Hidden pulpitis in appearance is a completely healthy tooth. We understand the symptoms of pulpitis

Pulpitis is a disease of the pulp caused by its inflammation. Due to the fact that it contains a nerve ending, this process accompanied by severe acute pain, which can be both continuous and intermittently stopping.
In most cases, acute or chronic pulpitis is formed due to untimely treatment of caries. It is under the influence of this disease that the hard tissues of the tooth are destroyed to such an extent that the infection manages to get to the roots of the tooth, destroying soft tissues.

• Reasons for the development of pulpitis
• Kinds
• Classification
• Symptoms
• How is pulpitis treated?
• Treatment of pulpitis in children

Reasons for the development of pulpitis

In addition to the fact that pulpitis can become a complication of such a common dental disease as caries, it often develops as a result of improperly performed procedures by a low-skilled dentist. For example, often such complications are manifested due to:

• The use of low-quality filling materials during the treatment of caries;
• Irregularity in the turning of the tooth, necessary for subsequent prosthetics;
• Errors in surgical interventions in the treatment of periodontitis;
• Effects on the patient's body of all kinds of chemicals used by the dentist.

There are a number of other factors that can cause inflammation of the pulp, which include all kinds of physical effects on the teeth. As practice shows, usually the appearance of a disease is the result of a combined effect of microorganisms present in carious cavities, and that is why they need to be disposed of in a timely manner, without postponing a visit to the dentist's office for an indefinite period.

At the same time, pulpitis often appears separately from caries, and the reason for this, as in the previous case, are microorganisms penetrating the neurovascular bundle. In particular, the development of the disease is caused by the growth and development of streptococci, lactobacilli or staphylococci, therefore the best remedy prevention of the growth of such microbes is strict adherence to the rules of oral hygiene.

Kinds

Pulpitis, as well as any other diseases, can have a very different form. According to their location, they can be:

• Crown;
• root;
• Total.

In addition, diseases are divided according to the nature of the course, and occur in the following forms:

• Acute;
• chronic;
• Chronic with exacerbations.

The most frequently encountered is acute form of pulpitis. It develops near the carious cavity, and leads to serous inflammation. Subsequently, the disease in the course of development of various chemical and biological processes evolves into purulent focal pulpitis, which develops into diffuse purulent pulpitis. The transition from one stage to another can last for a matter of days, and at each stage, the destruction of the pulp becomes more serious, and the treatment - the most difficult.

Chronic pulpitis differ from acute ones in that they do not appear simultaneously, but periodically, which is associated with the constant ingress of bacteria to the soft tissues of the tooth. Often they appear as a result of the development of an acute form, but they can develop on their own. As for the complications that can develop against the background of the disease, apical periodontitis is one of them. Therefore, at the first symptoms of pulpitis, we recommend that you do not postpone a visit to the dentist, but seek qualified medical help as soon as possible.

Classification

Additionally, pulpitis can also be classified according to morphological features. In such a situation, the classification assumes the following forms:

• Gangrenous pulpitis. The formation of such a variation of the disease begins with an acute form, which led to the death of part of the pulp. The remaining part of it suffers from serous inflammation, accompanied by the formation and increase in the amount of granulation tissue, which has a limiting effect on dead areas.
• Hypertrophic pulpitis accompanied by the appearance of a granulation cavity. This form of the disease is chronic, respectively, inflammatory processes occur over a long time interval. The granulation cavity gradually replaces the dental cavity and the carious cavity communicating with it, as can be judged by the softness of the formation and its slight bleeding.
• fibrous pulpitis- this is a special form of the disease, which is characterized by the presence in the oral cavity of a significant amount of collagen fibers and plasma cells.

In view of such a variety of forms of the same disease, it is not surprising that its symptoms can manifest themselves in various ways.

Symptoms

As we have already noted, the main sign of the appearance of pulpitis may be the presence of continuous or intermittent pain, which often intensifies at night. in addition, a change in temperature, characteristic of most patients, can also become a symptom of the development of the disease.

On the initial stage pulpitis, pain is rather weak, and is rather aching in nature. And the longer the visit to the dentist is postponed, the more advanced the disease becomes, and the more serious the discomfort. After a while, the pains become pulsating and prolonged, making it difficult for a person to lead a normal life.

All of the above is typical for the acute form of pulpitis, while in the case of chronic pain, they do not appear constantly, but only during exacerbations. Also, a symptom of the chronic and purulent form of pulpitis can become soreness, which manifests itself as a result of even the slightest pressure on the affected tooth.

Symptoms of acute focal and diffuse pulpitis are very severe pains of a spreading nature, transmitted from the affected tooth to the neighboring ones. These sensations do not appear constantly, but with a certain frequency, which becomes more frequent at night. A sick tooth becomes extremely sensitive to any kind of irritants, and even the elimination of these irritating factors does not lead to a decrease in pain.

The course of chronic fibrous pulpitis is characterized by the almost complete absence of any signs, and only periodically manifested unpleasant sensations that are non-symptomatic can indicate its presence. In view of this, this form of the disease is most often not diagnosed by the patient on his own, which leads to the development of hypertrophic chronic form, accompanied by destructive changes that occur in the periodontal tissues.

For the gangrenous form of pulpitis, the nature of the manifestation severe pain with rather unusual stimuli. For example, a tooth may begin to feel itself under the influence of warm food, and calm down from the cold. In most cases, discomfort does not last long, and quickly disappear on its own, as it appeared.

In any case, the appearance of toothaches, regardless of their form, indicates the development of pulpitis. Therefore, contact dental clinic worth it even if they were episodic.

How is pulpitis treated?

It should immediately be noted that serious illness as pulpitis, treatment at home does not imply, which is why it is not possible to eliminate it without the help of a dentist. In fact, today there are two main methods of treating this disease, such as:

• conservative;
• Surgical.

The conservative method is the most gentle, since it involves the treatment of the inflamed pulp, and not its physical removal. In this case, the full viability of the neurovascular bundle is preserved, for which the doctor uses all kinds of antiseptics, antibiotics and other drugs. In the same time, this method has serious limitations associated with the inability to restore the pulp as a result of its serious destruction, due to which conservative method most often resorted to with pulpitis resulting from an injury.

The surgical method is used by dentists much more often due to its overall effectiveness. This technology involves the removal of the inflamed pulp, after which the dentist treats the canals of the tooth, which implies their disinfection and filling with a special filling material. The only exception is the pulpitis of the wisdom tooth, which, due to the location of the channels in such a tooth, is usually not treated. The surgical method of treatment has two varieties:

• vital. Differs in the universality allowing to apply treatment at any forms of development of a disease. Pulp removal is performed within one visit to the dentist's office, under general or local anesthesia.
• Devital. This form is more gentle, since it involves the removal by a doctor of an already dead nerve, destroyed under the influence of a special drug, embedded in the carious cavity. Such removal of the pulp occurs in several stages, which is associated with the inability to instantly kill the nerve.

It should be noted that it is much easier to cure the initial pulpitis than its more serious stages. In view of this, we strongly recommend that you regularly visit the dentist's office, which will allow you to control the condition of your teeth, preventing the development of this disease itself.

Treatment of pulpitis in children

The occurrence of pulpitis in children today is not uncommon, which is associated with a number of structural features of milk teeth and low immunity of a growing organism. Due to the fact that the neurovascular bundle in such teeth is rather poorly developed, the disease is diagnosed already in the later stages, when it remains only possible surgical method treatment.

As in the case of adults, the dentist removes the affected pulp, but does this exclusively in the rind part, since milk teeth do not have formed roots. Therefore, after removing the soft tissues of the upper part, the doctor applies a special medicine to the bottom of the cavity, which has disinfectant properties that prevent the spread of infection. As a result, a new, completely healthy tooth grows in place of the healed tooth.

A significant factor is the fact that incorrect or untimely treatment of pulpitis in a child can cause a lot of problems in the future. Therefore, as in the case of adults, it is necessary to visit the dentist's office regularly to diagnose the current state of the oral cavity.

Treatment of pulpitis during pregnancy

Since the process of pregnancy is accompanied by serious fluctuations hormonal background, during it, expectant mothers often encounter manifestations of pulpitis. And, contrary to popular belief, it is possible to treat the disease without the risk of harming the child even during pregnancy, especially since untreated purulent inflammation will be more harmful than medical intervention.

All medical procedures for the removal of pulpitis in pregnant women should be limited to minimal use medical preparations including painkillers. The main goal facing the dentist is to eliminate inflammation and pain, while the end of treatment is usually done after the birth of the baby.

Popova Natalya ViktorovnaDirector, dentist

What is pulpitis, dental pulp? What threatens and why it is necessary to undergo regular examination? Let's look into these issues.

Many initially recognized only already in the dentist's office Small cavities on the surface of the tooth, violation of the integrity of the tooth enamel leads to the fact that pathogenic microbes get inside the tooth. This is where bacteria thrive. They multiply by "eating" the tissues of the tooth and moving deeper and deeper.

During this period, you can not always suspect something was wrong. Often cavities are located in places that you cannot see (on the inside of the tooth or in the interdental spaces). As long as the cavity is small, it rarely causes pain. Often these cavities can only be detected by a dentist during an X-ray examination.

In some cases, some sensations are still there. It can be a reaction to sweet, sour, cold, food stuck between the teeth..

The discovered cavity is easy to cure. Usually, the doctor diagnoses you with caries, removes tissues “spoiled” by microbes, and puts a filling.

Such treatment is possible if you turn to a specialist in time. If you do not regularly pass preventive examinations, and the course of caries is asymptomatic, the bacteria will eventually reach the dental pulp. There is a sharp pain in the tooth. The doctor diagnoses - pulpitis.

What is a pulp (pulpitis) and why does its inflammation cause such pain

The pulp is the internal tissue of the tooth, which contains the vessels and nerve supplying the tooth nutrients. Thanks to the pulp, the hard tissues of the tooth (enamel and dentin) are able to receive everything they need, especially calcium, which is so necessary for the integrity and resistance of the tooth to external influences.

With thinning of the dentin that separates external environment and the pulp occurs so-called initial pulpitis. There is no damage to the pulp yet, but there is already a toxic effect on it of the waste products of pathogenic bacteria.

At the first stage of treatment of pulpitis, after setting anesthesia and removing “spoiled” tooth tissues, it is not always possible to make a correct diagnosis. Often the doctor cannot be absolutely sure that microbes have not penetrated into the pulp, and the process of destruction of the pulp has not begun.

The most accurate criterion for assessing pulp viability is time. What does it mean? The doctor applies a medical bandage to the bottom of the cavity, which will strengthen and thicken the bottom, as well as prevent the penetration of bacteria and their toxins into the pulp. Then a temporary filling is placed. The tooth is monitored for two to four weeks. If the tooth does not bother you, a permanent filling will be placed at the next visit.

However, even this cannot be an absolute indicator that the pulp is alive and well. There is a so-called asymptomatic course of pulpitis. Therefore, even after setting a permanent filling, it is necessary to observe the tooth for at least a year. At periodic check-ups (once every six months) It is advisable to take an x-ray, and also assess the viability of the pulp using various tests.

"Why all this complexity?" you say. "Maybe just remove the nerve?"

A tooth devoid of pulp becomes brittle over time, its walls are chipped off. The color of the tooth changes, it acquires a grayish tint. Most often, the doctor suggests covering the tooth with a crown to avoid complications. Yes, and the removal of the nerve procedure is not as simple as it seems at first glance. In the root of the tooth, in addition to the main canal, which is visible to the doctor and can be processed, there is a whole system of microtubules that the dentist, armed with even the most advanced microscope, cannot go through purely physically. According to Russian and European studies, only 60% of "dead" teeth do not have complications after treatment.

The procedure for the treatment of pulpitis

So, the doctor, with your full understanding of the situation and consent, tried to save your tooth. But something went wrong. After a temporary filling is placed, the tooth continues (or begins) to hurt. You are diagnosed with acute or chronic pulpitis, it doesn’t matter, the doctor’s tactics are the same - the pulp (nerve) must be removed.

The procedure is performed in one or two visits., depending on the number of channels and their degree of accessibility and curvature. The treatment of such a tooth ends, in which the nerve has been removed by filling or, more often, restoration. The filling or restoration is strengthened with various pins. If necessary, the tooth is covered with a crown. The assessment of the need for a crown is determined by the doctor according to the degree of preservation and fragility of the remaining tooth tissues.

The treatment is considered completed only when all the stages are completed, up to the placement of the crown on permanent cement.

Warranty obligations begin from the moment when the treatment is completed and apply to the filling, restoration and crown.

Warranty obligations for canal treatment cannot be provided due to the above difficulties in their treatment. The doctor can only guarantee that the treatment he performed was carried out in accordance with today's accepted standards and at a high professional level.

So, the treatment is done, but do not forget about possible complications. Be sure to undergo preventive examinations every six months. X-ray examination treated teeth will help to identify and eliminate the problems that have arisen in time.

Take care of your teeth.

Stay healthy.

Toothache is one of the most common health problems. The man confronts her Everyday life as often as with ordinary SARS or acute respiratory infections. One of probable causes where a tooth can start to hurt is pulpitis. He is able to deliver pain and without proper treatment is dangerous complications.

What is pulpitis and its differences

Pulpitis is an inflammation of the pulp, the neurovascular bundle in the tooth. The inflammatory process provokes a high accumulation of such pathogenic microorganisms, like lactobacilli, staphylococci, streptococci or their toxins, penetrating the soft tissues of the pulp.

Defining pulpitis on your own is not an easy task, because it has many common features with other diseases of the oral cavity, and the difference is minimal. However, there are a number of symptoms by which it can be distinguished. For example, with caries, after the cessation of exposure to the stimulus, the pain goes away, with pulpitis - no. With neuralgia at night, the pain decreases, with pulpitis it becomes stronger. Periodontitis is different in that the tooth hurts after any physical impact. On the pulpit part of the jaw, tapping or biting does not produce a painful effect. In order to avoid complications and errors, it is better to entrust the diagnosis when the first symptoms occur to an experienced dentist.

Varieties of pulpitis

There are 2 classical forms dental pulpitis:

• acute;
• chronic.

The acute form is characterized by spontaneous development, with the sudden onset of paroxysmal pain. At the initial stage, a brown-black hole is formed in the enamel structure, which becomes deep over time. Damage affects the root canals of the tooth.

Acute pulpitis has its own classification:

1. Focal. Its duration is about 2 days from the moment the dentin is damaged. Attacks of pain last from 10 to 20 minutes, intervals between which can be several hours. Swelling of nearby tissues and the occurrence of pain in the lymph nodes are also likely.
2. diffuse. Inflammation extends to the crown, nerve endings and even the root of the pulp pocket. This disrupts the blood supply. The pain during pulpitis develops into a throbbing one, the attacks become longer, and the intervals between them are shorter.
3. Purulent. Distinctive feature- accumulation of pus at the bottom of the cavity of the damaged tooth. Accompanied by constant throbbing pain and deterioration of well-being.
4. Serous. According to statistics, children are more susceptible to it. It is infectious in nature, and is accompanied by brief bouts of pain.

If the process of inflammation of the pulp lasts longer than three weeks, then the disease becomes chronic. Pain attacks acquire periodicity and appear not only at night.

The chronic form of the disease is divided into:

Rare types of pulpitis

One of the rare varieties of the disease is retrograde pulpitis. With retrograde pulpitis, the spread of inflammation does not occur from top to bottom, but vice versa. First, the root part of the pulp is affected, and then its crown.

In case of retrograde pulpitis carious cavity is absent, and the characteristic symptomatology, including prolonged nocturnal attacks of pain, is present. The infection enters the tooth through holes in the upper part of the root. To provoke the development of retrograde pulpitis can:

Another rare species is calculus. It is non-infectious. Stones are formed in the pulp - parietal deposits that squeeze it for a long time, or replacement dentin is formed. Often seen in older people.

Traumatic pulpitis. The cause of the appearance of such pulpitis is a trauma to the tooth, leading to inflammation. Sometimes an infection in the oral cavity joins it. Most often, this form of the disease occurs in children, adolescents and asocial people. It is characterized by typical symptoms for pulpitis.

The reasons

The treatment of pulpitis largely depends on the knowledge of the causes that provoked the development of the disease. The factors that most often lead to inflammation of the pulp include:

Symptoms

Each type of tooth pulpitis has its own differences, but they all have and general symptoms. At the initial stage of pulp inflammation, a diseased tooth begins to react painfully to temperature changes and other irritating factors. Further development of the disease is accompanied by a sharp throbbing pain, aggravated at night or in the supine position. Attacks are spontaneous, but can be triggered by external stimuli.

It can be difficult to understand which tooth has been damaged, due to the presence of a headache that even radiates to the neck or throat. For example, if a tooth in the upper jaw is affected, the pain can spread to the temples, in the lower jaw - to the ears.

However, there are external signs that will help to suspect pulpitis:

• enamel acquires a gray tint;
• the tooth becomes mobile;
• bleeding;
• gums redden;
• the appearance of swelling around the inflamed tooth;
• fistula formation.

The chronic form can proceed with the absence of typical symptoms of pulpitis. Often with it there is a rotten smell in the mouth and aching pain.

Diagnostics

The characteristic signs of the disease, and how the tooth looks outwardly with pulpitis, resembles many other diseases, such as periodontitis or deep caries. In this regard, the doctor is obliged to deal with the diagnosis. An accurate diagnosis is established on the basis of the following studies:

Possible Complications

If pulpitis is not completely cured or treated incorrectly, it is dangerous for the development of complications such as:

Among other complications after pulpitis, osteomelitis is possible - inflammation in the bone tissues of the jaw, phlegnoma - inflammatory process affecting the tissues of the jaw and soft tissues of the face. This list of complications is incomplete, so timely treatment and prevention are important.

First aid

Before seeing a doctor and prescribing treatment, the following measures can be taken to relieve pain:

However, this is only a temporary solution that cannot cure the disease. It is not recommended to take other medicines or do warm compresses that are not prescribed by a doctor.

Treatment and prevention

Professional treatment of pulpitis in dentistry is divided into two methods:

The main point of therapy in the first variant is reduced to a high-quality treatment of the tooth cavity and the establishment of a permanent filling. For processing, antiseptics, antibiotics, corticosteroids that relieve inflammation, enzymes and vitamins are used. This is a more gentle method, which is especially important for children's and women's teeth during pregnancy.

One of effective drugs for the treatment of inflammation of the pulp is dimexide. It has a local anesthetic and antimicrobial effect. According to the instructions for use, applications with dimexide should be done 2-3 times a day. A napkin with dimexide is applied to the affected area for 10-30 minutes on the recommendation of a doctor.

Among other drugs that are relevant in the fight against pulpitis:

• chlorhexidine;
• ketorol;
• ibuklin;
• indomethacin;
• voltaren;
• etodolac;
• meloxicam;
• lornoxicam;
• nimesulide;
• nabumetone;
• celebrex;
• viox;
• tenoxicam;
• miramistin and others.

In any case, the use of medicines is allowed after consultation with a doctor. As for the prevention of pulpitis, it comes down to:

• timely caries therapy and hole filling;
• visiting the dentist 2 times a year;
• proper nutrition, including vitamins, calcium, and a minimum of carbohydrates;
• the use of fluoridated water, which strengthens the enamel;
• care oral cavity including brushing teeth, flossing and rinsing.

Pulpitis can be determined by a pronounced characteristic symptomatology, which gives patients a lot of discomfort. At the first manifestations of this inflammatory process, you should immediately contact a specialist and begin therapy. If you refuse treatment, then this will provoke complications and negative consequences, but at the same time, independent actions should be completely excluded.

Why does the disease occur?

Pulpitis appears in a patient as a result of many provoking factors, the main of which is caries in the third stage. The inflammatory process in the pulp begins due to the penetration of an infection there (streptococci, staphylococci, lactobacilli). These pathogens damage not only the surface of the tooth, but also affect the nerve.

The disease can develop not only as a result of the development of bacteria, but also for the following reasons:

1. Mechanical injury to the enamel, as a result of damage to the pulp.
2. Burn or overdrying of the pulp, as the patient was not provided with high-quality treatment.
3. tissue damage strong drugs or filling material.

In any situation, in order to eliminate the problems with the oral cavity, it is worth seeking professional help from a specialist.

How fast is it developing?

Pulpitis can be determined not only by the rate of development, but also by the corresponding characteristic features. The progression of the inflammatory process will depend on the stage of the disease and general condition oral cavity.

Symptoms will depend on the form of the disease, which is acute and chronic. acute form disease, in turn, is divided into focal and diffuse, and chronic - fibrous, hypertrophic and gangrenous. Also, experts distinguish the stage of exacerbation of the disease.

Characteristic signs of acute pulpitis:

1. Spontaneous pain that occurs in the form of seizures.
2. Pain that worsens at night.
3. Discomfort worries the patient for more than two to three weeks.

In this case, the nerve of the tooth is not exposed. The pain is intense, so the patient takes painkillers. It is worth considering the fact that in the acute focal form, the patient will be able to indicate which tooth bothers him.

Chronic pulpitis in most cases occurs without acute stage. The pain will be aching, and there are no other symptoms. The asymptomatic course of the disease can last for several months and be diagnosed with a chronic fibrous form.

A complicated form of pulpitis is necessarily accompanied by pronounced signs of pathology and has a transient course. With it, the patient's condition deteriorates sharply and therefore urgent medical intervention is required. If you refuse therapy, then this can provoke the formation of a fistula, that is, a fistulous tract.

You can also identify pulpitis on your own because of the characteristic symptoms of the disease and its stage, but, as for treatment, it must be prescribed by the dentist based on the results of the preliminary examination.

What does it look like on an x-ray?

Inflammation in pulpitis is practically not characterized by radiological signs, since it does not provoke changes in hard tissues sick tooth. An indirect symptom can be attributed to a deep carious cavity, which is communicated with the cavity of the tooth. The diagnosis is made by a specialist based on the results of electrical excitability and sounding.

The denticles, which are located near the walls of the dental cavity and the root canal, are determined on the X-ray image in the form of dense tissues, single or multiple, which have a rounded shape. As for chronic granulomatous pulpitis, it can be easily seen on an X-ray image, which has a rounded outline.

Can there be pulpitis if the nerve is removed?

Very often, patients are worried about pain after nerve removal. In most cases, this is not considered a pathology, since there was an intervention in the cavity and the tissues of the tooth were affected. But there are exceptions when pain indicate the development of complications and poor-quality treatment.

To understand that the pain is natural, it is worth paying attention to how many days discomfort has already been present. Sensations in the patient occur immediately after the removal of the nerve and can last more than 5 days. This will be associated with soft tissue injury.

If the discomfort increases or is observed for a long period of time, that is, contact a specialist and find out the provocative cause. As a rule, this condition is associated with a broken filling technique.

Why does my tooth hurt at night?

Pulpitis can be identified by nocturnal attacks of pain. This violation occurs for many reasons:

1. Horizontal position. In such a situation, there is a large rush of blood to the head and jaw, while increasing pressure on the inflamed area and the nerves of the diseased tooth.
2. Changes in the general condition of the body. At night, the body's susceptibility to various pathologies and inflammatory processes increases.
3. Increase in blood pressure.

Pain can occur with pulpitis at night due to exhaustion nervous system, chronic sleep deprivation, tobacco smoking, coffee consumption and mental disorders. Very often, the patient sets himself up for discomfort, thereby only exacerbating the situation.

- 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). At timely treatment- favorable outcome. 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 a strong pain syndrome. Patients note soreness both at rest and from irritants; when exposed to temperature stimuli, the pain intensifies. characteristic feature pulpitis is a toothache that 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. Pain worsens at night, which is 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 erased clinical picture. So at chronic fibrous pulpitis attacks of pain from various irritants are insignificant and short-lived. During the questioning 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. There is a history of complaints about sharp pains paroxysmal nature with irradiation along the course 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.