Surprisingly, the fact is that a disease such as pulpitis has more than 20 classification approaches. Dentists themselves use various methods for assessing the type of disease in the course of their work, but note that none of them is able to 100% accurately describe all the features of this insidious disease. Dentists note that they need a more convenient and capacious classification of pulpitis, which would allow characterizing the disease from all the necessary positions.
Why classify pulpitis?
The presence of such an extensive systematization of this dental disease is associated with different approaches to trying to describe the picture of the disease. Various types of classifications of pulpitis offer to consider them from different positions: the causes of occurrence and development, the clinical picture, progression, the circumstances of deep processes in the canals of the tooth, and others.
Describing from all angles pulpitis classification has not yet been developed. Therefore, dentists have to embedthe existing clinical picture in an individual patient within the framework of existing methods for its assessment. Some classification schemes were developed decades ago, but are still used in the practice of diagnosis and treatment of pulpitis.
The first attempts to systematize this disease of the teeth were made in the 20s of the last century and were designed to describe pulpitis as accurately as possible. These classifications were quite complex and cumbersome. That is why specialists have been continuously working to improve the methods of describing the disease. With a frequency of 5-10 years, a new classification was proposed, which was based on earlier schemes, but had some new position to describe the picture of pulpitis.
WHO classification
The end of the 20th century, namely 1997, for dentistry was marked by the introduction of the International Classification of Diseases of the 10th revision, which is known by the acronym ICD-10. It was approved by the World He alth Organization, and already in 1999 it began to be widely used in dental practice for the diagnosis and treatment of pulpitis. This system is the name of the codes and their interpretation to describe the clinical picture of the disease. The classification of pulpitis according to the ICD includes the following items:
- Diseases of the pulp and tissues of the periapical type are proposed to be designated using the code K04.
- Directly pulpitis is encrypted K04.0.
- The initial stage of the disease, characterized by hyperemia, is designated K04.00.
- Acute pulpitis offeredencrypt К04.01.
- If an abscess is detected, then the code K04.02.
- The chronic form of pulpitis is designated K04.03, and if ulcers are diagnosed, then it is proposed to code the diagnosis as K04.04.
- If a patient has a pulpal polyp in a chronic form, then it is designated K04.05.
- In case of a disease of the neurovascular tissue of a tooth of another specified nature, mark K04.08.
- If the cause of pulpitis is unclear, this is marked with the code K04.09.
- Necrotic or gangrenous phenomena in the pulp are indicated by the code K04.1.
- If the dentist observes degenerative processes, such as denticles, pulp stones or calcifications, then he designates them with the code K04.2.
- In the case of abnormal formation of hard tissue in the area of the pulp, a mark K04.3 is made. Moreover, if it is an irregular (secondary) dentin, then it is designated by the code K4.3X. It should be noted that in this situation, calcifications and stones in the pulp are excluded.
- In case of acute apical periodontitis, caused by changes in the neurovascular tissue of the tooth, the code K04.4.
- If the dentist believes that he has a disease of the pulp and periapical tissues that do not fit into the above points, then he puts a mark K04.9.
This classification of pulpitis by WHO, according to dentists, is not very convenient. However, to this day it is used as an official scheme for compiling statistical reports of specialists on the work done for a certain time period.gap.
Codes and ciphers according to this classification, the doctor is obliged to put down in the patient's card and coupon. Many dentists admit that they often have to enter the diseases they have treated into the scheme proposed by WHO, although they use completely different convenient ways to characterize dental pathology in their work.
Characteristics of pulpitis by its origin
This classification of pulpitis and periodontitis takes into account the causes of this disease. According to this criterion, dentists distinguish 4 types of disease:
- Infectious.
- Traumatic.
- Concremental.
- Drug or chemical.
Let's take a closer look at each pulpitis, the classifications of which describe the causes of its occurrence.
Infectious pulpitis
This type of disease is caused by the activity of bacteria that release toxins and provoke inflammation of the vascular and nerve bundle of the tooth. In 9 cases out of 10, microorganisms enter from the carious cavity inside through the dentinal canals or affect the open surface of the nerve. Less common is retrograde pulpitis, when microbes enter the tooth through a hole in the root apex. This occurs with infectious diseases such as acute respiratory infections, rubella, osteomyelitis, sinusitis or periodontitis. In isolated cases, infection can be hematogenous. The surest aspect in order to recognize pulpitis is etiology. Classification according to this principle is quite often useddoctors.
Traumatic pulpitis
It is worth noting that trauma causes a pathological process that can lead to pulpitis. In this case, the sterility of the cavities of the tooth is violated and they become infected with the further development of inflammation of the nerve bundle. Sometimes it is not the integrity of the tooth that is violated, but its correct location (dislocation or subluxation). In this case, the pulpitis is closed and progresses without the involvement of microorganisms.
Injuries can be of a domestic nature, be obtained as a result of an accident or injury, or may be the result of inept medical intervention.
For example, when grinding a tooth “under the crown”, pulpitis often occurs as a result of tissue perforation. This phenomenon needs immediate correction. It is very important for the doctor to follow the scheme: pulpitis - classification - clinic - treatment. With the consistent work of a specialist, almost any, even the most difficult case, can be corrected, avoiding a lot of unpleasant complications.
Concremental pulpitis
This type of pulpitis occurs due to some formations in the canals of the tooth - denticles or petrificates. They grow in the cavities of the channels and squeeze the blood vessels. As a result, microcirculation is disturbed, puffiness is formed. The consequence is pulpitis.
Medicated or chemical pulpitis
This classification pulpitis is usually not described, but in fact it occurs quite often and is due to medicalmistake. This happens if the dentist uses substances of a potent nature (alcohols or esters) when preparing a caries cavity or periodontal pocket, or a technical error was made during filling.
Platonov classification
Despite the fact that this type of disease assessment was proposed by Professor Platonov back in 1968, it is still used by dentists in practice to this day. This classification of pulpitis and periodontitis has its drawbacks, but is good for its simplicity and convenience. The professor in his methodology combined three approaches: assessment of pathological processes in the pulp, the nature of the course of the disease, as well as the localization of unpleasant sensations. This rather simple, but capacious disease assessment system has appealed to many specialists, which explains its current relevance.
This systematization considers the main aspects of such a phenomenon as pulpitis - etiology, pathogenesis. Platonov's classification of the disease is as follows:
- Acute type pulpitis: focal form (acute pain, localization of which is clear to the patient) and diffuse appearance (undefined localization, radiating along the trigeminal nerve on the face).
- Pulpitis of a chronic nature: hypertrophic (growth of the pulp with filling of the caries cavity), gangrenous (necrosis of the tissues of the nerve bundle and blood vessels) and fibrous (degeneration of tooth tissues).
- Exacerbation of chronic pulpitis.
This classification and clinic of pulpitisgreatly simplify the work of dentists, especially in budget clinics. As a rule, in such circumstances, the doctor does not have enough time to find out the causes of dental disease. To determine the type of disease, it is enough to ask the patient a couple of questions.
Gofung classification
This method is quite popular with dentists, as it describes the most important aspects of such a pathology as pulpitis - classification, clinic, treatment. It gives a concept of the stages of the disease, takes into account various clinical indicators and the morphology of pulp changes during the inflammatory process. According to this system, the following forms of the disease are distinguished:
- Acute form of pulpitis: partial (reversible, can be cured biologically with nerve preservation), general (diffuse, covers the entire pulp and is treated by extirpation), general purulent (extensive and irreversible pulp disorders, treated with vital extirpation with prophylaxis occurrence of periodontitis).
- Chronic form of pulpitis: simple, hypertrophic (these two types respond well to treatment with the possibility of preserving the root), gangrenous (destructive form, treated by extirpation in several visits to the doctor).
MMSI classification
This method of morphology of the disease of the neurovascular bundle is a direct continuation of the Gofung technique.
Classification of pulpitis MMSI includes the point of exacerbation of the chronic form of pulpitis and takes into account the peculiarity of inflammation in the previously treated tooth. According togiven morphology, the disease is subdivided into:
- Acute forms of pulpitis: focal or diffuse purulent, serous.
- Chronic types of pulpitis: gangrenous, fibrous or hypertrophic.
- Exacerbation of the course of the chronic form of pulpitis: fibrous or gangrenous.
Exacerbation of the gangrenous type of pulpitis can cause periodontal complications, as anaerobic microflora actively develops in it. If partial removal of the nerve does not solve the problem of inflammation, complete extirpation or re-mummification of the canals usually completely solves the problem.
Classification according to Vinogradova
Classification of pulpitis in children is made according to Professor Vinogradova's system, which suggests clearly separating diseases of temporary teeth from permanent ones. The doctor explains that inflammatory processes in milk and molars proceed differently. The professor recommends taking into account the specifics of the location of the tops of temporary teeth and insists on refusing to completely pass through the canal in the treatment method. This can damage the baby's permanent tooth germ.
Classification of pulpitis in children includes the following items:
- Pulpitis of milk teeth of an acute nature: serous (it proceeds quickly, the focal form becomes diffuse), purulent (quickly covers the entire pulp and can become chronic).
- Pulpitis of a permanent row of teeth of an acute nature: acute serous general or partial, acute purulent general or partial.
- Chronic pulpitis of temporary and permanent row of teeth: simple,proliferative or hypertrophic, gangrenous.
- Exacerbation of the chronic form of pulpitis of temporary and permanent teeth: most often occurs against the background of simple chronic pulpitis.
The peculiarity of the inflammatory process in a temporary tooth is that with a high probability the process will spread to the inter-root space.
This is due to the fact that the dentin in this area has a high degree of permeability. Such a phenomenon is dangerous, as it can provoke disturbances in the formation of the rudiment of a molar, change the period of its eruption, and reduce its resistance.
Chronic pulpitis of temporary teeth is characterized by the fact that it can occur as primary forms, bypassing acute phases. They can be asymptomatic, but they are insidious in that they quickly spread to periodontal tissues. Therefore, you should carefully monitor the condition of the oral cavity of children and do not neglect the treatment of milk teeth.
Features of the treatment of pulpitis
Classification of methods of treatment of pulpitis is directly related to the diagnosis. The success of therapy will depend on the skillful identification of the degree of complexity of the disease.
If the appeal to the dentist was carried out at the beginning of the development of pulpitis, then the doctor produces a biological method for its treatment. It consists in the following: the nerve is not removed from the tooth, a special calcium-containing and antihistamine drug is used. As a result of such treatment, inflammation in the pulp disappears, a replacement is formed.dentine. A filling is applied to the cleaned carious cavity.
If a timely visit to the doctor did not happen, then the opportunity for biological treatment was missed. At this stage, the dentist will have to figure out what kind of pulpitis the patient has. The concept, classification and diagnostic methods will help to do this as accurately as possible.
Quite often, the method of partial removal of the pulp is used. Under the influence of anesthesia, a part of the nerve is removed at the level of the crown, while the root zone remains viable. After that, a preparation with calcium is laid, and the tooth is sealed. If necessary, physiotherapy is carried out, anti-inflammatory therapy is prescribed. This method is recommended for children whose tops of the teeth are not yet sufficiently formed.
As dental practice shows, in most cases, complete removal of the nerve is used. This can be done under anesthesia or by applying a devitalizing paste containing arsenic. This substance is very toxic, and the bandage should be removed at the exact time prescribed by the doctor. After that, endodontic treatment is performed, during which the canals of the tooth are filled with gutta-percha.
After such treatment, an x-ray is taken to check the quality factor of the manipulation performed in the channels. If they are filled to the top, a filling is applied.
In case of almost complete destruction of the tooth, the doctor uses a pin stump tab, on whichtooth restoration. Each specialist will say that classification is guaranteed to help determine pulpitis. Treatment is a logical continuation of a thorough diagnosis of the patient's dental condition.
Appeal to the dentist in the early stages of pulpitis is beneficial to the patient himself. Treatment in this phase is virtually painless and inexpensive. If you start the disease, then periodontitis can develop, which is much more difficult and longer to treat.
