays the internal condition of the teeth, which makes it easier to make the correct diagnosis.

Depending on the condition of the pulp, treatment can be carried out in two ways - biological and surgical. The dentist determines the appropriate method of treatment after diagnosis, taking into account the most important factors: the degree of development of pulpitis, its type, location of development.

Biological treatment is most often used when pulpitis occurs as a result of external intervention (trauma, careless dental procedure). It consists of applying special pads containing calcium to the tooth, on top of which a filling is placed.

The surgical method of treatment is usually used for acute pulpitis, and it consists of complete or
partial removal (or amputation) of the nerve ganglion of the tooth.

Partial removal is carried out when it is possible to preserve the viable part of the pulp, thus not disrupting the blood supply to the tooth. Usually the coronal part of the nerve ganglion is amputated.

Complete removal is carried out when the pulp is completely affected, and it is more advisable to clean the tooth from inflamed tissue. The doctor can carry out this type of removal in two ways – vital and non-vital.

The vital method involves complete removal of the nerve, cleaning
tooth canals and filling, carried out in one visit to the dentist.

If, for one reason or another, the dentist considers performing this procedure impossible at one time, treatment is carried out using the devital method. In this case, you will have to visit the dentist twice or three times.

During devital treatment, a special paste is applied to the exposed pulp surface under a temporary filling, which remains there for 3-7 days. During this time, the tissues are devitalized, after which the dental canal is cleaned and subsequently filled.

Surgical treatment of pulpitis is carried out in several stages:

1. Removing painful pulp
2. Channel cleaning
3. Filling canals and dental crowns

Prevention of pulpitis

The main prevention of pulpitis, as well as other dental diseases, is careful oral hygiene.

Also, in order not to provoke pulpitis, it is important to consult a dentist promptly, as soon as you notice the first signs of caries.

It’s even better to visit the dentist once every six months to detect the first signs of disease in a timely manner.

Good afternoon or evening, dear site visitors. Today I will touch on a topic that is close to me, and therefore I can talk about it based on personal experience. This . More precisely, its chronic form. Many people who are diagnosed with chronic pulpitis by a dentist are completely unclear what kind of disease this is, where it comes from and what to do about it.

The doctor will tell you what to do. Everything else is worth finding out in advance. It is quite possible that this unpleasant fate will be avoided. After all, it is much easier and more pleasant to go to the dentist for regular routine examinations than to endure having your teeth drilled.

Important nuances

Human anatomy is a very complex thing. Believe me, the structure of a spaceship, together with the communications satellite that makes our mobile phones work, is much simpler than the nervous system alone.

So, pulp is the soft contents of the tooth, which is located under the layers of enamel and dentin. It contains blood vessels and nerve fibers. It is through it that substances that are needed to strengthen teeth enter the dentin. It also supplies replacement dentin to the tooth tissue during caries.

Since the pulp contains a bundle of nerves, when it is damaged by the carious process, we experience pain.

Pain also appears when dentin is damaged, since the latter has special tubules. This material is porous. That is why it is so important that the enamel remains intact.

Chronic pulpitis - forms, symptoms and features

Many people imagine what acute pulpitis is. Your tooth with a hole suddenly starts to hurt. This feeling may pass and repeat again. Everything is clear here. You need to run to the doctor, drill and fill it. With a chronic course, everything is somewhat more complicated.

The fact is that complaints with chronic pulpitis may be absent for a long time. You live without feeling any particular discomfort. A decayed tooth deteriorates further, but it “does not bother you.” At this time, the nerve dies and many negative changes occur inside the tooth.

Also, in some people the acute form does not appear at all. That is why they do not contact the dentist in a timely manner, which leads to complications.

You don’t need to be a doctor to understand what consequences can await a person whose tooth in the mouth is imperceptibly destroyed from the inside, spreading harmful bacteria throughout the body.

In general, the symptoms of chronic pulpitis depend on the form in which it occurs.

1. For example, in the chronic hypertrophic form there may be no complaints. Over time, bleeding and discomfort and pain while eating may appear. As the pulp grows, reactions to hot and cold food begin.
2. Chronic fibrous form - pain is rare and most often short-lived. It may seem to us that nothing bad is happening. Sometimes pain occurs with a sudden change in temperature.
3. The gangrenous type of chronic pulpitis is characterized by rare pain, reactions to temperature stimuli, and bad breath. Pain may radiate to other areas along the trigeminal nerve. Believe me, this is very unpleasant.

However, in most cases, patients feel relatively normal. They eat, drink water and tea, go to work, thinking that everything is fine and it’s okay that the tooth may sometimes hurt. But in the acute stage, chronic pulpitis begins to create real problems for us. Pains characteristic of the acute form appear, and the person begins to take pills to drown them out. It helps some, not so much for others. Eventually, the body gets used to the drugs and they become useless.

Chronic pulpitis in childhood

Most of us believe that serious dental problems are only for adults. Only statistics show that this phenomenon has no age. Chronic pulpitis is becoming more common in children.

The disease can affect both temporary (baby) teeth and permanent teeth. In the first case, it can lead to early tooth loss. This is quite unpleasant. After all, it is important that the baby tooth falls out on its own when the time comes. Otherwise, there is a high probability that the remaining teeth in the row will shift before a permanent tooth grows in place of the removed one. Then problems with teething and crowding of teeth begin. I have to wear plates and braces. In general, there are enough difficulties.

In children, in most cases, the fibrous form is diagnosed. In second place is gangrenous, and the third is hypertrophic.

Interestingly, in 30 percent or more of cases, pulpitis is found in teeth that do not have large carious lesions. That is, the crowns of such teeth are intact. Therefore, during a routine examination, in the absence of complaints of pain, the problem may not be detected.

What could lead to such a situation? Often the cause is a bruise or tooth dislocation, in which one of the roots is damaged. The neurovascular bundle ruptures, and the pulp ceases to receive proper nutrition. Over time, it begins to collapse.

Treatment of pulpitis in children

Often the course of the disease is accompanied by enlarged lymph nodes, inflammatory processes in the periodontium, and general intoxication. It is difficult for a child’s body to fight the inflammatory process, and waste products of bacteria simply poison it from the inside.

Typically, children begin to complain of pain while eating and reactions to cold and hot things. Upon examination, it is not always possible to determine the cause if there is no caries in the affected tooth. A photo may clarify the picture.

How to fight?

If you come across an article about “treatment at home,” feel free to scroll on. Because the process of pulp destruction is irreversible. It is impossible to cure a tooth with herbs, ointments and decoctions. You can achieve only one thing - the pain will suddenly disappear. This means the nerve tissue is dead. And everything dead has the most unpleasant property - to decompose and create a strong bacterial infection around itself. Your immune system will immediately connect. She will devote her strength to eliminating the threat. The inflammatory process will begin. Don't believe charlatans in advertisements who promise to save you with pills or any other means. Dentistry is an exact science. The placebo effect and other methods based on your own psychology will not help here.

To ensure that treatment of chronic pulpitis does not lead to complications, it must be carried out not while sitting at home, but in the dentist’s office.

Treatment methods depend on the degree of pulp damage. Sometimes it is possible to solve the problem with medication, stopping the process. In other cases, it is necessary to resort to partial removal of the pulp. In case of severe lesions, the tooth is depulped, cleaned, and medicine is applied. After eliminating the infection and inflammatory process, a permanent filling can be installed. It is important to clean and seal the canals well.

Treatment of pulpitis - photo

If this issue is not resolved in time, a cyst may develop under the root of the tooth or periodontitis. Their treatment is much more complicated and can cost a lot of money. In addition, such complications are fraught with negative consequences for the body as a whole.

Doctors always strive to fully save healthy tooth tissue. Therefore, if possible, treatment is carried out using conservative methods.

For example, pulpitis was found in a child. Until the permanent teeth are fully formed, preservation of the pulp is important. It is involved in the process of tooth development and growth. Therefore, it is worth fighting for its safety. Adults do not have this problem, which is why doctors are often more radical in their methods.

What is more effective? If there is severe pulp damage that cannot be eliminated locally using medications, it is better not to delay it and remove it completely. Because the development of this process will lead to the complications mentioned above. It's worth taking a photo. This will allow the doctor to better see the big picture.

In general, if you experience discomfort or tooth pain, this is a clear sign that pulpitis is developing. See a doctor immediately for examination and treatment. If you delay the process, you may subsequently pay a decent amount for the operation.

Video - Pulpitis

Pulpitis is an inflammation that affects the neurovascular bundle hidden inside the root canal and coronal chamber of the tooth. The pulp normally provides nutrition to hard tissues from the inside. As a rule, the pathology develops as a result of previously untreated and infection of soft tissues. Depending on the type of pulpitis, symptoms and treatment (medical tactics) may vary. The “classic” manifestation of the pathology is pronounced, increasing when exposed to thermal stimuli, and at night - spontaneously. In very rare cases, an asymptomatic course is possible. According to the nature of its course, like other inflammatory diseases, pulpitis can be either acute or chronic.

The chronic form is characterized by alternating periods of exacerbation and remission (remission of symptoms).

If you postpone a visit to the doctor over and over again, the process will inevitably progress. This can not only cause the loss of a dental unit, but also the spread of the inflammatory process to the structures of the jaw bone and blood poisoning (septic process).

Please note

In people with a weakened immune system, sepsis, which poses a serious threat to life, develops much more often than in people with a highly strained immune system.

Classification of pulpitis

According to the modern classification, the following types of disease are distinguished:

• spicy;
• chronic;
• exacerbation of a chronic process;
• focal purulent;
• diffuse purulent;
• hypertrophic;
• fibrous;
• gangrenous;
• condition after amputation or pulp extirpation.

Reasons

The disease always develops against the background of infection. Most often, infectious agents are introduced into the pulp intradentally, that is, through the coronal part, partially destroyed by the carious process. However, in a number of cases, doctors have to observe the retrograde spread of pathogenic microflora, that is, its penetration through the apical (apical) foramen from nearby foci of chronic infection.

According to WHO statistical studies, pulpitis has developed at least once in 20% of the world's population.

Typically, pulpitis is a direct consequence of caries, in which the hard tissues of the destroyed part of the crown are literally “impregnated” with pathogenic bacteria.

There is also an iatrogenic form associated with insufficiently qualified dentist. The doctor can overheat the pulp when preparing the tooth for a crown, bridge or even veneer, use low-quality filling materials, or install it from an aggressive material without a special insulating gasket.

It is customary to distinguish 3 types of factors that provoke the development of this pathology:

1. Physical;
2. Biological;
3. Chemical.

Physical include:

• tooth trauma leading to disruption of the integrity of the pulp chamber;
• excessive heating of the pulp when processing its hard tissues without sufficient cooling;
• accidental opening of the pulp chamber during treatment of medium or deep caries;
• the formation of dense deposits in the pulp (petrificates and denticles), which can irritate nerve endings, compress blood vessels and disrupt microcirculation.
• pronounced pathological abrasion of enamel and dentin.

Chemical factors

Intoxication of soft tissues in 100% of cases is a direct consequence of insufficiently professional actions of the dentist.

Common medical errors include non-compliance with the exposure of an aggressive gel for etching hard tissues, incomplete rinsing of this substance, unjustified use of powerful antiseptics during the treatment of a carious cavity, or the direct toxic effect of a composite filling placed without an insulating lining.

Biological factors:

• bacterial infection is possible with complications of caries (including secondary caries - which develops after the placement of a permanent filling);
• microorganisms in the rarest situations are able to penetrate through the dentinal tubules (in particular, when taking a prosthetic impression under high pressure);
• penetration of pathogenic microflora is possible through the apical foramen against the background of osteomyelitis of the jaw or during a surgical procedure - curettage of pathological periodontitis pockets.

Pathogenesis

At acute pulpitis the chamber is closed, and the process at an early stage is focal in nature. It initially occurs as a serous inflammation, but soon a purulent discharge appears. Intense pain syndrome is caused by the accumulation of a significant amount of exudate in the absence of outflow.

Chronic process is considered as an outcome of acute inflammation. Most often dentists have to deal with fibrous form associated with connective tissue hypertrophy.

At gangrenous pulpitis During instrumental examination, necrotic dark-colored tissue (putride masses) is discovered in the canal. A typical symptom is putrid breath.

Symptoms of pulpitis

The “classic” symptoms of acute focal and diffuse pulpitis are:

Chronic fibrous pulpitis is usually asymptomatic. In the hypertrophic form, the dentist discovers an overgrown polyp in the cavity. When pressed hard, it starts to hurt and bleed, but the rest of the time it doesn’t bother you.

In acute purulent form, the following symptoms are noted:

• severe pain;
• high sensitivity of the causative tooth to hot (cold can relieve pain).

Please note

If purulent discharge penetrates the gum through the apical foramen, a fistulous tract may form. When the pathological discharge comes out through it, the patient feels temporary relief.

Treatment of pulpitis

It is believed that serous pulpitis is subject to conservative treatment if the patient’s age does not exceed 30 years and he does not have serious general somatic diseases. An important condition for the success of the biological method of therapy is high caries resistance, due to which the rapid formation of secondary dentin is possible. During treatment, I apply bandages soaked in solutions and preparations with a high calcium content to the patient. An alternative technique is to remove the coronal part of the pulp while preserving the root part, but now the so-called. “vital amputation” is rarely used (mainly in children).

The main method of treating the pathology is mechanical removal of the entire neurovascular bundle, followed by instrumental and medicinal treatment of the canal. After these procedures, the cavity is hermetically sealed.

Extirpation can be carried out in one or two visits. In the first case, the patient is given conduction (if necessary, infiltration) anesthesia, after which the pulp is completely removed, the canal is processed, and filling material is introduced into it. X-ray control is required when sealing with cements– it is important that the pulp chamber is completely obturated, but even a minimal amount of material does not fall beyond the apical foramen (to avoid further periapical inflammation and cyst formation). An excellent modern alternative is the use of gutta-percha pins (they are pre-selected by diameter).

Treatment in two visits is now carried out less and less often (mainly when the onset of development is suspected).

A devitalizing paste is applied to the instrumentally opened area of ​​the pulp (on a single-rooted tooth - for a day, on a multi-rooted tooth - for two days). During a second visit, the vessels and nerves that died under the influence of an aggressive chemical substance are painlessly removed, after which the canal is also processed and sealed.

Please note

Relatively recently, a paste with arsenic was used for devitalization, but it was abandoned due to the high likelihood of developing arsenic periodontitis. Currently, a composition consisting of paraformaldehyde and an anesthetic is applied. Even if for some reason this paste is not removed within a week, there will be no harm. The devitalizing components are covered with a temporary filling made of aqueous dentin.

A pulpless tooth often darkens and is relatively weakly fixed in the socket. Therefore, it needs to be reinforced with a metal alloy pin or covered with a crown.

Possible complications with pulpitis

The main complication of untreated pulpitis in a timely manner is periodontitis, often leading to the loss of a dental unit. Insufficiently professional actions of the dentist lead to similar consequences.

It is important to remember that a “dead” tooth cannot be completely sterilized. Therefore, there is a possibility that sooner or later colonies of microorganisms that are resistant to antibiotics will appear in it.

Plisov Vladimir, dentist, medical columnist