The canals opened up in the tooth for a long time with pus. Causes of purulent pulpitis. What contributes to the disease

Painful sensations in the teeth are quite serious symptom, which should not be ignored. If you experience any discomfort localized in the dental area, it is better not to hesitate and seek help from a dentist. But in some cases, ignoring the state of one's own oral cavity leads to the development of quite serious problems, including severe pain that cannot even be tolerated. A similar sign often occurs with a problem such as acute purulent pulpitis, the symptoms and treatment of which we will discuss further in a little more detail.

This is a painful procedure and should only be performed in full agreement with the patient. The pulp should be bathed in a small local anesthetic solution before inserting the needle into the pulp chamber. Several studies have shown that the type of drug appears to be of minor importance, since saline administration was as effective as anesthetic fluid.

Perforation of cellulose is obtained with a small bur.
Injection should be carried out under pressure.
It is important mechanical pressure during fluid injection.

When patients present with pain, the pain profile may not correspond to the actual presence of pulpal inflammation.

Acute purulent pulpitis is a disease of the soft tissue of the pulp, in which the patient has an inflamed abscess area inside the dental cavity. This disorder is often a consequence of serous pulpitis.

Symptoms of purulent pulpitis

Purulent pulpitis is accompanied by severe pain. Pain often occurs in response to thermal irritants and tends to increase from contact with heat. Doctors know cases where debilitating painful sensations patients completely stopped sleeping at night and lost their ability to work. Dentists often call purulent pulpitis “cold” due to the fact that the patient’s unpleasant symptoms are somewhat reduced when touching a cold object or food.

Based on subjective and objective results, pulpitis is divided into two clinical diagnoses: irreversible pulpitis and reversible pulpitis. In reversible pulpitis, local inflammation should be able to resolve and the pulp returns to normal condition after proper management of the cause of the condition.

On the other hand, with irreversible pulpitis, the dentofacial pulp becomes highly inflamed and damaged after repair. In the acute phase, it is associated with a spontaneous burst of severe pain that typically lingers for several minutes or more. Necessary diagnostic considerations are outlined in the table.

Patients usually come to see a doctor with complaints of severe pain, which is characterized by a gradual increase and spreads throughout the entire branch trigeminal nerve. Painful sensations in such a disorder are radiating in nature (spread to many corners of the oral cavity and beyond), which makes it much more difficult to carry out differential diagnosis. Sometimes patients with purulent pulpitis make an appointment with a therapist, complaining of acute pain in places that are not their real sources. Unpleasant symptom may spread to the chin, temples and ears.

Dentists say that purulent pulpitis usually causes not only pain, but also general deterioration states, sometimes quite strong. Patients with this problem often experience fever, fever and symptoms of general intoxication. As for the pain, it is increasing, tearing and pulsating in nature. Also arises bad smell from the mouth.

Caries is the most common reason, which dentists use to perform root canal treatment. There is a correlation between the depth of caries damage and the degree of inflammation in the pulp. This appears to be critical to the prediction of cellulose viability if caries production can be carried out without cellulose turnover.

If the pulp is exposed due to deep caries lesions, pulpotomy or pulsectomy should be the most reliable means of pain relief. Prescribing systemic antibiotics for symptomatic irreversible pulpitis will not provide any pain relief. The infection is located within the hard tissues of teeth or in the superficial parts of necrotic cellulose tissue where antibiotics from the bloodstream cannot reach it.

When examining the oral cavity, the dentist notices an open and deep carious lesion, which is filled with a significant amount of destroyed dentin. Both the affected tooth and the gums around it are covered with a whitish coating, which may have some yellowish tint. Swelling of the gums may occur, and pressure on the tooth and areas around it causes severe pain. Perforation of the dental cavity layer leads to separation purulent exudate and is accompanied by pulsation in the gums. The drainage of pus causes a decrease in pain. A X-ray examination shows a practically unchanged state of the periodontium.

The purpose of a pulpotomy is to remove inflamed coronal tissue from the pulp chamber without penetrating the radicular pulp tissue. The pain-relieving effect is most likely due to the removal of the source of inflammation and drainage while reducing local tissue pressure and the concentration of inflammatory mediators. Pulpotomy leads to pain relief in 90% of cases.

In the presence of suppuration, drainage of exudate is the most effective method reducing pain and swelling. In some cases, exudate cannot or will not drain through the root canal, and surgery using a soft tissue incision may be necessary.

Purulent pulpitis - treatment of the disorder

Purulent acute pulpitis can be corrected using vital and devital therapy techniques. Treatment is designed to eliminate suppuration and eliminate tissue affected by pathogens. Filling the canals is carried out with special care; such manipulation should be monitored using x-ray examination. Vital treatment is carried out in one stage, while non-vital treatment requires several visits to the doctor.

If bacteria are allowed to remain in the root canal system after endodontic treatment rather than being excluded from nutrients, then they will continue to remain active, and this can lead to pain. In such cases, re-treatment with a surgical approach may be considered. If there is a vertical fracture of the cracks in the root, you need to extract it.

Periodontal abscess and endodontic-periodontal lesion

Endodontic periodontal lesions can be a diagnostic challenge for the clinician, but it is vital to correct diagnosis so that appropriate treatment can be provided. It is important to diagnose potential factors such as root fractures, root resorptions, perforations and dental malformations that may play a role important role in the development, progression and prognosis of endodontic periodontal lesions. Recognition of pulp viability has important for differential diagnosis and treatment associated with inflammatory lesions in marginal and apical periodontium.

With the vital technique, the dentist uses a strong local anesthetic, combining it with intrapulpal. First of all, the doctor removes all infected and injured pulp tissue from the tooth cavity. So the specialist dissects the soft tissue above the cavity, excises the coronal zone of the pulp, mechanically expands the mouths of the root canals and eliminates the root pulp part. Next, the doctor treats the canal with special antiseptic drugs. Root canals subjected to mechanical cleaning and processed again. This prepares the tooth for further filling. Before the procedure, the doctor performs a control X-ray examination and restores the tooth using a filling or a complex orthopedic structure.

This condition may mimic the presence of a periodontal pocket or abscess.

Figure Tooth 21 with an endodontic periodontal lesion showing spontaneous drainage of pus from the periodontal pocket. Radiographs showing the sinus tract are traced with the gutta-percha point.

Periodontal lesions of endodontic origin heal after endodontic treatment. However, the treatment prognosis is less favorable if the patient suffers from a general marginal periodontal problem. Initial treatment of a periodontal abscess involves pain relief and infection control. This can be encouraged by gentle irrigation with saline solution and pocket scaling when massaging soft tissues. With a history of recurrent periodontal abscesses and significantly compromised periodontal support, tooth extraction should be considered.

With the devital method of exposure, treatment is carried out in at least two stages. During the first visit to the doctor, the specialist administers application anesthesia and then prepares the affected carious cavity. Next, the doctor cleans the cavities using an antiseptic solution. Then the specialist probes the pulp horn and treats it with a special paraformaldehyde or arsenic paste, which makes it possible to kill the infected areas. Next, the cavity is covered with a temporary filling. The next visit to the dentist is carried out after one to ten days, the duration of such a pause is determined by the type of paste used, as well as the number of roots in the tooth. During the second visit, the doctor removes the necrotic pulp and performs a final filling using high-quality filling material, and also mechanically adjusts the shape of the filling.

Primary periodontal disease with secondary endodontic disease and true combined endodontic periodontal disease requires both endodontic and periodontal therapy. Summary various conditions is given in the table.

Pericorinitis and aspects related to the third molar removal

The indications for third molar surgery have been debated and debated for many years. There is insufficient evidence to support prophylactic extraction of third molars, and the current consensus is that third molars should only be removed if they repeatedly cause problems or if there is a risk of future damage to adjacent teeth.

When treating purulent pulpitis at the dentist, the patient does not feel any pain at all, because the anesthetic blocks the sensitivity of the entire trigeminal nerve.

Everyone, without exception, should regularly visit a dentist. And if painful sensations appear, you should immediately contact such a specialist.

Traditional treatment

This can happen when the third molar does not have enough space in it. lower jaw during an eruption and is a common development problem. The third molar may partially or completely impact adjacent tooth, concha of the mandible and surrounding soft fabrics. If bacteria gain access to the follicular space through a hole in the overlying gum, inflammation in the surrounding tissues, pericorinitis, will develop.

Principles of treatment for symptoms

Symptoms associated with pericorinitis are pain, soft tissue swelling, and alveolar osteitis. Local treatment, such as rinsing with sodium chloride in the soft tissue pocket, instructions for improving brushing techniques and rinsing the mouth with an antibacterial environment is the first step and can slow down the infection. Grinding on the opposing tooth may be considered if the patient experiences pain when biting or if the opposing tooth is traumatic by a swollen outer jacket. If the condition worsens, the patient may develop trimus dullness, lymph nodes, pain when swallowing and, as a rule, malaise with fever.

There is no remedy traditional medicine, which can cure purulent pulpitis. Therefore, if you suspect its development, it is better to seek doctor’s help as soon as possible and not self-medicate.

However, there are medicines based on herbs and improvised means, which are good for healing teeth, preventing caries, pulpitis and other health disorders.

If an abscess develops, the fibrin capsule inside must be dried by making an incision. Recurrence of pericorinitis is an indication for third molar surgery, but it is important to treat the infection before surgical removal to reduce the risk of spreading bacterial infection.

Antibiotics should be considered when drainage is not possible, there is evidence of spreading infection or systemic involvement. The first choice of antibiotics is phenoxymethylpenicillin, and if this is not sufficient, then metronidazole can be added. In case of allergies, clindamycin is the first choice, but can also be used when more is needed wide range antibiotics.

This is how traditional medicine experts advise using oil tea tree to destroy germs in the mouth and freshen breath. This product can be easily purchased at a pharmacy or found over the counter. To prepare the medicine, prepare a glass of water and dilute three drops of oil in it. Mix well and use immediately for rinsing.

Postoperative pain and flare up after surgery

If diffuse spread into deeper spaces is suspected, the patient needs treatment in hospital. Signs of this condition are swollen floor of the mouth, trismus, dysphagia and shortness of breath with rapid breathing and fever. In some cases this can be life-threatening. Oral surgery is associated with postoperative pain, swelling, and trismus. These symptoms are expected during the first three postoperative days, but if poorly treated, they are considered complications.

Postoperative pain may progress to persistent pain and new research is looking into neuro-inflammation as the cause. Therefore, in a clinical situation it is important to reduce sharp pain, as further progression of pain may be more difficult to treat. Full dose analgesics is important factor; to reduce pain signals and minimize the risk of long-term or persistent pain.

In order to make your teeth stronger, improve the condition of your gums and even strengthen your immune system, you should prepare special chewing balls from beeswax. To do this, melt one hundred grams of wax, mix into it a teaspoon of freshly squeezed lemon juice and a couple of drops peppermint oil. Also add three to five teaspoons of honey to the mixture. Mix all ingredients until smooth. Cool the finished medicine and form small balls out of it. Chew them three to four times a day.

Complications of the surgical procedure occur in the intra- or postoperative stages and include alveolitis with persistent pain, infection, bleeding and paresthesia. The incidence of complications ranges from 6% to 9%. Alveolitis, sicca dolorosis is one of the most frequent complications after third molar surgery of the mandible and is characterized by pain 2-3 days after surgery. After extraction, it is important that the blood clot develops in the alveoli to reduce the risk of dry socket.

Treatment with folk remedies

Empty socket, partially or completely deprived blood clot with exposed bone, extremely painful. Other symptoms may include halitosis and bad taste in the mouth. Irrigation with sterile sodium chloride and tamponade with a mixture of lidocaine and corticosteroid paste can be used initially and may relieve pain. The tamponade should not be left in the socket for more than 24 hours.

A remarkable strengthening and healing effect comes from using walnut. This way you can grind its shells into a powder. Brew a teaspoon of this raw material with a glass of boiling water. Leave until cool, then strain and use for rinsing.

Lemon leaves are great for strengthening teeth. If you are the owner of such indoor plant, chew its leaves periodically, slowly and for a long time.

Estimated prevalence and distribution of reported orofacial pain in the United States. London: Churcill Livingston; Anesthetic effectiveness of infiltration in the anterior teeth of the lower jaw. Local anesthesia for endodontic pain. Using ultrasound to guide needle placement for inferior alveolar nerve blocks. Articai for adjunctive buccal infusion anesthesia of the mandible in patients with irreversible pulpitis when inferior alveolar nerve block fails. Prospective randomized study of various additional methods local anesthesia after failure of an inferior alveolar nerve block in patients with irreversible pulpitis in the mandibular teeth. Effect of pulp inflammation on the quality of nerve impulses with or without anesthesia. Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized trial. clinical trial. Hyperemia in the pulse - correlation of clinical and histological data from 706 teeth. Root canal treatment in Denmark is most often performed on carious vital molar teeth, and repeat treatments are rare. Pulp inflammation: from reversible inflammation to pulp necrosis during caries progression. Dental biology, pathology and regenerative therapy. Emergency pulpotomy: pain relief effect with and without sedative dressings. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Clinical trial of pulpotomy versus root therapy in mature molars. Clinical evaluation of bacterial leakage of endodontic temporary filling materials. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth. Preparations for the treatment of pain in dentistry. A prospective double-blind evaluation of penicillin versus clindamycin in the treatment of odontogenic infections. Outbreaks after endodontic treatment: a meta-analysis of the literature. Microbial causes of endodontic outbreaks. Association of intracanal medications with endodontic outbreaks. New classification of endodontic periodontal lesions. Indications for third-molar discharge. A double-blind, randomized, controlled clinical trial of the effects of preoperative ibuprofen, diclofenac, paracetamol with codeine tablets, and placebo for the relief of postoperative pain after extraction of impacted third molars. Central sensitization events after third molar surgery: A quantitative study of sensory testing. Paracetamol for pain relief after surgical extraction of teeth with lower wisdom. Dodson, Types, frequencies, and risk factors for complications after third molar extraction.

Multidimensional nature of pain.
Local anesthesia for endodontics: mechanisms and management.

This document has been reviewed by experts.

The use of ordinary burdock provides a remarkable strengthening, antiseptic and healing effect. Brew a teaspoon of this plant with one glass of boiling water. Boil this product over low heat for several minutes. Leave the broth for an hour, then strain and use as a rinse several times a day.

Many traditional medicine specialists advise using horseradish to strengthen and heal teeth and gums. Grind it on a grater, dilute a couple of teaspoons of this raw material in a glass of wine. Use ready-made medicine for rinsing.

Purulent pulpitis is a rather serious health disorder that requires close attention and adequate timely treatment in the dental office.

Acute, painful inflammation of the pulp, characterized by the formation of an abscess on the surface or within the pulp.

Purulent pulpitis according to the most common classification, it is defined as a variety of it acute form. It can be focal (affecting part of the pulp) or diffuse (damaging the entire pulp). The formation of pus in the inflamed pulp occurs from the existing serous exudate.

With an increase in the amount of serous matter in the pulp, oxygen deficiency occurs, and accordingly, the metabolic processes V connective tissue. This leads to anaerobic glycolysis (accumulation of lactic acid). As a result, inside cells is disrupted acid-base balance, resulting in a decrease in the protective activity of cells. Thus, tissue decay occurs in this place, that is, an abscess occurs.

With the possibility of exudate outflow in the pulp chamber, the pressure decreases and the trophism of the pulp improves, stimulating its regeneration. When spontaneous opening of purulent accumulation into the carious cavity occurs, pulpitis enters the chronic stage.

Reasons: bacterial infection from caries, usually against the background of a pulp tightly covered with decay or filling (there is no possibility of outflow of exudate during initial serous inflammation).

Symptoms: severe pain, drilling, gnawing, or as if there is constant pressure in the tooth. The pain is paroxysmal, at night, on late stages constant. The pain is increased by hot and at times relieved by cold (prolonged cold can increase the pain). In later stages there may be a periodontal reaction.

Diagnosis: characteristic complaints, often the patient is pale and tired, holds his cheek in the area of the sore tooth with his hand, may have burns on the mucous membrane from the application of tinctures and other medications. EDI - within 40. On the radiograph there is a deep carious cavity or filling material on the “horn” of the pulp. Temperature test - cold soothes, heat intensifies pain. Percussion is slightly sensitive. When opening a tooth cavity, you can get a drop of pus.

Clinic of purulent pulpitis. Pain syndrome occurs spontaneously with acute purulent pulpitis, but if exudate has already broken through into the carious cavity, then the nature of the toothache will change: its appearance will provoke the impact external factors. Painful attacks of high intensity, practically without intermissions, only with periodic weakening. The nature of the pain is pulsating, tearing, with irradiation along the branches of the ternary nerve, depending on the location of the pulpitis. Symptoms are more pronounced at night, pain intensifies from a hot stimulus, calming from exposure to cold.

Upon examination, a deep carious cavity is discovered, filled with a significant amount of decomposed dentin, which is a source of unpleasant putrid smell. Dentin usually has light shade, if pulpitis is in acute stage(that is, with a closed dental cavity). At chronic stage development (that is, when there is a communicating canal in the arch of the dental cavity), dentin is pigmented.

The causative tooth, as well as the surrounding mucous membrane, are covered with plaque white. Swelling of the transitional fold may be observed. Percussion and probing are very painful. When perforating the layer separating dental cavity, pus is released, pulsation appears. After the purulent accumulation drains away, the pain subsides. There is a significant decrease in electrical excitability; in some cases it cannot be determined at all due to severe pain in the tooth. X-ray examination shows the unchanged state of the periodontium.

Differential diagnosis: with acute (serous) pulpitis (see above); with an apical abscess, which is characterized by swelling, sensitivity to percussion, tooth mobility, no response to current, or a fistula.

Histopathology: noticeable infiltration of the affected area with cells of pus, expansion venous vessels with blood clots and degeneration or destruction of odontoblasts. The abscess is localized or generalized down to the periodontal membrane.

Exodus: pulp necrosis.

Treatment: conservative endodontic.

Treatment of purulent pulpitis.Dental treatment, affected by purulent pulpitis, is possible only with the help of depulpation. It is carried out using the vital method or the devital method (in hard-to-reach root canals). Vital pulpectomy is carried out in one session by gradually cutting out the pulp under anesthesia and has the following stages:

Removal of damaged tissue from the carious cavity;
- antiseptic treatment;
- dissection of the tissue above the dental cavity and excision of the coronal part of the pulp;
- expansion of the mouths of root canals and removal of the root part of the pulp;
- preparation for filling root canals and their obturation;
- tooth restoration using filling materials or orthopedic structures.

The devital method is carried out in two sessions. During the first visit, using application anesthesia, the carious cavity is prepared. After cleansing with an antiseptic, the pulp horn is opened with a sharp probe, which is then covered with arsenic or paraformaldehyde paste.

A temporary filling is installed for a period of one to ten days, depending on the number of roots and the type of paste used. At the second visit, the pulp is also gradually removed, but it has already undergone necrotization.