Pulpitis is an inflammation that affects soft tissues, and it is also accompanied by neurovascular formations that affect the tooth cavity. This ailment is characterized by progressive paroxysmal pain, often it spreads to the entire jaw, radiates to the ear, temporal region and intensifies at night. Pulpitis does not go away on its own, here you need to urgently contact a dentist. After contacting a specialist, a diagnosis of pulpitis will be assigned, and then the best method of treatment will be selected. If the patient applied on time, then the outcome of the treatment is favorable. If you delay and wait, what will happen next, then in the end the consequences can be very serious: periodontitis or periradicular cyst. Pulpitis can manifest itself in several forms, and each is accompanied by its own specific symptoms.
Pulpitis: classification
After the diagnosis of pulpitis is made, the doctor can prescribe the correct therapy, which will end with a complete cure of the damaged tooth. Pulpitis, depending on the stage and characteristics of the course of the disease, manifests itself in several forms:
Acute pulpitis is divided into focal and diffuse. The acute form is the initial stage of the pathology. The inflammation is located inmaximum proximity to the carious cavity. Symptoms are manifested in the form of sharp spontaneous pain, which can last from a couple of minutes to half an hour. After that, it can calm down and not disturb for several hours, but at night it sharply intensifies. There may also be discomfort in the tooth, which occurs due to exposure to irritants, and it does not go away for a very long time. In this case, the patient can easily indicate which tooth hurts, and then the diagnosis of pulpitis will be facilitated
- Acute diffuse pulpitis. During this stage, inflammation spreads to the entire pulp. The patient suffers from attacks of severe pain, relief is rare and short-lived. And after the process has passed from serous to purulent, the pain becomes constant, and there is simply no strength to endure it. It is felt in the temporal part, in the ear and on that half of the jaw on which side the tooth hurts. The pain is aggravated by hot food or drink, and relieved by cold food. This stage can last up to 14 days, and if the diagnosis of pulpitis has not been carried out during this time, then it passes into the chronic stage.
- Chronic pulpitis is of several types: fibrous, hypertrophic, gangrenous and retrograde. Chronic fibrous pulpitis appears after the acute form becomes chronic. This period is accompanied by severe aching pain, most often it appears when eating or inhaling cold air. The hypertrophic form occurs at the moment when the carious cavity is connected to the tooth cavity. Thereafterthe pulp grows and a process is formed, which is called a polyp, which fills the free space. The patient feels pain when chewing, bleeding appears. The gangrenous form manifests itself at the moment when pulpitis was not detected in time, the diagnosis was not carried out in a timely manner, which as a result led to the fact that a putrefactive infection got into the diseased tooth. The patient has a smell from the mouth, tormented by pain. The retrograde type is a chronic form, accompanied by the formation of periodontal pockets, and it is in them that the infection collects. Bacteria, passing through the root canals, affect the soft tissues and cause inflammation. The bone tissue of the root is resorbed, in this case, therapy should be carried out immediately and everything possible should be done to remove the pulpitis. Diagnosis, treatment by experienced professionals will help save nearby teeth. It is important here to seek help in time.
Only modern techniques will help to easily identify pulpitis in the early stages. The clinic, in which differential diagnostics can be carried out, is located in any city. They will help to make an accurate diagnosis.
In our modern time, when technology does not stand still, it is not difficult to detect any kind of disease in the early stages. Using innovative methods and equipment, pulpitis can be easily diagnosed. Diagnostics in modern medicine can be of several types, and each of them is quite effective. So, where does the process begin after the patient asked for help:
- Detailed survey. The doctor writes down all the patient's complaints, finds out the reason for the treatment, the nature of the pain and the area of its manifestation. Such a survey helps to make a more accurate diagnosis.
- Examination of the oral cavity. It is carried out using special instruments, the doctor examines all the teeth where fillings were previously placed, checks the gums for inflammatory processes.
- Probing. The dentist examines the oral cavity with a probe. This procedure allows you to determine the degree of development of the disease with maximum accuracy. When probing, it is possible to establish the state of dentin on the bottom and walls of the carious cavity, what is its depth, and also to examine the pulp from the outside. But the main thing in this procedure is to establish a connection between the carious cavity and the pulp chamber.
- Temperature tests. This diagnosis of acute pulpitis or any other form involves exposure to high and low temperatures on the pulp of the tooth. This method helps to complete the picture and learn about the condition of the soft tissues.
- Electroodontodiagnostics. This method is based on checking the reaction of the pulp to an electric current. The higher the manifestations of inflammation, the higher the current strength. This method allows you to determine how deeply the neurovascular bundle is affected, and to identify where the focus of inflammation is located. The deeper its location, the stronger the current strength, and if the pulp is already completely gone, the patient will feel a push.
- X-ray. With it, you canfind out the structural features of the tooth, determine how much the disease has developed, and see the results of the therapy that was previously performed.
But there is another special method that allows you to determine chronic fibrous pulpitis - differential diagnosis. But what is she?
Differential diagnosis of pulpitis
This diagnostic method is ideal in cases where it is necessary to distinguish deep caries from chronic pulpitis, because both of these ailments require a special approach in treatment. With pulpitis, the pain that occurs from exposure to irritants does not go away for more than 20 minutes, and with caries, it subsides immediately as soon as the irritant is removed.
But in order to distinguish pulpitis from exacerbated chronic periodontitis, it will be quite enough just to knock on the aching tooth. If the patient has periodontitis, then knocking will cause discomfort.
Dif. Diagnosis of hypertrophic pulpitis will reveal tooth bleeding under mechanical action, this symptom will confirm the diagnosis, the pain in this case is not very pronounced.
If the patient has fibrous pulpitis, then the diagnosis will allow you to notice under the layer of dentin in the carious cavity how the pulp is translucent. If you touch the probe in this place, the patient will feel severe pain.
During the diagnosis of the hypertrophic form, it is necessary to exclude another diagnosis - the growth of the gingival papilla. If it's a nipplethen it can be pushed back with a probe.
Differential diagnosis of acute pulpitis and inflammation in the trigeminal nerve helps to determine the pain, which increases significantly at night. But if it is neuralgia, then it goes away at night.
After the diagnosis of chronic pulpitis or any other form has been carried out and the diagnosis has been made, then a specific method of therapy is selected for each specific case, this is the only way to achieve a stable positive result of treatment.
How to properly treat forms of pulpitis?
Features of pulpitis therapy depend on the form of pathology, as well as on the stages of development of the disease, in simple words, on the neglect of the disease. The sooner the patient seeks help from a specialist, the higher the chances of saving the tooth. After one or another form of the disease is identified, for example, chronic pulpitis (differential diagnosis is very effective in making an accurate diagnosis), the doctor will select a treatment method that will give a good result. But let's take a closer look at what methods doctors use in the treatment of each form of pulpitis.
Acute pulpitis
This form of the disease is treated in three stages:
- The pulp affected by inflammation is removed, the procedure is performed under anesthesia, and further the patient is recommended drug root canal therapy.
- Filling root canals, in this case the doctor uses a special sealant.
- Restoration of the crown of the tooth, a filling agent will come to the rescue.
Serous pulpitis
This is one of the most common forms, it can be of two types: diffuse or focal. Both of these forms are easily treatable if therapy is started early. First, the doctor cleans the tooth from dentin affected by caries. Then a filling is placed, but a lining with calcium is needed under it, bandages with an antibiotic are also used to help form secondary dentin. But antibiotics will only help if the patient is not chronically ill.
And if the process has been developing for a long time, then in this case the doctor may recommend the removal of the dental pulp and nerve.
Purulent pulpitis
This form is considered one of the most dangerous. After all, pathology can be both focal and diffuse. With a focal variety, the pulp is partially affected, and with a diffuse variety, completely. This form is treated only by surgery. The doctor cleans the root canals using the vital or devital method. This treatment is very complex, so it is better to entrust this work to a qualified specialist.
Cure this form in one day will not work, on the first day of the visit, the doctor performs the following manipulations:
- anesthetizes, opens and cleans the carious cavity from dental tissues affected by caries;
- disinfects the cavity with antiseptics;
- using a probe, opens the pulp horn;
- injects arsenic paste into tooth to help kill nerve;
- places a temporary filling.
The second visit to the doctor includes the following procedures:
- removal of temporary filling;
- removal of pulp from root canals;
- canal treatment with an antiseptic;
- tooth filling;
- tooth crown restoration.
Traumatic pulpitis
This form can be treated both conservatively and surgically, it all depends on the degree of pulp damage. If it is exposed at the neck of the tooth and only a small part of it, and the tooth itself is not affected by caries, then conservative treatment will give good results. And if a piece of the tooth breaks off and the pulp is severely affected, the doctor will remove it so as not to provoke the development of the inflammatory process.
Chronic pulpitis
With this form of pathology, conservative therapy is not effective. The only correct solution is to apply the surgical method. The complexity of this form is that the patient may not know for a long time that his tooth is sick. Pathology can be detected only if an x-ray is taken.
Depending on the form of the disease, the doctor will use one of the most effective methods. The best is the combined method, when the doctor uses several treatment options at once in order to eventually achieve a full recovery.
Fibrous pulpitis
If a patient has chronic fibrous pulpitis, then the therapy consists in removing the pulp affected by fibrosis. The procedure consists of several stages and is performed under local anesthesia:
- the carious cavity is opened and cleaned of caries;
- antimicrobial treatment in progress;
- septum resection;
- removal of part of the coronal pulp affected by fibrosis;
- expansion of channels and removal of pulp with fibrosis;
- treatment with antiseptics;
- installation of a temporary filling.
After a few days, the temporary filling is replaced by a permanent one.
Hypertrophic pulpitis
This form is characterized by the growth of pulp tissue granulations, as a result of which blood circulation is disturbed. Depending on the degree of damage, the doctor may apply one of two methods of treatment:
- partial pulp removal, affected areas only;
- complete removal of the pulp, if it is completely affected.
If the pulp is completely removed, then in this case it is very important to clean the root canals well, and then seal them. If all procedures are carried out correctly, then the inflammatory process will not appear.
Gangrenous pulpitis
This is one of the most serious forms, when the whole tooth is affected, and the pulp is covered with ulcers. Therapy of this form is considered one of the most difficult. The most optimal method is the complete removal of the pulp, or pulpectomy. The procedure consists of the following steps:
- pain relief;
- opening the carious cavity and thoroughly cleaning it;
- removal of the coronal part of the pulp;
- expansion of channels and removal of pulp affected by inflammation;
- cauterization of the nerve by electrocoagulation, thus bleeding can be prevented;
- drying;
- use of antisepticbandages;
- canal filling.
Diagnosis of acute focal pulpitis or any other form will help to accurately establish the diagnosis, as well as determine the affected area. Only in this case, the doctor can accurately select the treatment and conduct it as carefully as possible.
Even a small toothache should make you visit the dentist, so as not to start the disease and save the tooth. Any pathology, and this also applies to teeth, is easier to cure if detected in a timely manner at the initial stage of development. The current level of development of medicine is such that a visit to the dental office is not always accompanied by pain, the diagnosis of pulpitis and its treatment can be carried out completely painlessly.
