Pulpitis - treatment, symptoms, causes, prevention

Causes of pulp inflammation

The main cause of pulpitis is the penetration of infection into the pulp cavity, in which a bundle of blood vessels and nerves is located.

The causative agents of the disease can be both pathogenic (Staphylococcus aureus) and conditionally pathogenic (lactobacillus) microorganisms. They can penetrate into the tooth in several ways:

through the dentinal tubules in case of poor oral hygiene, accumulation of bacterial plaque and stone in the gum pockets;
through cracks in the enamel caused by tooth trauma;
through cracks due to a fracture of the dental crown;
through the apical opening of the root canal against the background of periodontitis, osteitis and other chronic inflammatory processes of the oral cavity.
Inflammation can also occur after treatment of deep caries

What are the causes of pulpitis in children?

Untreated caries, which is a source of bacteria that infects the pulp. The pulp of baby teeth is much less sensitive than permanent teeth, so caries is almost asymptomatic, the child does not complain, and the onset of the disease is very easy to miss without follow-up examinations. This is why it is so important to pay attention to the prevention of caries in children.
Tooth injury, damage to its crown (chip, crack) and infection. Very typical for hyperactive, restless children.
Common infectious diseases, when an infection enters a tooth through the hematogenous route (i.e., through the bloodstream). With such a lesion, there is no carious cavity in the tooth; inflammation begins from the inside.
Overheating of the pulp due to improper tooth preparation.
Poor quality filling during previous caries treatment.

Etiology of pulpitis

Based on etiology, which implies the nature of the inflammatory process, pulpitis is divided into three types. The classification is carried out depending on the nature of the irritant acting on the pulp:

Infectious pulpitis develops in acute, but more often chronic diseases of the teeth and oral cavity (caries, osteomyelitis, periodontitis, etc.). In rare cases, the infection enters the root canal and pulp through the circulatory system from other units of the jaw or internal organs.
Traumatic pulpitis develops when a tooth is damaged with the opening of a traumatic cavity (crack, chip) into the pulp. Occurs with sports injuries, crown and root fractures.
Iatrogenic, that is, occurring after dental treatment . Occurs after treatment of deep caries, when the internal tissues of the teeth are irritated by the use of chemical, mechanical or thermal irritants.

Knowledge of the etiology helps the dentist select the most appropriate treatment methods and avoid complications in the future.

Classification of pulpitis according to ICD-10

K04 – diseases of the pulp and periapical tissues
K04.0 – pulpitis
K04.00 – initial (pulp hyperemia), and (according to MMSI deep caries)
K04.01 – acute (according to MMSI acute focal pulpitis)
K04.02 – purulent (pulp abscess), (according to MMSI acute diffuse)
K04.03 – chronic (according to MMSI chronic fibrous pulpitis)
K04.04 – chronic ulcerative pulpitis (according to MMSI chronic gangrenous pulpitis)
K04.05 – pulp polyp (according to MMSI – chronic hypertrophic (hyperplastic) pulpitis)
K04.08 – other specified pulpitis
K04.09 – pulpitis, unspecified
K04.1 – pulp necrosis (pulp gangrene)
K04.2 – pulp degeneration (denticles, pulp petrification)
K04.3 – improper formation of hard tissues in the pulp (secondary or irregular dentin)

Symptoms

Inflammation of the pulp is not difficult to differentiate already at the stage of examining the oral cavity and interviewing the patient. This disease is characterized by:

sudden onset of pain and its intensification at night;
a gradual increase in pain intensity and duration in the first 3-5 days from the onset of the disease;
irradiation (spread) of pain to the ear, eye, chin, depending on the location of the diseased tooth.

A characteristic feature of pulpitis, which makes it possible to distinguish it from caries and other dental pathologies, is a sporadic increase in pain, which is not associated with thermal, mechanical or other effects on the tooth.

Treatment with a smile, no stress for the child, no tears

Pulpitis of primary and permanent teeth in pediatric dentistry is quite common; approximately 90% of children with advanced caries suffer from symptoms of this disease. Children's pulpitis is accompanied by excruciating toothache, which deprives you of joy. The use of painkillers will not solve the problem, so the only correct solution is to visit a dentist. The Novodenta dental clinic offers the services of a pediatric dentist who will not only treat pulpitis or periodontitis, but will also find an approach to every little patient.

Forms and types

The classification of pulp inflammation divides the disease into two forms according to the nature of the development of the pathology:

Acute pulpitis is a first-time inflammatory process that lasts from 3 to 5 days and is accompanied by intense symptoms.
Chronic pulpitis is a long-term inflammation that develops in the absence of treatment for acute pulpitis. Symptoms tend to periodically worsen, and in the intervals between them there is no discomfort or it is very mild.

Both forms have several subtypes, which differ in localization, degree of spread, and the nature of the development of the inflammatory process.

Types of acute pulpitis

There are four types of acute pulp inflammation:

Focal pulpitis . It is diagnosed during primary inflammation, when the carious cavity reaches the pulp. The localization of the pathological focus is the upper part of the tooth. This type of disease is accompanied by the most intense symptoms and signs of inflammation spreading along the trigeminal nerve and nearby lymph nodes.
Diffuse pulpitis . Diagnosed 1-2 days after the onset of acute inflammation. The lesion is located throughout the coronal part of the tooth, sometimes down to the neck and root part of the pulp. Attacks of pain last relatively short time and worsen when the patient lies down.
Serous pulpitis . An advanced form of acute pulpitis, accompanied by painful pain symptoms that do not subside.
Purulent pulpitis . The final stage of acute inflammation, in which a focus of suppuration forms in the pulp. The process is accompanied by signs of acute intoxication of the body, increased pain when eating warm and hot food. Symptoms weaken when cold is applied to the diseased tooth.

Classification of chronic pulpitis

Chronic pulpitis occurs in three types:

Fibrous inflammation is the most common variant and lasts about 3 months after the initial inflammation. It is accompanied by bleeding of the pulp when touched, periodic pain in the tooth when it comes into contact with cold or hot food.
Hypertrophic inflammation is a condition accompanied by the formation of a polyp inside the pulp. It looks like a piece of gum growing out of a tooth. Pain with this type of chronic pulpitis is minimal or absent.
Gangrenous inflammation is the most dangerous pathological process, which is accompanied by active necrosis of tooth tissue. Accompanied by an unpleasant putrid odor from the mouth.

Good to know! In addition to the listed types of acute and chronic pulpitis, dentistry distinguishes deep root, two- and three-channel inflammation, as well as pulpitis under a filling.

Treatment of complicated stages of acute pulpitis

Focal and diffuse pulpitis have their own varieties. The first has serous and purulent forms. Focal acute serous pulpitis often occurs as a complication of caries or during improper treatment of caries. It affects the root part of the pulp, which causes sharp attacks of pain. Diffuse serous acute pulpitis spreads to both the coronal and root parts of the pulp, causing severe swelling, which can develop into phlegmon.

Acute purulent pulpitis (pulp abscess), as the name suggests, is characterized by the accumulation of pus in the pulp chamber, throbbing pain, which can radiate to various parts of the jaw and head (which is why the patient often cannot identify the diseased tooth). For successful treatment, it is necessary to completely remove the pus from the canals, and in most cases the tooth is subsequently killed. Treatment of acute traumatic pulpitis is usually more difficult.

Complications

In the absence of adequate treatment, pulp inflammation spreads beyond the boundaries of the root canal, to the periodontium and periosteum. In addition to the formation of a purulent focus (abscess) that opens onto the mucous membranes of the oral cavity next to the affected tooth, there is a possibility of developing more serious complications:

flux or inflammation of the periosteum, which leads to the loss of a diseased tooth, and sometimes healthy teeth located nearby;
osteomyelitis or purulent inflammation of the bone, which requires complex, expensive therapy;
phlegmon - lesions of the soft tissues of the face, their “melting” with purulent exudate.

Each of these complications can, with a certain degree of probability, lead to life-threatening conditions, for example, sepsis.

Treatment

To treat pulpitis, exclusively surgical methods are used - vital or devital removal of the pulp followed by filling the cavity. During vital removal, the doctor injects an anesthetic and removes the inflamed pulp tissue with a bur or mechanically. During devital removal, the pulp is first exposed to special drugs that kill the neurovascular bundle.

Important! Treatment of a tooth with pulpitis with arsenic is an outdated method that is used extremely rarely.

After careful mechanical treatment of part or all of the pulp, the doctor performs a filling in several stages: first, he isolates the root canals, then places a photopolymer filling in the tooth crown. If a significant part of the crown is destroyed, there is intense purulent and necrotic processes, the doctor may remove the tooth.

Pulpitis of baby teeth

Pulpitis of baby teeth is dangerous because the pathological process from the affected tooth can move to the rudiments of permanent units. If the inflammation has not become irreversible, biological treatment is carried out. This gentle technique involves suppressing infection and the inflammatory process with maximum organ preservation of the pulp and neurovascular bundle.

Good to know! In case of pulpitis of primary teeth, it is extremely undesirable to remove the nerve from the tooth and fill the root canals, since this part of the teeth is not yet formed.

After using antiseptics and anti-inflammatory drugs, preparations with calcium hydroxide and calcium hydroxyapatite are placed into the pulp. These products will stimulate the formation of secondary dentin within a week. Only after this the doctor will place a permanent filling.

Treatment of initial K04.00 (pulp hyperemia),

For initial pulpitis, conservative treatment is carried out.

Mostly preparations containing calcium hydroxide are applied to the bottom of the cavity, and then filled with permanent fillings, it is better to monitor after three months.

Clinical picture of acute K04.01 (according to MMSI acute focal) pulpitis

Complaints: prolonged pain from all irritants, mainly at night. There are also spontaneous pains.
The pain is clearly localized, the light intervals can last for several hours, and later these light intervals become shorter.
When the chewing teeth (molars) are inflamed, pain during an attack can spread (radiate) to the ear, temple, and teeth of the opposite side (antagonist teeth).
Inspection - deep carious cavity, a lot of softened dentin, which, when removed, can open the pulp chamber.
Percussion is painless
EDI – 25-40 or within normal limits
Probing is painless