Pulpitis - symptoms, causes, types and treatment of pulpitis. What is dental pulpitis: causes and potential danger Causes of dental pulpitis

Dental diseases occur in people of any age and gender. Inflammatory diseases of the teeth appear, as a rule, unexpectedly, are characterized by sharp pain, often refer to emergency cases precisely because of the high pain of the pathological process. It is important for everyone to know the symptoms and treatment of pulpitis, because no one is immune from this inflammation, and the consequences can be severe, up to periodontitis, abscesses and necrotization of the jaw area.

What is pulpitis

Not everyone knows what dental pulpitis is, if only for the reason that dental diseases are rarely classified and truly treated. Acute toothache makes a person see a doctor, who almost always solves it with a tooth extraction, without going into the causes and details. Meanwhile, there is always a risk of a recurrence of the disease process, the transition of pulpitis to a chronic form, as well as the appearance of dangerous complications with insufficiently well-conducted therapy. On the other hand, it is not always necessary to treat the disease only by complete tooth extraction.

Pulpitis - from the word "pulp", the inner cavity of the tooth - is an inflammation of the connective tissue, rich in nerve endings and constantly supplied by the bloodstream. Normally, the pulp receives trace elements from the root and gums, providing nutrition to the bone structure. Due to this tissue, the tooth grows, it is also responsible for the sensitivity, the feeling of the structure of food during chewing.

The inflammatory process is such a mechanism:

The integrity of the bone of the tooth is broken. For the occurrence of the disease, microcracks invisible to the naked eye are sufficient. Tooth injuries appear as a result of blows, microburns and other mechanical damage.
Pathogenic or conditionally pathogenic microorganisms get inside. A huge number of bacteria constantly live in the mouth, but the inner cavity of the tooth remains completely sterile.
Bacteria penetrate into the crack or defect that has appeared. Most often, the direct causative agents of pulpitis are streptococci or staphylococci.
The inflammatory process begins as a result of the active reproduction of bacteria in a nutrient-rich environment. As they spread, microorganisms destroy the pulp cavity and contribute to the destruction of tooth tissues.

As a rule, it is impossible not to notice the main symptoms of pulpitis, but there is an asymptomatic course associated with nerve death or other causes. It is impossible to ignore the disease, because without treatment it develops into severe forms - from chronic pulpitis to life-threatening conditions: inflammation of the jaw, general sepsis.

On the other hand, many dentists approach the treatment of pulpitis too radically, simply by removing the inflamed tooth and cleaning out the cavity on the gum where it was located. This method is not always justified, since it is possible to preserve and restore tissue at the site of a not excessively advanced inflammatory process.

Diagnosis of the disease is carried out using a visual examination, anamnesis. Other methods are practically not used, since emergency intervention is almost always required. In the case of therapy for the chronic form of pulpitis, general therapy can be carried out, which will require the determination of a specific causative agent of the disease in order to select the most effective drugs.

Classification

Symptoms and treatment of pulpitis depend on the type of disease. Acute pulpitis is more common, which is manifested by a vivid clinical picture, immediately attracting the attention of a person. The chronic form is less common, but is considered more complex.

In general, the disease is divided into the following types:

Acute pulpitis - is focal or diffuse. The first option implies that only one tooth is affected, while in the second case, several are exposed to bacteria. Sometimes the entire jaw is affected, but this is not always an indication for the removal of pulpitis along with the teeth completely.
Chronic pulpitis. A chronic illness that gets worse from time to time. There are forms of gangrenous, fibrous, hypertrophic species. Gangrenous is considered the most dangerous, because it provokes the development of general sepsis without proper therapy. Fibrous is characterized by the degeneration of tissue into connective tissue, due to which the tooth slowly dies, but pain is reduced. A feature of hypertrophic is the formation of a polyp at the site of the affected pulp cavity.
Exacerbation of chronic pulpitis is distinguished by dentists as a separate condition. This form of the disease is more severe than the acute one, since the tooth is already partially destroyed, and neighboring areas are also often affected.

Pulpitis is reversible and irreversible, depending on the preservation of the viability of the pulp, which depends on the neglect of the pathological process. Timely intervention allows you to restore the tooth, preventing complete destruction. If an irreversible form is diagnosed, then the only treatment is removal followed by cleaning of the gums at the site of the inflammatory process.

Causes of pulpitis

The common cause is the penetration of infection into the internal cavity of the tooth. Normally, bacteria should not get inside, it is almost impossible to penetrate the bone barrier. Thus, the causes of pulpitis are always either integrity disorders or other inflammatory and infectious diseases.

Among the direct factors:

Deep caries as a neglected, untreated process. Carious cavities increase over time as the tooth decays. Bacteria penetrate deeper, affecting the pulp.
Violation of the integrity of the crown - as well as a complication of caries. Even if a person treated his teeth, there is no absolute guarantee of complete protection, sometimes there are microscopic gaps through which bacteria enter.
Gingivitis is inflammation of the gums, which may not be directly related to the tooth, but since the root connects directly to the gum, there is a risk of getting pathogenic bacteria in the bloodstream.
Periodontitis - occurs as a complication of pulpitis, but can also cause the development of the disease. It is necessary to understand that the systems are connected, one pathological process directly affects the development of another.
Injuries to the tooth in some situations cause infection of the pulp.

People with caries will always be at risk, especially if the pathological process captures several teeth and repeats often. The installation of crowns does not guarantee that bacteria will not penetrate inside. Also, any inflammatory processes in the oral cavity, especially the gums, can become a factor in pathogenesis.

Symptoms

Toothache is not the only sign of pulpitis, although it is with this symptom that people most often come to the dentist. The disease is characterized by a fairly wide clinical picture, especially in complicated chronic forms of the course.

You should pay attention to the following signs:

Soreness, the severity of which varies from "aching" to unbearable. A sharp acute toothache will almost certainly indicate an acute course of the disease with active reproduction of microorganisms and rapid damage to the internal cavity of the pulp. If you see a doctor in time, you can save a tooth.
Pain intensifies at night, which is associated with the peculiarity of the life cycle of microorganisms.
In the chronic gangrenous form, a putrid odor from the mouth is observed, which causes inconvenience to both the patient himself and the people around him. This is not only an uncomfortable and unaesthetic symptom, it indicates an active necrotic process in the tissues of the tooth, which can spread to the jaw and cause dangerous complications.
There is also bad breath with diffuse lesions, especially against the background of deep caries.
Even with mild pain, a noticeable temperature reaction is observed: it is unpleasant for a person to eat or drink cold or too hot dishes and drinks.
With a hypertrophic form and the formation of polyps, patients feel the appearance of growths in the affected area. Polyps are bleeding, serve as a source of subjective discomfort, and can also become inflamed as a result of injury.

If left untreated, the pathological process gradually captures more and more foci on the one hand, and bacteria also try to penetrate deeper into the jaw on the other. The symptoms and treatment of pulpitis should be known to everyone, because an advanced disease is fraught with destruction of the jaw, up to partial removal of the bone or the risk of developing general sepsis.

The patient's history should always be taken into account. If there is no pronounced pain, but there are unpleasant sensations, it is necessary to remember whether there were episodes of toothache in the recent past, whether caries was detected, whether fillings were installed. Perhaps a person noted the appearance of blood during hygiene procedures - brushing your teeth with a brush or dental floss.

Acute pulpitis is almost impossible to miss, since it is characterized by severe pain. Chronic forms develop more slowly, may go unnoticed, but they also need to be able to diagnose on time on their own so as not to miss a timely appointment with a doctor.

Treatment

The treatment of pulpitis depends entirely on the degree of neglect of the disease, its type and form. If the situation is reversible, then the dentist should not extract the tooth, but should instead try to save it. Surgical techniques are considered basic, but the ways to get rid of the inflammatory process are not limited to them.

Treatment approaches include:

Biological tooth-sparing treatment involves calcium pads that are attached to the affected area. Also, the doctor performs the sanitation of the tooth using bandages with antibiotics. The micro-filling is placed for several days, after which an x-ray is taken, if the inflammation has stopped, a permanent filling is installed.
Extirpation - removal of the pulp. The affected area is subjected to local anesthesia, after which the doctor removes the necrotic areas of the tooth and removes the affected pulp. During the process, an antiseptic is actively used.
Devital extirpation - if it is impossible to extract the pulp, it is first “killed” completely with the help of toxic substances that are placed inside the tooth. To prevent intoxication of the patient, a filling is applied. After the complete destruction of the pulp, it is removed - usually after 24-48 hours.
Amputation - complete removal of a tooth, is carried out only if the inflammatory process has gone far, the root is affected. This method is undesirable if there is a diffuse course of the disease.

Any type of therapy involves cleaning and complete removal of already destroyed structures with the help of special antiseptics. Treatment can only be carried out under conditions of sterility and a specialized dental office. Self-medication is unacceptable, since it is not sufficiently effective, but it can contribute to the transformation of the pathological process into a chronic one.

Prevention

Pulpitis is difficult to foresee by itself, the main preventive measure is oral hygiene and care for the health of gums and teeth. Recommendations include timely diagnosis of caries along with effective modern treatment of this disease. In case of chronic inflammation of a different origin - periodontitis, stomatitis, gingivitis, it is also necessary to take therapeutic measures in time, to carry out sanitation of the inflamed areas in order to avoid the development of infection and the appearance of new inflammatory foci. If a person has fillings, they need to be checked from time to time. It is also desirable to avoid trauma to the teeth and jaw.

Often, teeth start to hurt at the most inopportune time - many people know this the hard way. Often, the symptoms of pulpitis are taken by surprise during long holidays, at work, on vacation, and it is not always possible to immediately consult a doctor for help. It is impossible to guess at what point deep caries, as the most common cause of pulpitis, will be complicated by inflammation of the dental "nerve" with the appearance of characteristic symptoms, it is impossible in advance, it can happen at any time.

It is important to keep in mind that in case of untimely contact with the clinic, pulpitis often turns into when you can endure to the extraction of a tooth and expensive prosthetics, or even to processes that are irreversible for the general health of a person, sometimes bordering on life and death.

The photo below shows a tooth removed due to complications after pulpitis:

But here's how to distinguish the signs of pulpitis from other dental diseases (say, from severe pain with), what complications can threaten and whether there are ways to prevent them - this and much more will be discussed further.

Characteristics of pulpitis as inflammation of "living" tissue

In order to better understand the root causes of the various symptoms of pulpitis and imagine in advance what may await you during future treatment, you must first understand what, in fact, inside the tooth can, in principle, hurt. The very definition of pulpitis significantly clarifies this issue.

Pulpitis is an inflammatory process that occurs in the so-called pulp chamber, or, in other words, in the dental "nerve" (neurovascular bundle). And this process is connected in most cases with the activity of microorganisms: as a result of untreated deep caries, pathogenic microflora sooner or later penetrates through the thinned dentin into the soft tissues of the pulp with the appearance of characteristic signs of tooth pulpitis.

Inflammation in the pulp proceeds according to the same laws as in any other tissue. Against the background of the aggressive effect of bacteria and their toxins on living tissue, gradual cell death occurs, which activates inflammatory factors. If it were possible to observe this picture under a microscope, then its meaning would be as follows:

immunity sends cells (leukocytes) to fight infection to destroy the source of pulp damage;
the result of this struggle are structural changes in the pulp tissue, up to its complete necrosis (necrosis) and the appearance of a characteristic clinic of chronic or.

Soft tissues inside the tooth cannot recover on their own, but the process can turn into a long-term chronic one with limited inflammation from the tissues surrounding the root - this helps protect them from diffuse purulent fusion.

The picture below shows this process schematically:

Question: Why does pulpitis sometimes cause a strong bad breath?

With a deep carious process, food particles accumulate on the walls and bottom of the carious cavity, and often there is practically no self-cleaning of the cavity or it is very weakly expressed. The result of the gradual decomposition of organic residues is the appearance of putrid odor from the mouth - this symptom often accompanies deep caries. Moreover, if pulp necrosis occurs, then the smell of rotting food debris is also accompanied by the smell of a dental “nerve” rotting in the pulp chamber. And the more carious cavities (especially with pulpitis), the more pronounced are the signs of bad breath, which interferes with normal communication with people.

Photo of a tooth with a deep carious cavity, which at any time can cause pulpitis:

Classic symptoms of pulpitis

First aid for pulpitis

If the symptoms of tooth pulpitis interfere with work or rest, but it is problematic to get to the dentist in the next day, then it is not forbidden to help yourself by choosing either or medications.

Common folk methods:

rinsing the mouth with warm decoctions of chamomile, St. John's wort, sage, oak bark, mint, lemon balm, valerian - until the attack completely disappears or its severity is significantly reduced;
rinsing with warm soda-salt solutions (usually a teaspoon of soda and salt are diluted in a glass of warm water);
rinsing the mouth with vodka or holding it near the diseased tooth for a while. This method of treatment has age restrictions.

Common medications to relieve the pain symptoms of pulpitis:

Use conventional painkillers for oral administration (, Pentalgin, Dexalgin, etc.) in therapeutic doses. Before taking them, you should consult (possibly remotely) with a therapist or dentist, as side effects, contraindications or individual intolerance are possible.
Alcohol tinctures of eucalyptus or valerian. They are suitable for both applications and for the treatment of a carious cavity. This achieves a certain anti-infectious and analgesic effect.

Often, propolis is also used to close a carious cavity with an open "nerve" as a temporary filling. If there is no allergy to this drug, then it is perfect for temporary use.

And finally, advice: Is it possible to warm the tooth when the first signs of pulpitis appear?

In case of acute toothache, it is not recommended to warm the sore spot from the outside. A warm heating pad, scarves and warm compresses will stimulate inflammation, turning it into a purulent process literally overnight. Heating always exacerbates the infectious process, which cannot be said about the warm rinses of the oral cavity itself. Therefore, you do not need to put your sore cheek to the battery to reduce pain - the opposite effect is obtained.

Interesting video: treatment of pulpitis under a microscope

What is important to know about pulpitis

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

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

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

note

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

Classification of pulpitis

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

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

The reasons

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

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

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

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

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

physical;
biological;
Chemical.

The physical ones are:

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

Chemical Factors

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

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

Biological factors:

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

Pathogenesis

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

chronic process regarded as the outcome of acute inflammation. Most often, dentists have to deal with fibrous form associated with connective tissue hypertrophy.

At gangrenous pulpitis during instrumental research, necrotic dark-colored tissue (putrid masses) is found in the canal. A typical symptom is a putrid odor from the mouth.

Symptoms of pulpitis

The "classic" symptoms of acute focal and diffuse pulpitis are:

Chronic fibrous pulpitis is usually asymptomatic.. In the hypertrophic form, the dentist finds an overgrown polyp in the cavity. With strong pressure, it starts to hurt and bleed, but the rest of the time it does not bother.

In acute purulent form, the following symptoms are noted:

severe pain;
high sensitivity of the causative tooth to hot (cold is able to stop the pain syndrome).

note

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

Treatment of pulpitis

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

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

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

In two visits, treatment is now carried out less and less (mainly with suspicion of the onset of development).

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

note

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

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

Possible complications of pulpitis

The main complication of pulpitis not treated in a timely manner is periodontitis, often leading to the loss of a tooth unit. Insufficiently professional actions of the dentist lead to similar consequences.

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

Plisov Vladimir, dentist, medical commentator

Pathologies of dental tissues are diverse, as are diseases of any other internal organs. One of the most common is pulpitis, which is diagnosed in almost every fifth patient who has come to the dentist-therapist with a toothache.

What does the diagnosis "pulpitis" mean?

A human tooth is a complex structure consisting of many elements from various tissues. As a result of the influence of certain factors, these components may change or be affected by the inflammatory process.

The tooth is not one continuous bone formation covered with a layer of enamel. Inside, it has a cavity that extends into its roots, forming long dental canals. This cavity is filled with the so-called pulp, which looks like a loose fibrous tissue, which, in a living and healthy state, has a rich pink color due to the presence of a large number of capillaries.

It consists of connective tissue fibers and many cells for various purposes, which surround the neurovascular bundle as a single homogeneous mass. These bundles enter the tooth through holes in the roots and are branches of the jaw nerves and vessels.

Thanks to arterioles, dental tissues receive oxygen and nutrients, metabolic products and carbon dioxide are removed through the veins, and nerve conductors ensure the regulation of all these processes. The nerve plexus located along the periphery of the pulp, called Rashkov's plexus, is responsible for pain in pulpitis.

The term "pulpitis" means the presence of an inflammatory process in the pulp. Moreover, it can begin in any structural part of the pulp, but quickly covers the entire mass of the main substance. The changes that have begun in the parenchyma of the pulp (its main tissue) sooner or later reach the nerve plexus, which signals this with the appearance of pain.

The clinical picture of pulpitis, its diagnosis

Permanent pain syndrome may appear not in the initial period of development of pulpitis, but when inflammation has already destroyed a significant part of the main substance. An earlier symptom is an increase in the sensitivity of the diseased tooth. He begins to react to cold or hot, a person cannot drink a cup of tea or eat ice cream without feeling aching pain, which disappears when the stimulus stops. Even inhalation of cold frosty air causes a short-term pain attack.

If at this stage a person does not go to the dentist, then the inflammatory process spreads to the entire volume of the pulp and irritates Rashkov's nerve plexus. The pain changes its characteristics, it becomes several times stronger, acquires an almost constant course, sharply intensifying under the action of stimuli. A paroxysmal course is also possible, when periods of severe throbbing pain are replaced by quiet intervals.

The pain attack can last up to 30 minutes, and the period of rest - from one hour to several hours and even the whole day. At this stage, pulpitis is characterized by irradiation (spread) of pain to other parts of the face and head. The patient complains that the whole jaw hurts, that the pain is felt in the temple, throat or ear, even in the eye socket. This means that irritation of the branches of the trigeminal nerve has begun. Characterized by an increase in pain at night, which does not allow the patient to fall asleep and sleep normally.

If the inflammation of the pulp grows at a slow pace, then in its early stages there is no pain syndrome at all. A person may notice some heaviness or discomfort in the area of the tooth, the appearance of an unpleasant odor, the growth of a carious defect.

Seek dental care as soon as possible. After asking the patient, clarifying all the features of complaints and anamnesis, examining the oral cavity, the doctor will be able to diagnose chronic pulpitis in most cases immediately. Sometimes an additional study is performed to clarify the diagnosis.

Finding out the complaints, the dentist focuses on the characteristic signs of pain, the reaction to cold and hot, the duration of pathological symptoms and the presence of pain irradiation. But, even when the pain spreads to other areas, the patient always indicates exactly which particular tooth hurts. Examining the tooth, the pulp of which has become inflamed, the specialist states the presence of a carious focus, usually deep and filled with soft dentin tissue, which is in the process of decay.

A sick tooth reacts sharply to irrigation with cold water. When probing, in most cases it turns out that the pulp chamber is closed, and its border with the carious cavity is sharply painful with mechanical irritation (by tapping). In addition, the inflamed pulp shows through the dentin, causing the tooth to change color.

In the diagnosis of pulpitis, additional research methods are also used. These are electroodontodiagnostics and radiography. The use of an electric current of low intensity makes it possible to determine the viability and sensitivity of the pulp, the presence of focal or diffuse lesions.

If the patient feels an unpleasant tingling, then the inflammation of the pulp is still insignificant, most likely, this is pulpitis of the initial stage. If he notes a painless push, then this indicates the death of the entire pulp tissue.

Radiography is necessary when it is important to know the anatomical features of the diseased tooth, neighboring teeth and adjacent tissues to determine the tactics of treatment.

Acute pulpitis has similar clinical features with other dental diseases. Therefore, it is very important to carry out differential diagnosis with pathologies such as deep caries, chronic periodontitis, neuralgia of the trigeminal branch.

Causes of pulpitis

Pulpitis most often begins when exposed to natural factors, which include infection and traumatic injury. A rarer cause is an iatrogenic effect, that is, caused by the intervention of a dentist. The vast majority of cases of pulpitis is the result of the penetration of infectious microflora into the pulp.

Deep caries, periodontal pathology, enamel abrasion with exposure of dentinal tubules are the main ways in which the infection enters the pulp chamber. Theoretically, the penetration of microorganisms by the hematogenous route, through the bloodstream, is also possible.

Factors of traumatic origin are cracks and fractures of teeth, chips of enamel, damage to crowns. In all these cases, the dentin and pulp are exposed, there are open gates for any microflora, so acute pulpitis always manifests brightly and violently. The formation of a blood clot in the cavity of a tooth during an injury is very undesirable; it becomes an ideal breeding ground for the rapid reproduction of microorganisms. In most cases, necrosis and complete death of the pulp occurs during the first day.

A parallel mechanism for the development of traumatic pulpitis is a violation of the normal blood supply to the tissues of the tooth. This is especially true for fractures, dislocations, contusions of the teeth. Traumatization and death of the capillary network inside the tooth causes pulp ischemia followed by necrosis. But if the tooth is in the growth stage, then the pulpitis that has arisen is able to heal itself, since revascularization occurs (recovery of capillaries and full blood flow inside the tooth).

Pulpitis of an iatrogenic nature deserves special attention. Many dental procedures, although they do not contribute to the penetration of infection into the pulp, can cause irritation. Such pulpitis is neither infectious nor traumatic. It can develop after treatment of the carious cavity (its preparation and drying), when exposed to vibration, heat or cold, when filling a tooth or taking an impression for prosthetics. These causes of iatrogenic pulpitis are called physical.

There is a group of factors and chemical nature, that is, the use of various reagents in dental procedures. These are means for cleaning, disinfecting and drying the treated carious cavity, for antiseptic treatment of opened canals. A variety of varnishes, gaskets, filling and adhesive materials can also cause iatrogenic pulpitis.

The most convenient for dental practice and widely used is the classification of pulpitis according to Platonov. It subdivides pulpitis according to the features of the onset and development of the pathological process, according to the nature of their course:

pulpitis is acute, having a bright and violent manifestation, with a pronounced and persistent pain syndrome; is divided into focal (damage to a separate section of the pulp) and diffuse form, characterized by inflammation of the entire pulp;
chronic pulpitis, beginning and proceeding with a gradual increase in clinical symptoms; according to the characteristics of pulp damage, it has three forms: fibrous, hypertrophic and gangrenous;
exacerbation of chronic pulpitis, isolated in a special form, as it proceeds acutely, with a vivid clinic, but against the background of chronic pulp damage.

Therapy of pulpitis

Depending on the form of pulpitis, the rate of inflammation and pulp death is different. Often there is time and plenty of opportunities to save the pulp in whole or in part, restoring its viability and functionality. Such methods are called conservative, or biological. If there is no hope of saving the pulp, then it is removed by radical or surgical methods.

The biological method is the preservation of the pulp, nerve and the entire tooth in a "live" state. It is possible only in the early stages of acute diffuse pulpitis or with a focal form of pathology, as well as with a traumatic origin of inflammation or an accidental opening of the pulp chamber. This method is more often used in young patients who do not have a "bouquet" of concomitant chronic diseases.

The first stage in conservative treatment is the treatment of the pulp with antiseptics, the application of a gasket and a temporary filling. Further, courses of anti-inflammatory drugs and physiotherapy are prescribed. Be sure to conduct x-ray control of the condition of the tooth and surrounding tissues. As a rule, biological treatment started on time saves the entire tooth, preserving the nerve and pulp.

If pulpitis is chronic or acute with a significant lesion of the entire pulp, then there is no point in fighting for its safety. In these cases, its pulpitis is removed along with the nerve through surgical intervention. When a dentist resorts to using traditional arsenic or modern arsenic-free products, this is called the devital method.

This method requires a certain amount of time and a minimum of two visits to the dentist's office. If the treatment needs to be done quickly, then local anesthesia is applied, and the nerve with the pulp is removed immediately, in a “live” state. This method is called vital.

The next steps are the treatment of the carious cavity and root canals, their disinfection and drying, subsequent filling, the imposition of a permanent filling on the tooth, giving it a natural and finished shape. Depending on the degree of damage to the pulp, all these steps can be carried out in one or more appointments.

One of the most modern methods of treating pulpitis is a dental laser. Its effectiveness is especially evident in focal inflammation of the pulp. The laser beam, "burning" the dead tissues of the pulp, activates the processes of metabolism and regeneration in the remaining areas, which eliminates the pain syndrome and completely restores the functionality of the tooth within just one day.

If the canals of the tooth are branched and difficult to clean from necrotic pulp, then depophoresis is the best method of therapy. A special substance, copper-calcium hydroxide, is delivered to the channel by means of an electric current. Cleansing and disinfection of canals by depophoresis reaches 95%. In addition, the processes of formation of new bone tissue are activated, which clogs the treated dental canals.

When treating pulpitis, one should not forget about traditional methods of physiotherapy. Being additional methods, these sessions provide invaluable assistance and consolidate the positive result obtained. UHF, infrared laser therapy, iodine electrophoresis are widely prescribed.

Complications of pulpitis

Appeared constant or throbbing pain, increased sensitivity of the tooth should immediately lead the patient to an appointment with the dentist. After all, the early stages of pulpitis, its focal forms can be completely cured, keeping the tooth alive and functional. If this is not done, then the inflammatory process will completely capture the entire pulp and leave no hope of saving the tooth.

In some cases, neglected or illiterately treated tooth pulpitis can lead to complications, the most common of which is periodontitis. This is a loosening of the dental ligaments that hold the tooth in the jaw. As a result, the tooth begins to wobble, the tissues surrounding it become inflamed, and cysts form in the jaw bone.

Other complications of pulpitis are possible:(inflammation of the periosteum of the jawbone), the formation of abscesses and the danger of their breakthrough into soft tissues, tooth loss. The most dangerous is the spread of the inflammatory process to the soft tissues adjacent to the tooth and the jawbone, as it requires a long and complex treatment, and also delays prosthetics for a long time.

Can pulpitis be prevented?

To reduce the likelihood of infection entering the dental pulp, and this is the most common cause of pulpitis, it is necessary to engage in constant and daily caries prevention. It is important to understand that it performs not only cosmetic tasks, but is designed to cleanse the oral cavity of harmful microflora. Therefore, it is necessary to brush your teeth not just every day, but in the morning and in the evening. In addition, it is recommended to rinse your mouth with water or decoctions of medicinal herbs after each meal, and also use dental floss, which perfectly cleans the gaps between the teeth and their enamel.

Do not forget about regular visits to the dentist. At least 1 time in 6 months, which will help to diagnose the early stages and start treatment in time not only for pulpitis, but also for other dental pathologies.

Pulpitis is a serious disease, leading to dangerous complications. But timely diagnosis and the latest methods of therapy can not only save the tooth, but also restore its viability.

- an inflammatory process affecting soft tissues with neurovascular formations that fill the tooth cavity. It is characterized by paroxysmal progressive pain, often spreading to the entire jaw, radiating to the ear and temple, aggravated at night. Requires urgent treatment by a dentist, often - tooth depulpation (nerve removal). With timely treatment, the outcome is favorable. Otherwise, it can cause the development of periodontitis, the formation of a root cyst of the tooth.

General information

called inflammation of the dental pulp, caused by pathogenic microflora - mainly streptococci and staphylococci. The main clinical manifestation of pulpitis is severe pain. Patients note soreness both at rest and from irritants; when exposed to temperature stimuli, the pain intensifies. A characteristic sign of pulpitis is toothache, which worsens at night.

Reasons for the development of pulpitis

Untreated caries or poorly filled carious cavities are the entrance gate for pathogenic microorganisms. Their waste products become the main cause of pulpitis. Most pulpitis is caused by hemolytic and non-hemolytic streptococcus, therefore, with streptococcal tonsillitis and the presence of untreated caries, a complication in the form of pulpitis may occur. Staphylococci, lactobacilli and other microorganisms are less likely to cause pulpitis.

The inflammatory process begins with an already infected area, which is located near the carious cavity, then microbes and toxins penetrate into the root pulp. Another cause of pulpitis is trauma to the tooth, mainly broken parts of the crown, chips of enamel and tooth fractures. Less commonly, pulpitis occurs under the influence of aggressive temperature and chemical factors.

Clinical manifestations of pulpitis

A common symptom for all types of pulpitis is severe soreness, especially with changes in temperature, and continuous or intermittent toothache at night.

Acute focal pulpitis characterized by paroxysmal pain, with a clear localization and long intervals of intermission. Attacks of pain in acute focal pulpitis are mostly short-term, the pain comes from exposure to temperature stimuli. Soreness intensifies at night, which is a characteristic symptom for all pulpitis. The examination reveals a deep carious cavity, the bottom of the cavity during probing is painful. The electrical excitability of the pulp is reduced on the side in which focal pulpitis is localized.

At acute diffuse pulpitis pain attacks are longer, light intervals are insignificant. Diffuse pulpitis differs from focal pulpitis in more intense pain at night. Soreness increases in the supine position, pain can radiate to different areas, depending on the location of the diseased tooth. On examination, the carious cavity is deep with soreness along the entire bottom during probing. The response to temperature stimuli in acute diffuse pulpitis is sharply painful, but in some cases cold reduces pain. Percussion of a tooth affected by pulpitis is mostly painless. The electrical excitability of the pulp is reduced in all areas, including at the bottom of the carious cavity. It is the data of electrical excitability that help to accurately establish the type of acute pulpitis.

Chronic pulpitis have less pronounced symptoms and blurred clinical picture. So at chronic fibrous pulpitis attacks of pain from various irritants are insignificant and short-lived. During the interview of the patient, it turns out that the tooth hurt earlier, and the symptoms of pain corresponded to acute pulpitis. In chronic pulpitis, spontaneous pains rarely occur, mainly due to a violation of the outflow of exudate. The reaction to cold is slow, sometimes there is pain with a sharp change in ambient temperature.

Probing the bottom of the carious cavity confirms the presence of communication between the carious cavity and the cavity of the tooth. The electrical excitability of the tooth with chronic fibrous pulpitis is reduced, and the X-ray image confirms the rarefaction of the bone tissue at the root apex.

Chronic gangrenous pulpitis clinically manifested by pain in the tooth while eating hot food or when exposed to other temperature stimuli. Patients with gangrenous pulpitis complain of rare spontaneous pains and an unpleasant putrid odor from the mouth. In the anamnesis there are complaints of acute paroxysmal pain with irradiation along the trigeminal nerve. During examination of a tooth with chronic gangrenous pulpitis, it is found that the carious cavity communicates widely with the tooth cavity. Probing of the carious cavity is painful throughout the entire depth of both the coronal and root pulp. The depth of the lesion is determined by the prevalence of gangrenous pulpitis and the deeper the lesions in gangrenous pulpitis, the lower the degree of electrical excitability of the pulp. In half of the cases with gangrenous pulpitis, destructive changes in the periapical tissue are determined on x-ray images, the severity of destruction depends on the depth of pulpitis.

At chronic hypertrophic pulpitis subjective sensations are practically absent. Patients complain of bleeding from the overgrown pulp tissue and minor pain during meals. In history there are complaints of acute paroxysmal pain, which is characteristic of focal or diffuse pulpitis. When examining a tooth affected by hypertrophic pulpitis, it is clearly seen that the crown of the tooth is destroyed, and a hypertrophically altered pulp swells out of the carious cavity. Superficial probing is almost painless, with deep probing the pain intensifies. The periapical fissure on the x-ray is unchanged.

During exacerbations of chronic pulpitis, spontaneous paroxysmal pain occurs. Often, patients during the period of relapse complain of prolonged intense pain from various external stimuli. Pain radiates along the course of the trigeminal nerve, at rest the pain is usually aching in nature, which increases when biting the antagonist tooth. The patient's history includes manifestations of acute and chronic pulpitis. During the examination, it becomes clear that the carious cavity and the cavity of the tooth form a single whole, the cavity is open, and probing the pulp is sharply painful. With exacerbation of chronic pulpitis, the electrical excitability of the pulp is reduced, and the expansion of the periodontal gap is clearly visible on the radiograph. The rarefaction of bone tissue in the periapical zone is a characteristic manifestation of chronic recurrent pulpitis. allow to clarify the nature and depth of pulpitis.

Pulpitis treatment

The goal of pulpitis treatment is to restore the functionality of the tooth, so the main method of therapy is conservative or biological. It is used when inflammation in pulpitis is reversible, with traumatic pulpitis or in case of accidental opening of the tooth cavity. The technology for the treatment of pulpitis is the same as in the treatment of carious disease, but more attention is paid to drug treatment and disinfection of the tooth cavity. Antibiotics, antiseptics and proteolytic enzymes are used for processing.

The main stage in the treatment of pulpitis is the application of therapeutic anti-inflammatory and regenerating pastes to the bottom of the cavity, the cavity is closed for 5-6 days and then, if there are no complaints, they are sealed. After the treatment, it is recommended to pay more attention to oral care and treat dental caries in a timely manner.