jaw, worse at night.

In this article we will talk about one of the common diseases of the oral cavity, which is known as “pulpitis”. Here you can find out what the disease is, how it is diagnosed, what it leads to and how to deal with it. So, the name of the disease comes from “pulp”. This is a bundle of blood vessels and nerves that is located inside the tooth. Some doctors call it the dental nerve.

As we noted earlier, pulpitis is a common disease. Approximately one fifth of all dental patients suffer from this disease. If you look a little more into the anatomy, then the pulp is nothing more than a connecting link between the enamel, cement and dentin of a tooth (hard tissue) and its periodontium (a set of soft, hard tissues surrounding the tooth). Exactly what we are talking about above is a kind of “barrier” between bacteria that cause caries and other diseases. After the dental nerve dies, harmful bacteria can easily move through the mucous tissues of the oral cavity, even attacking the jaws, which leads to unpleasant complications.

Causes of pulpitis

Why does pulpitis appear? The inflammation that appears in this nerve bundle is a “response” to pathogens that penetrate into the tooth from the oral cavity. These can be not only irritating bacteria, but also their decay products, which are no less toxic to pulp tissue. They can get inside the tooth in several ways:

• Periodontal. In this way, bacteria and their derivatives enter the nervous tissue of the tooth due to excision and dissection of the gums. It is important to emphasize that inflammation can cause surgical intervention to treat periodontal disease with an erroneous diagnosis (in fact, the patient, in this case, has generalized periodontitis, which requires different treatment).
• Cariogenic. Harmful microorganisms penetrate into the tooth from a carious cavity, which eats into the dentin itself. Due to caries, the protective “barrier” of hard tissue becomes thinner, allowing bacteria to penetrate inside the tooth and lead to irritation. If, during the treatment of caries, microgaps remain between the carious cavity and the filling, then bacteria can get inside the tooth.
• Hematogenous. Infection occurs through blood and lymphatic vessels. Through the blood, the infection can enter the tooth and penetrate the nerve. In such cases, the tooth may appear intact on the outside, but pulpitis develops due to descending infection:

There are other reasons why pulpitis appears:

• Tooth trauma (breakage of a piece of tooth, crown or part thereof, accidental opening of the pulp, improper treatment of a similar disease).
• Therapeutic influence, surgical intervention for periodontal disease.
• Ultrasonic radiation with low frequency and high intensity, which has a destructive effect on the hard tissues of the tooth.

New formations - denticles and petrificates - appear when there is a metabolic disorder in the dental nerve. Accumulating in the pulp tissues, they compress the nerve endings and blood vessels, which leads to the appearance of the disease.

But not only bacteria cause pulpitis. This process is started with the help of chemical (filling materials, the negative effects of acids and artificial cements) and temperature irritants (burn when grinding a tooth). In this case, the effect on the soft tissues of the tooth passes through the dentinal tubules, through which there is a “communication” with the dental nerve.

Stages of pulpitis

Pulpitis is associated with complex changes of a functional, biochemical and structural nature. It is worth noting that the intensity of the disease is also determined by how quickly the body responds to irritation. In addition, the outcome of the disease and the diversity of the clinical picture also depend on the nature of the inflammation, whether there are toxins, and the presence of bacterial waste products, which has an additional impact on the course of inflammation.

An important feature of the disease is that all negative changes occur in a “closed space” - the so-called pulp chamber, which is limited by the hard tissues of the tooth. Therefore, most often, advanced pulpitis leads to compression and disruption of the pulp, venous stagnation and gradual death of soft tissues.

But, despite the various clinical signs and symptoms of the disease, pulpitis develops in three stages:

1. Alteration. The first pathological changes occur, damage to the pulp tissue occurs.

2. Exudation. Blood circulation inside the tooth is disrupted.

3. Proliferation. Division of harmful cells, increase in the affected area, complications.

The root (located in the root of the tooth) and coronal sections of the pulp, due to the characteristics of their structure, react differently to stimulation. For example, in the coronal part, patients experience the second stage of the disease most strongly, while in the root part, complications are felt more strongly.

At the beginning of the development of the disease, the heavy passage of fluids in the pulp is compensated by increased venous outflow. But, soon, the permeability of blood vessels becomes worse, plasma and blood seep inside the tooth. This effect leads to a decrease in the content of beneficial acids, which further increases the development of the disease. As a result of these processes, damage to dental cells and protein breakdown occur.

Exudation, which at the beginning of the disease was rather “serous in nature,” soon becomes a real abscess with separate parts. Thus, purulent contents and swollen tissues lead to severe pain in the patient, which is the first “bell” to the death of pulp tissue.

The acute form of this disease has quite a lot of outcomes. This is influenced by how the final stage of the disease occurs - purulent melting of the pulp, necrosis of the soft tissues of the tooth, or transition to a chronic form.

But, in the case of the latter, such pulpitis can develop independently, without the “obligatory” acute form. Even the body may not know anything about the occurrence of a chronic form. The disease is discovered by the dentist, where the patient goes with caries.

Symptoms and diagnosis of pulpitis

What are the symptoms of pulpitis and how to distinguish the disease from any other dental problem? Recognizing this disease is not as difficult as it seemed. Difficulties arise at the stage of determining the shape of pulpitis. Symptoms of inflammation of the periodontium, pulp and periodontium are very similar to each other, which makes diagnostic measures practically useless.

To make a clear and correct diagnosis, the doctor should pay attention to the following symptoms:

• The presence of painful sensations.
• Their duration.
• Intensity.
• Light spaces (are there or not?);
• Does the pain radiate to the ear, neck, head?
• The occurrence of discomfort from “hot”, “cold”.

In addition, for objective research, doctors use:

• Examination with palpation.
• Percussion.
• Thermometry and sounding.
• Electroodontodiagnosis, radiography.

During the first visit, the dentist finds out the nature of the pain that the patient has, the history (picture of development) of the disease, and general well-being. It is worth emphasizing that anamnesis is essential to identify the factors that caused pulpitis.

The survey allows the doctor to build an approximate course of the disease and predict the outcome in each specific case.

At the same time, research using equipment allows us to specify the diagnosis, refute or confirm it, and, depending on the form of the disease, prescribe treatment.

Anesthesia for the treatment of pulpitis

Take note - grinding a tooth with pulpitis is extremely painful for the patient, and the doctor must take all measures to numb the tooth before performing medical procedures. As a rule, local and general anesthesia is used in dentistry. Local anesthesia occurs using injections (injections of drugs), applications, physical and chemical methods.

In this case, injection occurs in different ways:

Conduction anesthesia

Disables a large area of ​​the face by introducing an anesthetic into the area where nerves and trunks are concentrated. This type of anesthesia is used if treatment of multi-rooted teeth in the lower jaw is required. This is caused by excessive bone density. But ordinary local anesthesia doesn’t help much here.

Infiltration anesthesia

Eliminates pain on the small and peripheral nerves of the diseased tooth. This type of anesthesia can be performed in addition to conduction.

Intraligamentary anesthesia

This type of anesthesia involves the introduction of an anesthetic into the circular ligament of the tooth through the gap between the tooth and the socket. This method is effective because there is little anesthesia and zero chance of complications such as hematoma, allergies, damage to blood vessels and nerves due to surgical manipulations.

Intraseptal

A type of anesthesia when the drug is injected into the bone located between the teeth.

Spongy

This anesthesia also involves injecting the drug into the bone (in the area of ​​the cortical plate) using a syringe.

The next type of anesthesia in the treatment of pulpitis is application. This type of pain relief occurs with the help of lotions, sprays and gels that are applied to the oral cavity. Painkillers, in this case, lead to the patient temporarily losing sensitivity to pain in the damaged area of ​​the oral cavity, where the doctor is going to carry out therapeutic measures. As a rule, in addition to application anesthesia, the dentist also performs infiltration or conduction anesthesia.

Physical methods of pain relief are the safest and do not harm the patient’s health. They are carried out using:

• Electrophoresis;
• Electroanesthesia with direct current;
• Diadynamic, fluctuating currents;
• Vacuum electrophoresis.

True, physical types of anesthesia cannot be used if the patient has the following contraindications:

• Diseases of a nervous nature;
• Individual intolerance;
• Sclerosis of cerebral vessels, pathologies of the cardiovascular system;
• The presence of malignant and benign tumors;
• If the patient is sick with infectious, viral diseases.

The dentist can perform general anesthesia only in the following cases:

• If the patient is found to be absolutely intolerant to local anesthetics, and in other cases when local anesthesia cannot be administered.
• Relative contraindications: phobias before dental treatment; heart and central nervous system diseases.

What types of anesthesia are there:

• Inhalation anesthesia.
• Non-inhalation (the drug is administered intravenously, intramuscularly, subcutaneously, rectally, inside the bone, intraperitoneally).
• Audio anesthesia.
• Electronarcosis.
• Reflex anesthesia.
• Psychotherapy.

Treatment of pulpitis

In modern dentistry, doctors use two methods of treating this disease: surgical intervention and biological.

The second, as a rule, is aimed at preserving the pulp, its restoration and improvement. Bringing the functionality of the dental nerve back to full normal.

The doctor should pay attention to the following indications when treating acute forms of pulpitis in this way:

• Pulp hyperemia;
• Acute focal pulpitis;
• Accidental opening of the dental nerve.

As an exception, it is possible to restore functions in such a disease with fibrous pulpitis. But, only if the doctor did not detect clinical signs of periodontitis, which may appear on an x-ray.

In addition, when choosing a biological treatment method, you should pay attention to the age of the patient. The greatest effectiveness of therapy is shown by patients with pulpitis who are less than thirty years old. Of course, this is also influenced by individual indicators, such as the absence of diseases of other organs and the condition of the periodontium.

Contraindications to this method of treatment are:

• Presence of periodontitis;
• The patient is over thirty years old;
• The teeth that were intended to support plate and bridge prostheses are affected;
• Odontogenic intoxication.

The treatment process itself with this type of therapy includes taking antibiotics, sulfonamides and their combination, corticosteroids, and drugs containing calcium.

Treatment with antibiotics helps, in most cases, to cope with the infection. But antibacterial therapy is not enough to restore the pulp - therefore, the doctor prescribes antibiotics along with drugs that help stimulate the regenerative, plastic functions of the pulp.

In addition, corticosteroids have an excellent effect on reducing pain; have anti-inflammatory properties. Their use leads to a decrease in pulp reactivity and prevents the formation of granulation tissue. If the bandage is applied for a short time (up to three to four days), then side effects can be avoided. And then treatment is carried out with other drugs.

Nitrofurans, when combined with glycosaminoglycans, help speed up the recovery of the dental nerve.

Calcium hydroxide helps to normalize the acid-base balance in the pulp, and as a result, slows down the development of the disease. In addition to this, dentin tissue is replenished with minerals. Which also has a beneficial effect.

The doctor may prescribe enzyme therapy, which in combination with other drugs shows good results. For example, such substances are capable of melting necrotic tissue and breaking down microthrombi in pulp vessels. Thus, microcirculation of blood in the tooth is resumed, inflammatory processes are reduced; the cells of the soft tissues of the tooth are gradually restored.

The technique of such therapy includes several mandatory points:

• Anesthesia;
• Treatment of the oral cavity with antiseptics;
• Mandatory treatment of the crown of the diseased tooth, as well as neighboring teeth, using an iodine solution;
• Isolation of a diseased tooth with a rubber dam and cotton balls;
• Preparation of the carious area;
• Inserting a cotton ball into it to absorb liquid during exudation;
• Application of a temporary filling; Medicines are applied to the burned pulp horn.

A second visit to the doctor with this treatment will be required after 1-2 days. If the patient has no complaints, then the dentist begins the second stage of treatment - applying calcium hydroxide to the burned pulp of the horn, closing it with a temporary filling.

The next inspection takes place in a week. If the patient again has no complaints, then the third phase of treatment begins - installation of a permanent filling. But at the same time, the dentist must place a therapeutic pad on the horn of the affected dental nerve. And then - insulating. And all this is closed with a permanent filling, which is hermetically fixed to the carious cavity.

True, there are cases that even in the absence of contraindications to biological treatment, such therapy does not lead to a positive result. In this case, it is worth using a surgical treatment method.

It involves carrying out surgical measures - vital amputation (pulp removal, partial removal, pulpotomy), vital extirpation (complete removal of the dental nerve, pulpectomy). After this, the doctor fills the root canal and carious cavity.

The dentist, when choosing one or another treatment method, must pay attention to the condition of the neurovascular bundle of the tooth.

The essence of vital amputation is that the patient is under anesthesia to remove the affected area of ​​the coronal pulp. Next, treatment with medications and restoration of the remaining stump occurs. A medicinal paste is applied to it so that the tooth cavity can then be closed with a permanent filling.

What are the indications for pulpotomy?

• Focal pulpitis;
• Acute diffuse pulpitis;
• Pulp hyperemia;
• Chronic fibrous pulpitis;
• Acute and chronic forms of the disease, when baby teeth are affected; in the case of permanent ones, the same forms of the disease occur when teeth are affected with incomplete root growth.

Tooth extraction due to pulpitis

Amputation must take place in several stages:

1. Hygienic treatment of the oral cavity and the beginning of preparation of the carious area. The doctor removes all layers of softened, pigmented dentin from the walls of the cavity, since it is from these tissues that the toxic components that cause inflammation come. After this, the cavity is generously coated with a solution consisting of enzymes and antibiotics.

2. Opening of the pulp chamber. The dentist must take every precaution when performing this procedure, as insufficient exposure will mean that the dentist will not be able to remove all of the affected dental nerve. And in this case, the recurrence of the disease will be ensured.

3. Amputation of the coronal part. All manipulations at this stage are performed with a sharp excavator. Using this instrument, the doctor carefully scrapes out the inflamed area of ​​the dental nerve; boron cleans out the residue.

4. Application of anti-inflammatory drugs to prevent recurrence of pulpitis. Bleeding from the root canals can be stopped by “cauterizing” with hydrogen peroxide, or using diathermocoagulation.

5. Applying medications to the stump to prevent inflammation; then it is necessary to close the cavity with caries using water-based dentin.

A few days later, if the patient has no complaints, the dentist begins installing a permanent filling.

Vital extirpation

Another method of surgical treatment - vital extirpation - differs in that the doctor removes the dental nerve completely, in one moment. This technique is used if there is no preservation of functions and no hope for restoration of the pulp. This occurs in the following forms of pulpitis:

• Acute, purulent;
• Traumatic;
• Chronic, hypertrophic and gangrenous;
• Concrete;
• Complicated by lymphadenitis, periodontitis;
• In the presence of somatic, infectious or viral diseases;
• Orthopedic, orthodontic contraindications.

This method of surgical intervention also includes a certain “list” of manipulations:

1. Oral hygiene;

2. Conducting anesthesia;

3. Preparation of a carious cavity with complete removal of dead dentin tissue;

4. Opening, opening of the carious cavity;

5. Removal of the affected dental nerve in the coronal region;

6. Removal of the root part using pulp extractors.

There are cases when the removal of the affected dental nerve cannot be carried out instrumentally. This especially happens when the root canals are severely curvature. Thus, obstruction of the canals makes physical extirpation impossible. Then carry out the following manipulations:

Drug electrophoresis

This manipulation is carried out to prevent complications of pulpitis. First, the dental cavity is cleaned and dried, into which a cotton swab thoroughly moistened in a solution of potassium iodide and 10% iodine tincture is inserted. Following the cotton ball, an active electrode is inserted. The tooth cavity is sealed with wax for 20 minutes. A current of two to three microamps is turned on so that the medicine can penetrate into the tissues. After a few days, if the patient has no complaints, the doctor places a permanent filling.

Depophoresis with copper-calcium hydroxide

This technique is very helpful in endodontic treatment if the canals are infected or poorly accessible. As in the previous case, the tooth cavity is treated to dry and expand the canal. The doctor applies a special aqueous suspension and inserts a needle electrode. Under the influence of current, the medicinal substance constantly enters the channel, filling all the holes and micropores of the channel. Next, copper plugs are created, which disinfect the lumen and hermetically close the root canal.

If bleeding from the canals occurs, the doctor uses hemostatic solutions, hydrogen peroxide, and cauterizes the wounds with electric current. Having stopped the bleeding and cleaned the canal, the dentist treats the instruments, which includes the following measures:

1. Expansion of the mouth;

2. Full length passage;

3. Additional expansion;

4. Reconciliation of dimensions;

5. Removal of affected dentin.

Using tools, the tooth canal is processed and given the shape of a cone, the walls of which are dense and smooth. In this case, filling is the final stage of treatment. It is important to pay attention to the filling material itself, which must have the following qualities:

• Antiseptic property;
• Reliable adhesion to the walls of the root canal;
• No shrinkage, insoluble in liquids;
• Clearly visible on x-ray;
• Does not change tooth color.

It has a certain plasticity, which will allow the introduction of medicinal paste; if necessary, remove the prosthesis without difficulty.

It happens that filling pastes are used together with plastic pins, which makes it possible to seal the root canal even better. This technique, although simple, requires attentiveness and caution on the part of the dentist:

• The filling paste is mixed in a glass plate. Next, the substance is applied to the canal filler (there is such a tool for filling) and injected into the root canal. The doctor performs additional cleaning of the tooth cavity with a drill.
• Next, the remaining material is removed from the cavity. To check the quality of the filling, an x-ray is taken.
• The canal is closed using gutta-percha pins. To do this, a small amount of filling paste is injected into the canal. Next, there are pins that are pressed against the walls one at a time. Up to the complete closure of the channel.
• You can also use one pin, which is comparable in size to the canal.
• The pin ends are cut off with heated tools.
• A permanent filling is put on.

Every person in the world faces a problem, and it can be triggered by various factors. If you do not seek qualified help in time, the consequences of inaction can lead to serious problems, which most often end in tooth extraction. Very often, dentists, examining another patient, discover he has pulpitis. But what are the main methods and stages for a child and an adult?

Pulpitis - what kind of pathology is this?

Pulpitis is an inflammation that affects the neurovascular bundle (pulp). One of the most common causes of inflammation is caries, which contributes to the destruction of hard tooth tissue. Pathogenic bacteria filling the carious cavity provoke an inflammatory process in the pulp (popularly called the nerve).

Pulpitis can also develop due to a poorly performed filling procedure or tooth injury. There are several types of pulpitis, each of them requires emergency assistance from a specialist. Methods and stages of treatment of pulpitis are selected individually for each type.

Types of pulpitis

In the initial form of pulpitis, the pulp's reaction to irritation is hyperemia, during which blood flow in the pulp arteries significantly increases. The amount of blood inside the cavity increases and thereby creates pressure on the small fibers of the nerve, which leads to aching pain. After the irritation is removed, the pain immediately goes away.

The acute form of pulpitis is accompanied by severe pain. If the pulp is not yet very inflamed, then the process can be stopped, in which case the pain goes away immediately. The pulp heals on its own, you just have to remove the causes of irritation.

If the pulp does not recover on its own, the pain continues to bother you and becomes even more acute, especially intensifying at night, then you cannot do without the help of a dentist. Upon examination, a tooth with a deep carious cavity and a painful bottom during probing is revealed. The stages in this case are selected depending on how much the tooth is affected and whether the inflammation has progressed further.

The purulent form is one of the most severe and is characterized by sharp pain, which intensifies at night, and cannot be relieved with painkillers.

The chronic form of pulpitis is characterized by attacks if an irritant appears, and if it is eliminated, the pain goes away. The dull pain can last for quite a long time. During the examination, a deep cavity with caries and bleeding is revealed.

Chronic hyperplastic pulpitis is an irreversible form that requires serious stages of pulpitis treatment to be carried out. This form is much more common in children and young people. It consists of hyperplastic pulp tissue called a pulp polyp.

Necrosis is an irreversible form of pathology; it is characterized by the death of the pulp, appears after prolonged bacterial invasion, or is a consequence of acute purulent pulpitis.

Symptoms of pulpitis

Pulpitis is a very serious disease that requires a quick response and seeking qualified help. If the initial stage of the disease is accompanied by aching pain, which can be relieved by taking an anesthetic, then acute and chronic cause severe pain, which intensifies at night and does not subside even after taking medications.

When the tooth is exposed to irritants - thermal, mechanical or chemical - the pain intensifies. If therapy is not started in the acute phase of the pathology, then eventually everything will end in a chronic form, which is characterized by pain when touching a tooth, it intensifies when exposed to hot foods, and weakens when exposed to cold foods. If you do not take any measures and do not begin to carry out the stages of treatment of pulpitis, then inflammation can affect the bone structures of the jaw.

Why do you need to treat pulpitis?

If you imagine a person who is constantly busy with problems at work or in the family, he does not always immediately pay attention to a slight pain in a tooth. The first thing he does is take a painkiller: “Ketanov”, “Nurofen”, “Ketorolac”, “Baralgin”, “Nise” - and forgets about the problem. But over time, bacteria that remain in the pulp chamber of the tooth continue to destroy it and ultimately lead to pus appearing in the root canal.

After the pus leaves the root canal, flux appears, and it can manifest itself not only in the form of a slight swelling of the gums, but also in the form of severe swelling with a severe violation of symmetry. Severe forms of pathology require serious steps in the treatment of pulpitis, otherwise it can threaten not only tooth loss, but also pathologies such as phlegmon, blood poisoning and bone tissue damage.

Main stages of endodontic treatment

The initial form of pulpitis can be cured very quickly, one visit to the dentist is enough, but for serious forms it requires a long period of time. The stages of therapy will require the patient to have several appointments with the doctor, and each of them is designed to relieve pain, disinfect the tooth cavity and other, but first things first. When performing root canal therapy, it is important to follow the steps:

Filling is the last action of the dentist, completing all stages. But the treatment does not end there; the doctor also recommends certain procedures that will effectively cope with inflammation and help protect against relapse.

Prescriptions after the first stage of treatment

After the doctor has treated pulpitis, its stages are completed, you will need to take medications and procedures at home for a few more days:

• Physiotherapy is the use of a laser; in this case, it is best to carry out the procedure using a helium-neon apparatus. Just a few procedures will be enough to consolidate the therapeutic effect and prevent relapse.
• Taking medications. Since pulpitis is an inflammation, it is simply necessary to take a course of non-steroidal anti-inflammatory drugs, such as Ibuprofen, to completely remove the inflammatory process.

It is very important to monitor a patient, for example a child, after he has undergone all stages of treatment for pulpitis of baby teeth, it is very important to monitor his condition, and if complaints arise, then immediately consult a doctor. A child cannot always independently determine what is happening to him, so the doctor advises parents to monitor him or simply come for a follow-up appointment a few days later.

Vital amputation method for pulpitis

There are several methods for treating pulpitis, one of them is vital amputation, which involves preserving the pulp only in the canals of the tooth, but it is removed in the crown area. This technique is attempted if a multi-rooted tooth is affected. This method is not used to treat a single-rooted tooth, and all because there is no boundary between the coronal and root zones of the pulp. This technique consists of the following steps:

• local anesthesia is administered;
• areas affected by caries are removed;
• the pulp is removed;
• the tooth cavity is treated with medications;
• a medicinal pad is placed in the canal;
• then apply an insulating pad;
• temporary filling.

Method of surgical treatment of pulpitis

There are several methods of treating pulpitis, including the surgical approach. This method involves removing the nerve, and this occurs in both the coronal and root zones. This method is called depulpation. It is used for advanced forms, in which it is necessary to take all measures to begin treatment of pulpitis, the stages consist of the following manipulations:

• all tissues affected by caries are drilled out;
• the nerve in the coronal and root parts is removed;
• the canals where the nerve was located are carefully processed;
• then the canals are filled, and then the coronal part.

At the same time, it is worth remembering that it will not be possible to carry out all the procedures at once in one visit to the doctor, so you need to be prepared for the fact that there will be two, or maybe three, visits.

Now let’s take a closer look at all the stages of treatment.

Stages of pulpitis treatment: first visit to the doctor

So, in order to accurately understand all stages of pulpitis treatment, you need to know how everything happens and how the dentist carries out the treatment:

1. Most often, the patient seeks help at the moment when he is bothered by severe pain, which does not stop even after taking painkillers, so the doctor immediately administers anesthesia.
2. After the injection takes effect, they begin to eliminate the tissues affected by caries; for this they use a drill, which allows them to be drilled out.
3. After this, you need to install a rubber dam to prevent saliva and bacteria from getting into the cleaned canal.
4. Then the pulp is removed using a pulp extractor; this tool is very thin and has small serrations that help pull the pulp out of the thin canal.
5. Next, you need to accurately measure the root canal in order to completely fill it and thereby protect it from complications. To do this, an x-ray is taken; a tooth may have several canals, which means that each one needs to be measured.
6. Afterwards, all canals are treated with antiseptic solutions and a temporary filling is installed.

This will complete the first visit, although very often it is not always possible to carry out all this for the first time; the first visit may end with anesthesia, drilling out the canals and placing medicine in them to kill the sensitivity of the nerve.

Follow-up and final visits

But the second visit to the doctor involves the following stages of pulpitis treatment:

• The doctor removes the temporary filling, and then the medicine from the canals.
• Next, the channels are washed with antiseptics.
• A filling is installed, and a sealer is also used for this.
• Afterwards, an x-ray is taken to check how well the canals are sealed.
• If the x-ray shows that everything is fine, then a filling can be placed.

But not only adults suffer from pulpitis, it also often bothers children who do not yet have molars, but only milk ones. Treatment of pulpitis in children with primary teeth has simple stages, only partially similar to the treatment of primary teeth. But parents must remember that inaction and untimely treatment can lead to complications.

Stages of treatment of pulpitis of primary teeth in children

Often, pulpitis in a child occurs in a severe form, so in this case the doctor may recommend removing a baby tooth, but if there is even the slightest opportunity to save it, and the bite will not be affected, then they begin treatment. Stages of treatment for pulpitis of primary teeth:

1. On the first visit, the doctor opens the nerve and applies a paste that has a devitalizing effect; it helps kill the pulp. If it contains arsenic, then it can be kept for no more than 2 days, and a product without arsenic can be kept for up to 7 days.
2. At the next visit, a special substance is pumped into the tooth to mummify the infected pulp, most often it is a resorcinol-formalin mixture.
3. On the last visit, a permanent filling is installed.

Treatment of pulpitis is a simple procedure if you seek help from a doctor in time. Moreover, today, thanks to modern technologies and effective means, you can very quickly cure a bad tooth.

You shouldn’t sit until the last moment and wait until the pain becomes completely unbearable; it’s better to visit the dentist regularly, then you won’t have to endure the pain and have the tooth removed.

Anyone who has ever experienced acute toothache due to pulpitis is primarily interested in how to cure this disease as quickly, efficiently and as painlessly as possible. Treatment is aimed at eliminating the inflammatory process in the dental pulp. The main methods of treatment are biological and surgical. With the biological or conservative method, the pulp is preserved, but with the surgical method, it is completely removed, after which the canals are sealed. Let's take a closer look at both of these methods.

Biological method

Conservative treatment of pulpitis, or the so-called biological method, is possible only in the early stages of the disease, when the inflammatory process in the pulp is reversible. This treatment does not involve removing the dental nerve, so the tooth remains alive. Most often, conservative treatment is used in the following cases:

• with traumatic pulpitis;
• accidental opening of the pulp chamber;
• treatment of young patients without a history of chronic diseases.

Treatment without removing the nerve involves the following actions by the dentist:

• use of antibacterial and calcium-containing drugs;
• the use of physiotherapeutic procedures to sanitize the pulp and restore the alkaline reaction;
• systematic x-ray monitoring of the treated tooth to prevent the transition of the inflammatory process to the chronic stage.

In case of traumatic pulpitis, the doctor carefully treats the exposed pulp with antiseptic agents, then applies a pad with calcium hydroxide, and then seals the tooth with a temporary filling. And although the likelihood of recovery after such treatment is very high, the doctor should advise the patient to undergo systematic X-ray monitoring.

Surgical removal of the nerve

Surgical treatment by amputation involves opening the pulp and removing the dental nerve. It should be noted that both acute and chronic pulpitis are treated surgically.

The surgical method is divided into two types - vital and non-vital:

• With the devitalizing method, the nerve of the tooth is killed using so-called devitalizing agents, which include arsenic, as well as modern arsenic-free drugs. In this case, removal is carried out without anesthesia. It should be noted that treatment with arsenic requires high qualifications from the doctor, because the quality of its effect on the pulp depends on the correct installation of the medicine in the tooth cavity.
• With the vital method, the doctor does not use drugs that kill the dental nerve, and the treatment itself takes place under anesthesia, so the patient does not feel pain. The nerve is removed under local anesthesia, so pain-free treatment is not a fairy tale; it is quite possible with proper pain relief. The doctor injects an anesthetic into the patient’s gums, opens and removes the pulp, and thoroughly cleans the root canals, removing nerve endings. Next, you should thoroughly rinse the root canals with antiseptic solutions to prevent relapse of the inflammatory process.

The treatment algorithm for pulpitis depends on the condition of the tooth, the complexity and severity of the inflammatory process. Treatment in one visit to the dental clinic is quite possible. After analyzing the condition of the tooth, the doctor may decide to fill the root canals immediately after treating them with antiseptic drugs and thoroughly drying them. The canals must be sealed very tightly; you should definitely take a control photo to ensure that the canals are tightly sealed. Next, a filling is placed on the carious cavity, with the help of filling material the appearance of the tooth is restored, after which the treatment is considered complete.

In more complex and advanced cases, the doctor may offer the patient step-by-step treatment. In this case, the canals are first filled and a control x-ray is taken, after which the carious cavity is closed with a temporary filling for several days. After the filling material inside the canals has hardened, the doctor fills the tooth with a permanent filling made of composite materials and restores its shape.

Laser

Treatment of pulpitis without a drill is the dream of everyone who has experienced acute toothache. Thanks to modern methods of therapy in dentistry, this dream has become a reality. One such therapy is the use of a dental laser.

The laser allows you to painlessly and safely cure pulpitis, while keeping the pulp alive. Laser radiation activates metabolic processes in tooth tissues and helps stop the inflammatory process, while stimulating the process of regeneration of pulp cells. Within 24 hours after the procedure, pain is relieved and tooth function is restored. The most effective use of laser is in the treatment of focal pulpitis.

Depophoresis

Physiotherapy

Physiotherapeutic therapy for pulpitis is supportive of other methods of treating the disease. A very effective anti-inflammatory method is pulpitis therapy with UHF, which helps to resolve the inflammation in the pulp and reduce pain. No less effective is infrared laser therapy, which has a positive effect on the regeneration of pulp tissue. The diatemocoagulation method prevents the penetration of infection into periodontal tissue. Transcanal iodine electrophoresis stimulates the regeneration of pulp and periodontal tissue, which helps to avoid complications such as apical periodontitis.

How to treat different forms of pulpitis

Features of the treatment of pulpitis depend on the form of the disease, as well as on the stages of development of the disease, in other words, on its neglect. The sooner the patient consults a doctor, the higher the chances of using conservative methods. Conversely, the longer a patient waits to see a doctor, the higher the chances of losing a tooth. Therefore, at the first signs of illness, you should not postpone your visit to the dentist until “later”, but should make an appointment with an experienced dentist as soon as possible. Let us consider in more detail the features of the treatment of various forms of acute and chronic pulpitis.

Spicy

Acute pulpitis begins suddenly with intense throbbing pain that radiates to the temple and ear. The pain usually intensifies in the evening and subsides somewhat during the day. But you should not delude yourself that over time everything will go away on its own. Without proper treatment, the disease becomes chronic, which is much more difficult to cure.

Typically, the treatment protocol for acute pulpitis consists of three points:

• removal of the inflamed pulp, which is carried out under local anesthesia, followed by drug treatment of root canals;
• filling root canals with a special sealant and gutta-percha pins;
• restoration of the tooth crown using filling material.

Serous

The most common form is serous pulpitis. It comes in two types:

• diffuse serous;
• focal (or limited) serous.

Serous limited pulpitis is localized in the area of ​​one tooth, and diffuse serous pulpitis is localized in the area of ​​several teeth at once. Since the pain often radiates to the ear, temple, and eye, it is sometimes difficult for the patient to determine the source of the pain, and the doctor cannot immediately determine which tooth is the cause of the patient’s suffering.

Both limited and diffuse serous pulpitis are curable diseases. If it was possible to start therapy at an early stage of the disease, the doctor may limit itself to conservative treatment. First, you need to clean the tooth from caries-affected dentin. A special calcium-containing spacer should be used under the filling; in combination with the use of antibiotic dressings, this promotes the formation of secondary dentin. We especially emphasize that treatment of pulpitis with antibiotics is possible only if the patient does not have chronic diseases and the tooth itself is not destroyed by caries. Otherwise, you will have to resort to a more radical surgical method of treating the disease.

If the process has gone quite far, the doctor may decide to depulp the tooth, that is, remove the dental pulp and dental nerve. The procedure is performed under local anesthesia. The doctor cleans the root canals of pulp residues, treats them with an antiseptic solution and special medications. This is followed by filling the canals and subsequent restoration of the tooth crown using filling materials.

Purulent

The most dangerous type is purulent pulpitis. In its distribution it can be either focal or diffuse. With focal purulent pulpitis, the tooth pulp is only partially affected; with a diffuse form, the pulp is completely damaged and cannot be restored.

Typically, purulent pulpitis forms if acute serous pulpitis is not treated promptly. From the serous exudate already present in the tooth, pus is formed, which can even cause blood poisoning.

Purulent pulpitis can only be removed surgically; conservative treatment will not bring recovery. The doctor, using the vital or devital method, will clean the root canals from remnants of pulp, nerves and purulent exudate. The treatment is complex, so it should be entrusted only to an experienced dentist, in order to avoid unwanted complications both at the treatment stage and after its completion.

It is possible to cure pulpitis in one day, using the vital method of pulp removal. The doctor anesthetizes the tooth, removes dental tissues damaged by caries from the carious cavity, carries out antiseptic treatment of the cavity, removes the coronal part of the inflamed pulp, expands the root canals and removes the root part of the inflamed pulp. Next comes the stage of preparing the canals for filling, filling them with a special filling material. At the end of the appointment, the doctor restores the tooth crown using filling material or orthopedic structures.

The use of the devital method of pulp removal requires two visits to the doctor. During the first visit, the doctor:

• anesthetizes the tooth and gum, opens and cleanses the carious cavity from dental tissues affected by caries;
• disinfects the carious cavity with antiseptic drugs;
• using a probe, opens the pulp horn;
• injects arsenic or paraformaldehyde paste into the tooth, which kills the nerve;
• covers the tooth with a temporary filling.

A second visit to the doctor is usually scheduled after a few days, depending on the number of canals in the diseased tooth. During the second visit, the doctor:

• removes a temporary filling and cleans the carious cavity from its remains;
• gradually removes necrotic pulp from root canals;
• treats the tooth canals with antiseptic and medicinal preparations;
• performs filling of canals using special filling materials;
• restores the tooth crown.

Traumatic

A special feature is its non-infectious origin. It occurs as a result of mechanical action on the pulp. It can be damaged both at home (when trying to bite through something hard) and at a dentist’s appointment, as a result of careless manipulations by the doctor. If, as a result of damage to the crown of the tooth, the pulp is exposed, pulpitis develops.

Treatment of traumatic pulpitis can be either conservative or surgical, depending on the degree of damage to the pulp. If the pulp is exposed at the neck of the tooth, in a small area, and the tooth is not affected by caries, the doctor can use a conservative treatment method. If the crown of the tooth has chipped off, resulting in the pulp being exposed over a fairly large area, the doctor will remove all of the inflamed pulp to prevent the inflammatory process from becoming chronic.

Conservative therapy for perforation or puncture of the dental pulp with a sharp dental probe during careless actions of the dentist is possible, but only if the overall condition of the tooth is good and the patient does not have multiple caries or chronic diseases.

Chronic

With this diagnosis, treatment with a biological (conservative) method is ineffective, so the only acceptable option is the surgical method. The complexity of this disease is that the patient may not even be aware of the presence of chronic pulpitis for a long time, because very often the disease occurs without severe pain. In this case, the doctor may detect the disease completely by chance on an x-ray.

Depending on the form of the disease, the doctor will use one of the available modern treatment methods. Sometimes the most effective is the so-called combined method of treating pulpitis, in which the doctor uses a variety of techniques and methods to achieve complete recovery.

Fibrous

With fibrous pulpitis, the patient's connective tissue of the pulp thickens. This occurs due to the spontaneous proliferation of collagen fibers and a simultaneous reduction in the number of cells, which leads to the formation of secondary dentin. The complete blood supply to the pulp is disrupted, which leads to hypoxia, as a result of which it gradually turns into a dense grayish tourniquet.

If a patient is diagnosed with chronic fibrous pulpitis, treatment consists of removing the fibrotic fragment of the pulp. If the entire tooth pulp has undergone changes, the doctor will remove it completely. The procedure is performed under local anesthesia and consists of the following steps:

• opening the carious cavity and cleaning it from dentin affected by caries;
• antimicrobial treatment of carious cavity with antiseptic solutions;
• resection of the septum, which separates the tooth cavity from the pulp;
• removal of the part of the coronal pulp affected by fibrosis;
• expansion of the mouths of the root canals and removal of pulp affected by fibrosis from the tooth canals;
• treatment of the tooth cavity with anti-inflammatory drugs;
• installation of a temporary filling, which after a few days is replaced by a permanent one.

As you can see, treatment of chronic fibrous pulpitis is usually carried out in two visits to the doctor.

Hypertrophic

Hypertrophic pulpitis most often occurs as a result of incorrect opening of the carious cavity, in which the pulp tissue becomes infected. As a result of infection, it becomes covered with granulations, which over time grow deep into the tooth, reaching the root canals. As a result of the proliferation of granulations, the pulp tissue undergoes significant changes and the blood supply is disrupted.

Depending on the degree of damage to the pulp, the doctor decides on the method of treatment. There are two possible ways:

• partial removal of pulp affected by granulations;
• complete removal of the pulp if it is completely covered with granulations.

Depending on the complexity of the disease, as well as the wishes of the patient, the doctor may decide to carry out treatment under either local anesthesia or general anesthesia.

When partially removing the pulp, it is very important that the doctor correctly applies a healing pad to the remaining part of the pulp, otherwise the process of infection of the pulp will continue, which can lead to its further complete removal.

When completely removing the pulp, it is very important to thoroughly clean the root canals from pulp residues, and then carefully seal them, without the slightest gaps or cracks. Careful filling of the root canals guarantees that the inflammatory process will not continue in the future.

Gangrenous

Gangrenous pulpitis is the most dangerous stage of the disease. At this stage, the dental pulp is covered with ulcers, the septum between the carious and dental cavities is completely destroyed, the upper layer of the pulp is covered with necrotic tissues, and granulation and connective tissues are located under them. The root canals are filled with pulp with fibrous changes.

Treatment of chronic gangrenous pulpitis is quite complex and requires a highly qualified dentist. The most optimal method of therapy is complete removal of the pulp, or pulpectomy, during which the doctor:

• anesthetizes the tooth and adjacent gum;
• opens the carious cavity and cleanses it of tissues affected by caries;
• removes the coronal part of the pulp;
• expands the root canals and removes from them the remains of the inflamed root pulp;
• cauterizes the dental nerve using electrocoagulation, which prevents bleeding;
• dries the surgical area;
• applies an antiseptic bandage;
• fills the canals.

Stages of treatment

Tooth extraction for pulpitis is no longer the only effective method of combating the disease. Modern dentistry offers much more gentle and no less effective methods of treating the disease. Moreover, depending on the complexity of the disease, treatment may take from one to three visits to the doctor.

Standard therapy for pulpitis of permanent teeth consists of four stages:

Stage 1	Diagnosis of the disease, anesthesia of a tooth affected by pulpitis, opening of the carious cavity and cleaning it from tissues affected by caries
Stage 2	Removal (complete or partial) of inflamed dental pulp, which is carried out using both vital and non-vital methods
Stage 3	Expansion and cleaning of root canals, preparing them for filling and filling them directly
Stage 4	X-ray quality control of tooth root canal filling, restoration of the tooth crown using filling material and orthopedic structures

Despite the fact that the treatment of the disease consists of four stages, you can get rid of it in one, two, or three visits to the doctor. It all depends on the complexity and severity of the inflammatory process. Treatment at one time is possible in cases where we are talking about mild stages of the disease. Usually, elimination takes two visits to the doctor, but sometimes the doctor may decide that a third visit is necessary. In addition, it is recommended to cover the cured and filled tooth with a crown, and this also takes time. Treatment of pulpitis and strengthening of the tooth with a crown are mandatory, since the tooth after treatment becomes fragile and without such strengthening can crumble quite quickly.

It is technically impossible to cure pulpitis through a crown, so the doctor must first remove the crown, treat the tooth, and then put the crown on it again.

Errors

Unfortunately, errors in the treatment of pulpitis sometimes occur. They depend, first of all, on the insufficient qualifications of the dentist and insufficient attention to diagnosing the disease. The most common medical errors occur:

• misdiagnosis, when pulpitis is mistaken for deep caries or another disease with similar symptoms;
• the use of a biological method of treatment without taking into account contraindications in the case of a severe stage of the disease;
• improper application of arsenic paste, in which it seeps into the surrounding tissues and causes necrosis of the oral mucosa;
• perforation during treatment of the bottom of the tooth cavity, if the doctor does not take into account the anatomical features of the structure of the patient’s teeth;
• incomplete removal of the inflamed pulp, in which part of it remains in the root canal and provokes the further development of chronic pulpitis;
• poor-quality filling of root canals, which leaves cavities filled with air and pathogenic bacteria, as a result of which the inflammatory process continues to develop even after completion of treatment.

A lot of mistakes are associated with the treatment of pulpitis in children. Therefore, if a child has a toothache, you should contact an experienced pediatric dentist, because the treatment of children’s teeth, especially baby teeth, has its own peculiarities.

If after treatment the swelling of the tooth does not resolve for a long time, you should contact your dentist to exclude the possibility of developing a chronic form.

In order to avoid medical errors, you should contact only specialized dental clinics and experienced specialists.

Complications

If treatment for pulpitis is not started in a timely manner, it can provoke the development of very serious complications, among which the most dangerous are:

• the occurrence of acute and chronic periodontitis;
• formation of granulomas and perihilar cysts;
• general intoxication of the body.

To prevent complications from occurring, you should consult a dentist at the first signs of disease. Remember: you cannot cure pulpitis at home using folk remedies! Even if the pain completely subsides, this does not mean that the disease has passed. Most likely, it simply became chronic. And if at the initial stage you can get by with conservative therapy, then at a later stage, removal of pulpitis may entail the removal of the entire tooth.

Often patients do not consult a dentist in a timely manner because they believe that treating pulpitis is painful. In fact, modern technologies make it possible to completely anesthetize the tooth and the adjacent gum, so that the patient does not feel any pain at all. In some cases, the doctor may even perform treatment under general anesthesia.

Prices in dentists

The price in Moscow varies depending on both each specific dental clinic and the qualifications of the dentist. However, this is not the case when you can save money. Incorrect treatment can lead to tooth loss and overall serious complications.

The cost of treatment in dental clinics varies from 5600 to 10000 rubles. The price depends both on the complexity of the disease and on the quality of the materials used in the process. Also, treatment under local anesthesia is significantly cheaper than under general anesthesia.

The price also depends on how many roots the diseased tooth has. Thus, treatment of a single-rooted tooth will cost the patient on average from 6000 to 7000 rubles, while treatment of a three-rooted tooth will cost 8000-10000 rubles.

Hello, dear readers. We have prepared new interesting material for you, in which we will tell you about the biological method of treating pulpitis. You will learn what it is, in what cases it is used and how effective this technique is.

Dental problems are familiar to most people in the world. Only a select few lucky people have never felt toothache, and only heard about caries from advertising. This is a fact, as is the fact that a huge number of our compatriots and residents of other countries are terrified of dentists. And not at all because they were “healed by evil doctors.” This is a subconscious fear. Dentistry is associated with pain. And although modern medicine has long offered effective and safe means for anesthesia during procedures, the stereotype has not been eradicated to this day. For this reason, caries often turns into a much more dangerous and painful inflammation, and then decomposition of the dental nerve, the pulp, occurs.

What is a biological method of treating pulpitis?

In most cases, the development of pulpitis occurs in such a way that it is impossible to save the nerve. However, any specialist understands that without pulp the tooth is dead. It breaks down faster due to natural processes. Therefore, there are a number of cases when doctors try to save not only the tooth itself, but also part of the nerve. Let's explain the situation in more detail.

The pulp consists of two parts. One is located inside the crown of the tooth under the layers of dentin and enamel, the other is in the root canals. First of all, the carious process affects the upper part. While the inflammation has just begun, you can try to stop it. If it doesn’t work out, you have to remove the coronal part.

The biological method is without even removing the crown part. But this technique has certain limitations. They are associated with the regenerative capabilities of the dental nerve.

When is this type of treatment used:

• in children;
• in teenagers;
• in young people no older than 25–27 years.

Unfortunately, most dentists do not even offer conservative treatment for pulpitis. Why is this happening?

1. Firstly, they simply don’t have time. The flow of patients is too high.
2. Secondly, dentists are conservative people. They rarely experiment, preferring proven methods that provide an almost 100% guarantee.

If you come at the first signs of tooth pain and intend to save the nerve, immediately ask if this is possible. If the doctor answers in the negative, clarify why. Sometimes it is easier to go to a private clinic.

Why is it better to preserve the pulp?

We have already mentioned the fact that this is a kind of source of life for the tooth. It provides two main factors - nutrition and protection. When the nerve is destroyed or removed, the tooth becomes more fragile. In addition, by removing the pulp completely, the dentist is forced to clean and fill the root canals. This endodontic procedure is often performed poorly. As a result, bacteria multiply inside the canals, and an inflammatory process begins in the area of ​​the root apex. That’s why it’s so important to try to preserve the pulp, or at least part of it.

Unfortunately, in practice it is not often possible to achieve success. Usually people come for an appointment after the nerve has begun to deteriorate and a purulent inflammatory process has begun. In this case, there is simply nothing to treat. If the inflammation is at the initial stage, there is a chance to save the nerve and the specialist chooses the means for treatment. It takes place in two stages.

The main indications for the use of a biological method of treating pulpitis:

• primary inflammation of the pulp. In this case, a small fragment of the nerve is affected, located directly under the resulting carious cavity;
• not aggravated pulpitis, occurring in a fibrous form;
• accidental opening of the pulp chamber by a doctor when treating deep caries;
• The patient's age is up to 27 (maximum 30) years.

At the first stage of treatment, the doctor performs the following actions:

• administers an anesthetic drug to relieve the patient of pain;
• removes hard tissue affected by bacteria;
• isolates the tooth from saliva using a rubber dam;
• treats the cavity with antiseptics;
• applies a special gasket based on calcium compounds to the bottom of the cavity. These may be materials such as Septodont, Life or their analogues;
• installs a protective liner to isolate the pulp. This is usually a glass ionomer based cement;
• installs a temporary filling.

After this, the patient receives a series of appointments. In particular, this is laser therapy. One to three sessions are required. Using a helium-neon laser, the specialist acts on the neck of the tooth.

In parallel, NSAIDs (Ibuprofen and its analogues) are used to relieve inflammation. There is no point in prescribing a course of antibiotics, since “”, “Ampicillin” and similar drugs are unable to destroy bacteria that cause the development of caries. If treatment is unsuccessful, the pulp will be removed and the tooth will be filled.

The second stage of treatment (applied if the first is successful) includes:

• removal of temporary filling;
• insulation of the cavity with a rubber dam from moisture;
• installation of a seal. These are usually light-curing materials.

It is important to see your doctor regularly. If pain or discomfort appears, most likely the inflammation has returned. Here we have to resort to less gentle treatment methods. In such situations, do not delay contacting a doctor.

Back in 1999, author V. Suntsov described a method of conservative treatment of pulpitis using a gel based on chlorhexidine and calcium phosphate compounds. The duration of such treatment is from two weeks to a month. The technique is relevant in the treatment of injured teeth

Video - Treatment of pulpitis of baby teeth

Conditional conservative treatment

Conditionally conservative is a method of treating pulpitis in which the doctor removes the coronal part of the pulp, while maintaining the viability of the root. Amputation of part of the pulp is performed under local anesthesia. The procedure is painless and quite quick.

This treatment is often called vital amputation. That is, a part is amputated while preserving its elements that go through the root canals into the periodontium. The technique is used for multi-rooted teeth. First of all – molars. In a single-rooted tooth, such an operation is impossible, because it does not have a clear distinction between the root and coronal pulp.

Like the biological method, vital amputation is carried out in two stages. At first, the following sequence of actions is performed:

• first, the enamel and dentin affected by the carious process are removed;
• then the doctor removes the damaged coronal pulp;
• the cavity is treated with medications;
• a therapeutic bandage based on calcium hydroxide is installed;
• A glass ionomer gasket is installed at the bottom of the cavity;

After the procedure is completed, the dentist may place a temporary filling on the tooth to monitor the condition. In parallel, physiotherapy and NSAID treatment are used, as in the previous case.

At the second stage:

• the tooth is isolated from saliva by a rubber dam;
• the temporary filling is removed;
• the surfaces of the cavity are cleaned and treated with adhesive;
• A permanent composite filling is installed.

The effectiveness of the use of red and infrared radiation in the treatment of pulp inflammation in the initial stage has also been proven. The procedures are simple, quick, and no medical examination is required. There is only one minus - there are no guarantees that the preserved nerve will not begin to become inflamed again under a permanent filling.

If after a week or more the patient begins to feel pain, the scenario is classic:

• referral for radiography or radiovisiography;
• the image is examined by the attending dentist;
• If inflammation develops again under the filling, classical treatment methods are used.

Unfortunately, relapses of pulpitis with conservative and conditionally conservative treatment methods occur frequently. In addition, these methods are not suitable for middle-aged and older people. In particular, the biological method of treating pulpitis is based solely on the ability of the pulp to recover at a young age.

Video - Treatment of pulpitis using a conservative method

What about contraindications to biological treatment?

This method, like any other, has its contraindications. In particular, we are talking about:

• purulent-necrotic pulpitis located in;
• aggravated chronic pulpitis;
• gangrenous pulpitis (they are also called ulcerative-necrotic);
• concrete;
• pathologies with focal periodontitis;
• cases when the carious cavity is located on the approximal surface or in the cervical area of ​​the tooth;
• all types of pulpitis, provided that the tooth will subsequently be covered with a crown or used as a support for installing a bridge;
• pulpitis in weakened patients, the elderly or with somatic pathologies.

It is also worth noting that the patient’s age should be a maximum of 35 years, moreover, he should not suffer from concomitant diseases!

Are you interested in this opportunity? Ask your doctor questions.

Consequences after improper treatment of pulpitis

Consequences	Photo
As a result of unfilled canals, the following develop: radicular cyst,
The occurrence of prolonged pain and neuralgia is possible as a result of refilling
If the doctor makes a mistake - perforation is allowed, a root fracture occurs, and also appears after treatment, then this will lead to tooth extraction

We wish you successful treatment. Don't forget that you can comment on the article, distribute it through blogs (with the source indicated) and social networks!

Video - Treatment methods for pulpitis

Pulpitis is inflammation of the tooth pulp. This disease must be treated; if this is ignored, the inflammation leads to pulp necrosis and periodontitis. Treatment of pulpitis is carried out using several methods, it all depends on the form of the disease. It is possible to independently determine the form of pulpitis only by characteristic symptoms. To diagnose the disease at an early stage, it is necessary to visit the dentist in a timely manner. Pulpitis occurs after deep caries.

Stages

Treatment of pulpitis can be carried out using several methods:

1. Surgical. During this procedure, the nerve of the tooth is removed from the crown and root parts.
2. Conservative. Helps keep the pulp alive, therapy takes place without removing the nerve. The conservative method is used when visiting the dental office in a timely manner.

The surgical treatment method is carried out in several visits, depends on the number of channels, and includes the following stages:

First visit

• Anesthesia.
• Removing carious lesions using a drill.
• Isolation of a diseased tooth from saliva. A rubber dam is used.
• Removal of pulp from coronal and root canals.
• Correction of root canal length.
• Processing channels using manual files.
• Treatment of canals with antiseptics.
• Adding antiseptic and installing a temporary filling.

Second visit

• Removing the temporary filling.
• Flushing the canals with antiseptics.
• Drying the channels.
• Filling canals with gutta-percha and sealer.
• Mandatory quality control of canal fillings performed using x-rays.
• Installation of a temporary filling.

Third visit

As for the conservative method, there are two types:

• Biological method - complete preservation of living pulp in the coronal and root canals.
• Amputation method (vital amputation method) - preservation of the pulp in the root canal.

Stages of treatment using the conservative method:

1. Anesthesia.
2. Removal of carious lesions.
3. Applying medicinal paste to the bottom of the cavity.
4. Restoration of a dental crown.

If the treatment is carried out in one visit, then the filling is installed immediately; if in two, then a temporary filling is first installed, and then replaced with a permanent one.

Very often the patient’s tooth ache after treatment. This could be for several reasons:

1. Poor quality therapy.
2. Injury to the mucous surface around the tooth.
3. Conservative treatment did not produce positive results.
4. Poor quality canal filling.
5. Poor quality tooth filling.
6. Periodontal overload during filling.

Modern methods

How is pulpitis currently treated? Several methods are used in modern dentistry:

1. Biological method.

2. Surgical method:

• Without pulp devitalization: vital amputation or vital pulp extirpation.
• With preliminary devitalization of the pulp: devital amputation and devital pulp extirpation.
• Application of a mixed surgical method.

3. Laser therapy. Its use is carried out in two stages:

• Surgical. Used at the preparation stage.
• Therapeutic. Used for sterilization of tooth root canals.

During the treatment of pulpitis, various pastes, ointments and preparations are necessarily used.

Medication

When treating pulpitis, medications must be used. If it so happens that the patient did not seek timely help, and serious complications began, including pus entering the blood, then antibiotics must also be used.

To expand root canals, dentists use:

1. ENDOJI No. 2.
2. "Belodez" 3% and 5.2%.
3. ENDOJI No. 3.
4. Pulpevitis.
5. Endosept.
6. Calcept.

Pastes are also used in the treatment process:

• Grinazol.
• Calcipulp.
• Calcipulpin.
• Metrosol.
• Non Arsenic.
• Pulposeptin.
• Devit-ARS. Arsenic based paste.
• Devit-P.
• Devit-S.

Additionally, the dentist can use ointments, bandages for sore gums and solutions.

At home

As for treating pulpitis with folk remedies at home, this is impossible. This is explained by the fact that the inflammatory process of the pulp occurs in a confined space and is rapid and irreversible.

The only thing you can do at home before visiting the dentist is to relieve the pain by taking medications or rinsing your mouth to relieve inflammation. It is recommended to take the following analgesic medications:

1. Ketanov,
2. Ketorol,
3. Pentalgin,
4. Baralgin,
5. Spasmalgon.

If you don’t have the listed drugs on hand, you can use Analgin.

You can also drink and rinse your mouth with cool water, which can also relieve pain. You can also rinse your mouth with baking soda, especially with chronic gangrenous pulpitis.

During pregnancy

Very often it turns out that pulpitis occurs during pregnancy. Then the woman wonders, is it possible to treat pulpitis during pregnancy and how does this happen? Pulpitis can be treated during pregnancy, but the process itself has its own nuances and takes place under more careful and close medical supervision.

Currently, there are rumors that pulpitis cannot be treated during pregnancy. It can and even needs to be treated. At best, it can be prevented, since pulpitis is a complication of deep caries. If pulpitis is not treated, infection of the fetus may occur. Also, arsenic should not be used during pregnancy, but modern dentistry rarely resorts to it.

Due to the interesting position of the woman, therapy is carried out to a minimum during this period. The dentist tries to completely eliminate pain during the procedure. The second trimester of pregnancy is considered the best option for treating pulp inflammation.

This is due to the complete formation of the placenta and the prevention of microorganisms from reaching the fetus. It is recommended to exclude the procedure in the first trimester, since the fetus’s internal organs are just beginning to form. It is not advisable to carry out the procedure in the third semester, as this may provoke labor.

In any situation, it is necessary to treat pulpitis, as well as its prevention, since the inflammatory process can negatively affect the condition of the fetus. During pregnancy, temporary treatment is carried out. Canal filling is carried out using safe materials and medicines. Installation of a permanent filling is carried out after childbirth. Therapy is recommended to be carried out without the use of anesthesia; if this is not possible, then modern anesthetics without adrenaline are used.

X-rays are not prescribed for pregnant women; only modern equipment is used. When visiting a doctor, a pregnant woman must inform her about her due date, talk about her health and report allergies to components and medications.