Probably there is no such person who has never had a toothache. And when, as they say, the process has begun, all sensations are concentrated around a single diseased tooth. If you postpone the visit to the dentist for later, then the patient has every chance to know all the "charms" of chronic pulpitis.
What is the process?
Pulpitis, if we speak clearly, is an inflammatory process that develops in the neurovascular bundle inside the canals of the roots of the teeth and their crown part. If the patient went to the doctor with complaints of severe pain (i.e., there is an acute pulpitis), then in some cases the inflammatory process can be stopped and the tooth can be saved.
In a state of chronic pulpitis, the pulp gradually degenerates, fibrous tissue is formed, necrosis or transformation of the neurovascular bundle is observed up to such a state when the entire carious cavity is filled with its tissues, which led to pathology.
Most often, with chronic pulpitis, there is no acute pain, and patients come to the doctor in order to save the tooth from extraction. However, the chronic form of pulpitis is almost always an irreversible disease.
Reason for development
Any pathology has prerequisites and circumstances that gave impetus to the development of the disease process. Pulpitis is no exception. Chronic forms of this disease are provoked by pathogenic microorganisms and their metabolic products. As a rule, the beginning of all beginnings is the presence of deep caries in the patient or poor-quality treatment of this widespread ailment. The latter concept means non-compliance with the technique of processing a diseased tooth, insufficient cleaning of the carious cavity, poor-quality filling, etc.
Less common causes of chronic pulpitis, provoking the development of the pathological process, may be a trauma to the tooth, blockage of the channels of the neurovascular bundle with s alt plugs ("calculi"). Also, chronic pulpitis can appear as a complication of maxillofacial and general diseases (sinusitis, influenza, periodontitis, osteomyelitis, periostitis, etc.) During the course of such diseases, pathogenic microorganisms can penetrate through the top of the tooth root.
Varieties of chronic process
Dentists distinguish 3 types of chronic pulpitis: hypertrophic, fibrous, gangrenous.
With a hypertrophic process in the carious planeproliferation of pulp tissues in the form of a polyp is observed. As a rule, the patient sees a bleeding growth, which is injured when chewing food. Pain can be moderate and is caused in most cases by external irritants.
Fibrous form occurs most often and is characterized by recurrent aching pain, which within 1-2 days stop by itself, but the carious cavity bleeds almost constantly.
Gangrenous form is characterized by complete decomposition of the nerve tissues of the tooth and a large destruction of its crown part. This form of pulpitis is always accompanied by bad breath. Pain is usually mild and intermittent. The typical complaints of the patient in this case look like this: “the tooth hurt a lot, and then it stopped by itself.”
It is worth noting that most often (≈ 70% of cases) doctors diagnose chronic fibrous pulpitis, much less often - gangrenous. The hypertrophic form in adult patients practically does not occur. This diagnosis is sometimes made by pediatric dentists.
Diagnosis of chronic pulpitis
In order to make a diagnosis, the doctor, in addition to listening to the patient's complaints, will need to carry out a certain set of measures, consisting of a visual examination of the diseased tooth, thermometry, EOD and radiography.
During a visual examination, the doctor receives about 50% of information about the condition of the causative tooth. Thermometric studies on the reaction to cold andhot stimuli make it possible to understand with what disease and what variety of it the patient turned to the doctor. For example, a reaction to a cold indicates that the “nerve” has not died.
Electroodontodiagnostics (EDI) is one of the most reliable ways to diagnose pulpitis. The technique is based on the fact that diseased and he althy pulp tissues have different electrical excitability. A he althy nerve will react with slight pain to the impact of a current strength of 2-6 μA, fibrous pulpitis will respond with pains of the same intensity to 35-50 μA, gangrenous will require exposure to 60-90 μA.
X-ray involves assessing the condition of the tooth from x-rays.
Differential diagnosis of chronic pulpitis involves a comprehensive assessment of all the above methods and a comparative analysis of the information obtained in the process of making a diagnosis.
Symptomatics of the chronic form of pulpitis
Basically, the disease at this stage is asymptomatic. How can you understand that a person has chronic pulpitis? Complaints are mainly reduced to the presence of aching pains with different intervals of calm between them.
In the fibrous form, as a rule, there are pain sensations as a result of exposure to irritating factors (hot, cold, sweet). Pain does not go away for a long time even after the influence of irritants is eliminated. A characteristic symptom can be called the development of prolonged pain when the extern altemperature from cold to warm (for example, the transition from the street to the room). Although in some cases the course of fibrous pulpitis is possible without obvious signs. This happens if the irritants do not have direct access to the carious cavity (for example, it is localized under the gum or has a through communication with the pulp chamber). In the latter case, there is no swelling, the pulp "does not burst", and, as a result, there is no pain.
With gangrenous pulpitis, there is always an unpleasant odor from the diseased tooth and from the mouth. Characterized by pain from exposure to hot, which does not stop for a long time even after the irritant is removed. Often there are sensations of fullness in the tooth. In addition, the color of the tooth almost always changes: it becomes grayish.
Hypertrophic pulpitis is accompanied by aching pain when chewing food and bleeding. This is due to the germination of the pulp into the carious cavity by the type of "wild meat". It is this factor that most often scares the patient and forces him to see a doctor.
Stages of chronic process treatment
Since with this disease the soft tissues in the tooth can no longer be preserved, the main type of therapy is the removal of the pulp from all canals of the tooth. Modern dentistry in the overwhelming majority of cases prefers the method of vital extirpation (live extraction) of the nerve, when only anesthetics are used without the involvement of medicines to kill the pulp.
However, sometimes the individual characteristics of the patient's jaw,lack of time and lack of good anesthetics do not allow the nerve to be removed immediately on the first visit. Then the treatment of chronic pulpitis is applied in stages, when a special paste is placed in the carious cavity, with the aim of preparing the pulp for removal, which happens on the second visit.
After treatment
Quite often after the treatment of chronic pulpitis is completed, people complain of pain. These sensations are called post-filling (as dentists call them). As a rule, discomfort appears for several reasons and fits into a conditionally acceptable norm. The occurrence of pain after the treatment of pulpitis is possible due to the fact that the tissues around the diseased tooth may be slightly injured or with a rough, sharp separation of the "nerve" in the process of its removal. Also, pain may appear if, during the treatment, the canals of the tooth were treated with powerful antiseptic agents, which in small volumes could go beyond the root.
Another reason for post-filling pain is the exit of a thin instrument that dentists use during the treatment process to work inside the canals, beyond the apical foramen of the root.
Causes of complications after therapy
Sometimes after a seemingly successful "communication" with the dentist, severe pain begins, and the initially treated exacerbation of chronic pulpitis becomes more complicated. There may be several reasons for this phenomenon. These are poor-quality canal filling works.tooth, breaking off a dental instrument while it is in the root canal or perforating (creating a hole) in the root wall.
If the canals were poorly sealed or the penetration of the filling material beyond the root tip was allowed, within a certain period of time (from several days to a year) symptoms of periodontitis will appear in the acute stage. Breaking off the instrument may not immediately manifest itself, but the infection in the unwashed and unfilled canal will still declare itself as a flux, the periodic appearance of fistulas on the gums (at best) or the formation of cysts with purulent contents.
Exacerbation of a chronic process: signs
If a sick tooth with manifestations of acute pulpitis is not cured in time, the disease will become chronic and will remind of itself with enviable constancy throughout life. How is exacerbation of chronic pulpitis manifested? Symptoms are unpleasant: pain from exposure to various stimuli (warm, cold, sweet, transition from cold to heat), quite negative sensations on palpation and percussion (slight tapping of the causative tooth with the leg of a dental instrument). Most often, patients describe the pain as paroxysmal. At the stage of exacerbation of the chronic process, the spread of pain along the pathways of the trigeminal nerve is characteristic. It is for this reason that patients say that pain is given in the temple area or under the eyes, in the nose or chin.
Exacerbation andreasons for its development
Exacerbation of chronic pulpitis can make itself felt for several months. Pain is not as intense as in the acute form. The most common causes of exacerbation can be such phenomena as deterioration of the outflow of exudate, trauma to the tooth, increased activity of pathogenic bacteria. In addition, weakening of general immunity, inflammation in the lymph nodes and general intoxication of the body can contribute to relapse.
Exacerbation of the chronic form of pulpitis may be accompanied by phenomena of focal periodontitis. In such cases, patients come to the dentist with complaints of persistent pain. Pathological changes are fixed on the x-ray.
Temporary teeth in small patients
Not only adult patients are diagnosed with chronic pulpitis. In children, and not only with permanent, but also with temporary teeth, this disease is also possible. All forms of chronic inflammation are characterized by pronounced symptoms.
Baby can't chew food properly. The causative tooth reacts to temperature stimuli. With the gangrenous form, pain appears in response to irritation with warm, hot, or when moving from a cold to a warm room. Proliferative pulpitis (and its hypertrophic form in particular) is characterized by the appearance of pain when food particles enter the carious cavity. In addition, the pulp polyp bleeds when mechanically applied.
Feature of the course of the diseaseat this age, there is a low intensity of pain, which can be explained by a structural change in the pulp and its dense communication with the periodontium. In this case, optimal conditions are created for the free removal of exudate, as a result, there is no severe pain.
Permanent teeth in children
Permanent teeth in children are also susceptible to pulp disease. The forms of chronic pulpitis in children are exactly the same as in adult patients. The chronic process in the acute stage in young patients, as a rule, is characterized by a long sluggish course with periods of acute pain. Often, the growing discomfort suddenly disappears, and nothing bothers the child for a sufficiently long period of time. But in most cases, patients complain of paroxysmal or tearing sharp pains that radiate in the direction of the branches of the trigeminal nerve. Low electrical excitability (120-160 μA) indicates changes in the nerve elements of the pulp, which are dystrophic and destructive.
Summarizing all of the above
To the great regret of the patients, neither the acute phase of the disease nor the subsequent exacerbation of chronic pulpitis will pass by itself. You will need dental treatment sooner or later. And it is better that this happens as soon as possible in order to save the patient from unnecessary suffering and costly and painful measures, and the doctor from long and tedious work that requires considerable experience and patience.
