Inflammation of the dental nerve, that is, the pulp, is called pulpitis. A similar disease appears due to mechanical damage to the crown of the tooth or a medical error during filling. However, the most common cause of pathology is the neglected state of caries.
What a dental nerve looks like is interesting to many. The development of pulpitis is due to the infection entering the pulp cavity (chamber). Harmful microbes (staphylococci, streptococci and lactobacilli) inhabit the pulp, moving there from a deep focus of caries.
Bacteria enter through various routes: enamel cracks, dentinal tubules, etc.
Why does the pulp become inflamed?
The pathogenesis of inflammation of the dental nerve is often caused by a bruise or fracture of the dental crown, inaccurate opening of the tooth cavity by the dentist during treatment. In this case, traumatic pulpitis occurs.
Another cause of pathology is a retrograde infection that enters the root canals through the apicalholes. Retrograde pulpitis, as a rule, appears against the background of otitis, periodontitis and other chronic diseases of the oral cavity.
Often, inflammation of the dental nerve (pulpitis) occurs due to medical errors:
- toxic effect of therapeutic agents used for filling;
- use of overly concentrated antiseptics during treatment of the tooth cavity;
- Pulp overheating, for example, during dental preparation for a prosthesis or photobleaching of enamel.
The essence and etiology of pulpitis
Inflammation of the dental nerve, or pulpitis, appears under the influence of various stimuli: temperature, chemical, mechanical and infectious.
- Infectious. Occurs when an infection enters the dental pulp. This can happen for various reasons. Bacteria most often enter the pulp through dentin thinned by severe caries. This can be avoided if you go to a specialist in a timely manner and cure caries. Another retrograde way of infection penetration through the root tip in periodontitis or periodontitis, when the gum pockets are greatly enlarged or the inflammation process occurs near the tooth (periodontitis, osteomyelitis, sinusitis, etc.). Through the lymphatic and blood channels, the infection can also penetrate the pulp from other organs.
- Iatrogenic. This is a consequence of a mistake made by the dentist in the treatment of caries or its complications. Long-term treatment of the caries cavity with a drill with insufficient cooling with water provokesoverheating of the pulp with its further inflammation. The same mistake can be made with a rough dental preparation for a crown. In addition to the influence of high temperatures, the inflammation process can develop due to the treatment of root canals with strong antiseptics, the use of pads containing a lot of alkali, filling allergenic materials and products without taking into account human allergic reactions.
- Traumatic. Sports, industrial and domestic injuries can cause the progression of pulpitis and, even worse, pulp necrosis. Small cracks and chips without opening the pulp can let bacteria into the tooth. In such a situation, manifest pulpitis appears.
Pulp opening
Even more serious case at the opening of the pulp. Dislocation of the tooth, fracture of the root or crown, exposure of the pulp accidentally when grinding the tooth before installing the crown or in the treatment of caries often causes post-traumatic pulp necrosis or acute inflammation. In the most severe situations, the patient is diagnosed with complete necrosis within a week.
What the dental nerve looks like is shown in the picture.
Excessive abrasion of teeth due to misaligned bite or bruxism is fraught with subsequent exposure of the pulp horn. In some cases, pulpitis is the result of a very large filling, as well as the pressure of petrificates or denticles (dentin-like formations in the tooth root or crown). They contribute to the disruption of microcirculation and compress the blood vessels and nerve endings.
Pulpitis symptoms
The main symptom of inflammation of the dental nerve is aching spontaneous pain, worse at night.
At first, the pain syndrome appears several times a day and lasts a maximum of twenty seconds. However, over time, unpleasant sensations become more frequent, become continuous, their nature is radiating, that is, pain can be given to the chin, temple or ear. In some cases, it seems to a person that half of his jaw hurts. Symptoms of inflammation of the dental nerve should not be ignored.
It is very easy to see the difference between caries and pulpitis. If there is a carious focus, discomfort appears only under the influence of external factors (when chewing food or brushing your teeth). With pulpitis, pain most often does not depend on various kinds of mechanical stimuli, it occurs unexpectedly.
Forms of pulpitis
Pulpitis according to the nature of the inflammation process can be as follows:
- Acute - the first inflammatory stage, lasting from three to five days. Inflammation at this stage affects only the coronal area of the pulp.
- Chronic - if acute pulpitis is not treated in time, it develops into a chronic form. The nerve of the tooth begins to die off gradually, dead tissues accumulate in the tooth cavity, while the pain is either absent or mild. May flare up periodically.
By location of inflammation:
- pulpitis under a filling is a secondary caries that forms under a filling;
- deep root pulpitis -the spread of infection occurs along the entire length of the root canal and is able to leave the limits through the apical opening (apex);
- two-channel and three-channel pulpitis - the process of inflammation develops in premolars and molars, capturing root canals, as a result of which the dental task becomes more complicated.
Pulpitis of temporary teeth is also a frequent occurrence. Children's milk teeth have an extensive pulp chamber and weak enamel, so the inflammatory process of the dental nerve is characterized by rapid development. The danger lies in the fact that the infection is able to penetrate the tissues near the tooth, and also harm the rudiments of permanent teeth.
Types of acute pulpitis
- Diffuse - affects the entire root and coronal part of the pulp. Unpleasant sensations last 10-15 minutes, appear every few hours. Unpleasant symptoms are aggravated when the patient lies down.
- Focal. Inflammation affects only the upper part of the tooth. This form is characterized by severe paroxysmal pain, spreading along the branches of the trigeminal nerve. In some cases, gingival swelling and inflammation of the submandibular local lymph nodes appear.
- Serous. Acute pulpitis in advanced form develops by 3-4 days. Pulsating spontaneous pains continue almost all the time.
- Purulent. A purulent focus appears in the dental cavity. When heat is applied, the unpleasant sensations are intensified, from the cold, uncomfortable sensations are removed. Body temperature may rise to38 degrees, general he alth worsens.
Varieties of chronic pulpitis
- Hypertrophic, which is accompanied by the expansion of the polyp (granulation tissue), sometimes beyond the carious cavity. There is bleeding from the tooth when eating. In this case, the crown is destroyed, does not hurt when tapped, does not react to cold.
- Fibrous. The most common type of pathology. The pain syndrome most often does not bother a person, however, a reaction to hot or cold may appear. The pulp bleeds on palpation. This stage lasts about 2-3 months.
- Gangrenous. Pulpitis in severe form, characterized by decay (necrosis) of the pulp. The enamel of an inflamed tooth becomes darker, a putrid bad breath appears, and a person's reaction to hot intensifies. Can develop in both closed and open tooth cavities.
It happens that the dental nerve in the wisdom tooth hurts.
Pathology of the wisdom tooth
Like other teeth, "eights" are also exposed to negative factors, only more often. Since the third molars are difficult to reach, a quality cleaning cannot be done. Bacterial plaque quickly appears on them, caries and its consequences develop, that is, pulpitis.
The clinical picture is standard - unbearable pain, fever, etc. Wisdom teeth are treated with arsenic, which kills the inflamed pulp. However, such therapy is rarely prescribed, the "eight" is most often simply removed.
Complications
Pulpitis needs immediate treatment. If it is absent, significant complications may appear. Bacteria eventually leave the root canal, deep periodontal tissues become inflamed.
The likelihood of such pathologies increases:
- periosteal inflammation (flux);
- purulent type of inflammatory disease of the jawbone - osteomyelitis;
- purulent abscess in the oral cavity - abscess;
- the most dangerous pathology in which purulent exudate affects soft facial tissues - phlegmon.
How to kill the dental nerve? Let's figure it out.
Treatment of pulpitis
In the past, pulpitis was treated only with the removal of the affected tooth, but now the latest technology often allows you to save it even with such a disease. In some situations, when a patient comes to the doctor with a slight inflammation, the pulp can be preserved whole or at least part of it without loss of functionality.
As a result of the treatment of inflammation of the dental nerve, the pulp is either preserved or partially or completely removed. Depending on the stage of the disease, the dentist uses surgical or biological methods of therapy.
Surgical method. It is used when pulp preservation is simply not possible. The nerve is removed and filling is performed
The pulp in this situation is removed partially or completely. However, the preferred option is to preserve at least a small portion of the nerve, since a "dead" tooth is most oftenmore brittle and breaks faster.
Completely or partially, the pulp is removed using devital and vital methods. In the first case, it is eliminated without pre-treatment with drugs or toxic drugs. For devitalization, a special medication is placed inside that kills the pulp, and only after that it is removed.
How to kill the dental nerve? Stages of partial or complete removal:
- injection of local anesthetic;
- dental preparation with removal of affected tissues;
- complete or partial removal of the pulp;
- treatment with an anti-inflammatory agent and application of drugs to the orifices of the canals and pulp, installation of a temporary filling;
- root canals are sealed;
- a photopolymer permanent filling is installed.
Prevention measures
In case of pulpitis, prevention consists in high-quality hygienic care of the oral cavity and timely caries treatment.
To determine the carious lesion in time, you need to contact the dentist twice a year and conduct preventive examinations. In addition to home cleaning, it is also advisable to have professional tartar removal at least once every six months.
