Pulpitis is the process of inflammation in the neurovascular fibers (pulp) of the tooth. It refers to a complex reaction to various types of stimuli trapped in the pulp, more often it is microorganisms, less often chemicals or trauma. It is also one of the most frequent diseases in dentistry, up to 30% of patients go to the dentist with pulpitis, it occurs as a complication of caries. It is worth remembering that caries does not go away by itself, and sooner or later will lead to this complication, especially pulpitis is much more difficult to treat.
The symptoms of pulpitis correspond to its forms. There are two main types: acute and chronic. There is a more detailed classification, but it makes sense to describe the symptoms only for these two main forms.
Symptoms of acute pulpitis: a very strong and unbearable pain attack, the pain occurs spontaneously, manifests itself in a paroxysmal manner, has a tearing and pulsating character, increases in the evening and especially at night. As a rule, there is an irradiation of pain in the temple, ear and eye socket. Pain-free, so-called light intervals are observed between attacks. With the progression of pulpitis, there are fewer such intervals, their duration also decreases. Under the influence of hot, the pain increases and intensifies, there is no such thing from cold, and from the action of cold, the pain attack may even subside.
The symptoms of chronic pulpitis are different. In general, chronic pulpitis occurs in cases where the acute form was not treated and the patient managed to endure the pain, as well as after unsuccessful treatment of caries. The main difference between the chronic form is a decrease in the severity of symptoms, one can even say that the disease has an asymptomatic course. In some cases, the patient may complain of mild discomfort or the appearance of mild pain from hot or solid food. The above symptoms are characteristic of chronic fibrous pulpitis, but there are several more subspecies: hypertrophic and gangrenous. Hypertrophic is characterized by the presence of a polyp that grows out of the tooth cavity, touching it causes pain and bleeding. With gangrenous pulpitis, the pulp may be covered with a yellowish-gray coating, there is a putrid and pungent odor from the mouth, the tooth is severely destroyed, the course of the disease is long.
Exacerbation of chronic pulpitis has the same set of symptoms as the acute form. In all forms of this disease, the general condition of the body is not disturbed, the body temperature does not increase.12
The causes of pulpitis can be divided into groups:
In the vast majority of clinical cases, pulpitis has a bacterial etiology. Microorganisms penetrate into the tooth cavity as a result of non-treatment and further progression of caries, and pulp inflammation is a reaction to bacteria and their toxins. Iatrogenic causes include the doctors mistakes in the treatment of caries, less often other diseases. Also, the causes of inflammation in the pulp can be injuries: a fracture or dislocation of a tooth.
Pulpitis treatment can be carried out by the following methods:
Biological method. Unfortunately, this method cannot always be used, only in acute form, and then only in the early stages of the development of inflammation. It is a pity, because the main difference of this method is that the tooth is kept alive, the nerve is not removed from it. Just with the help of special drugs eliminate inflammation in the pulp. Then the tooth is filled in the usual way. Physiotherapeutic methods of treatment are prescribed.
In cases where the biological method can no longer be applied, it is possible to partially remove the pulp of the tooth, its upper part. The tooth remains nourished, it is partially viable. This method is more often used in children whose teeth have not completed the formation of roots.
And yet, as a rule, the treatment of pulpitis is carried out due to the complete removal of the nerve and pulp as a whole. There are two ways here, either to remove the nerve under anesthesia simultaneously on the first visit, or to put "arsenic" thereby to kill the pulp and remove it on the second visit. How to act is decided by the doctor. After removal of the pulp, the root canals expand for their subsequent filling.
The choice of filling material is also carried out by a doctor, currently gutta-percha pins are popular, they never dissolve. After filling the channels, the patient is sent for an X-ray to determine the quality of filling the channels, according to the rules they must be sealed to the apex (apex).
And the last stage, as usual, is the setting of the seal. And in the end I would like to say that pulpitis is a rather insidious disease and it needs to be treated, because no one needs complications.