Treatment of pulpitis: what is pulp and its structure, classification of pulpitis according to ICD-10, pulp hyperemia, treatment of acute and purulent pulpitis

What does dental pulp consist of?

Anatomical structure of the dental pulp

From an anatomical point of view, the tissue is divided into two zones. The coronal dental pulp has a loose structure and is involved in dentinogenesis; all layers of the dental pulp in this part are penetrated by an extensive network of capillaries and nerve cells. The root pulp of a tooth is denser because it does not contain a large number of cellular elements, but is saturated with collagen fibers. Through the apical foramen, the canals communicate with the periodontal tissues and allow minerals and nutrients to reach the tooth walls.

The pulp and dentin of the tooth form a strong complex - the hard tissue protects the tooth pulp from external irritants, and it, in turn, helps the formation of dentin.

The pulp of the front tooth smoothly passes from the crown to the root part, the dental pulp of the molars has clear boundaries - the mouths of the dental canals.

Histological structure of dental pulp

The pulp contains a large number of different elements:

• Elastin and collagen fibers supply the organ with hyaluronic acid, reducing susceptibility to toxins and bacteria.
• Odontoblasts and stellate cells are responsible for the regeneration of dental pulp.
• Leukocytes, lymphocytes and fibroblasts support the vital activity of the epithelium and organize communication between cells.
• A branched network of nerve processes forms Rashkov's plexus and provokes the occurrence of pain sensitivity when exposed to stimuli - the innervation of the dental pulp occurs due to the trigeminal nerve.
• Vessels and capillaries provide the blood supply to the dental pulp, which is necessary to nourish the tissues.

Composition of dental pulp

The fabric is 74% water, the remainder being organic and inorganic layers. Pulp cells include protein compounds, acids, lipids, glucose and various enzymes, which allows the epithelium to actively consume and process oxygen.

Age-related changes in dental pulp

The pulp of temporary and permanent teeth has a similar structure and only becomes thinner over time. Before the roots are formed, the pulp of a baby tooth is concentrated in the coronal part. Later, the tissue begins to spread into the dental canals through the apical foramen and grow into a wide network. The dental pulp in a child has a massive and dense structure, as well as a large fiber size.

The development of dental pulp continues throughout life, but with age, regeneration processes slow down: the number of active cells decreases, which leads to vascular fragility, insufficient tissue nutrition, the tooth suffers from odontoblast atrophy, that is, the impossibility of dentin formation. The described changes apply to older people.

Secondary treatment of canals and installation of a permanent filling

After a few days, the patient will need to make a second visit to the dentist to evaluate the results of the treatment. An X-ray is taken again, which allows you to evaluate the success of the measures taken and, if the image shows the cessation of the inflammatory process, then the treatment continues and will consist of secondary treatment of the canals and restoration of the natural tooth crown with a photopolymer filling.

While working with the canals, the dentist will remove previously placed gaskets from them, rinse the cavities with an antiseptic, and then seal them with gutta-percha. After completing these procedures, X-rays are taken again, which is necessary to assess the quality of canal filling. Having completed the restoration of the natural tooth crown, the doctor will advise the patient on proper oral care after treatment of pulpitis.

Compliance with the specialist’s recommendations in full is a guarantee that complications will not arise and the treated tooth will not hurt again. We hope the material helped you find out as much useful information as possible about what pulpitis is and why its treatment should begin in a timely manner. Concluding the article, we will add - do not try to cure pulpitis yourself, using traditional medicine, this may be unsafe for your health. The inflammatory process with pulpitis can only be stopped with well-chosen medications, removal of damaged tissue, and all these measures can be put into practice only in a dental clinic. Regularly visiting the dentist's office and undergoing an examination will be the best preventative measure against pulpitis.

In our dentistry "Uni Dent" in St. Petersburg (St. Petersburg), all conditions have been created to guarantee effective, safe and high-quality treatment of pulpitis. For a consultation or to make an appointment with our specialists, just dial our contact phone number!

Functions of the dental pulp

The main role of the pulp is to perform several tasks to support the vital functions of the tooth.

1. Plastic function.
   Formation of basic dentin, as well as the formation of hard tissue in case of damage.
2. Protective function.
   Preventing infections from entering the periodontium through canals, removing dead cells, maintaining regeneration processes.
3. Sensory function.
   A signal about the presence of an external or internal irritant to preserve tooth health.
4. Trophic function.
   Supply of nutrients to dentin and tooth enamel.

Treatment of acute K04.01 (according to MMSI acute focal) PULPTIS

The first thing you need to do is stop the inflammatory process, that is, stop the inflammation.

First, painkillers are prescribed to reduce or relieve pain.

First way.

In young people, at the beginning of the inflammatory process, it is possible to stop the inflammatory processes and preserve the pulp using conservative processes. To do this, the carious cavity is prepared with modern instruments that are available in our clinic, and then

is treated with medication and an anti-inflammatory, regenerating and odonotropic paste is applied, mainly based on calcium hydroxide paste for 4-6 days, and then if there are no complaints, the tooth is filled with permanent fillings.

Second way

When performing this method, first infiltration or conduction anesthesia is carried out, and then the softened tissues of enamel and dentin, as well as the inflammatory pulp at the level of the canal mouth are removed with a diamond bur, then the tooth cavity is cleaned, the bleeding stops and a paste based on calcium hydroxide is applied without any pressure. And ionomer cement is applied to it. The first control after three, and the next controls after 6 months and 1 year.

This method is called vital pulp amputation or pulpotomy .

Clinical picture of acute purulent K04.02 (pulp abscess) (according to MMSI acute diffuse) pulpitis.

• spontaneous pain;
• prolonged pain with short light intervals;
• radiating pain along the branches of the trigeminal nerve;
• intense, unbearable pain;
• increased pain from hot foods;
• short-term relief of pain from cold;
• EDI 30 – 50 mA;
• deep carious cavity with a large amount of softened dentin;
• the tooth cavity is not opened;
• probing is painful;
• percussion is painless;
• palpation of the transitional fold at the level of the inflammatory tooth is painless, but may be sensitive;
• with unformed root apices, percussion and palpation are painful;
• Severe swelling and disturbances in the general condition of the whole body may be observed.
• X-ray – no changes;

What can cause pulpitis?

Burn of tooth pulp

As a rule, a pulp burn during tooth grinding occurs as a result of medical error or carelessness. Before prosthetics, the crown part is treated at high temperatures. Insufficient cooling during the preparation process can lead to a burn, which will provoke subsequent inflammation of the dental pulp.

Dental pulp hematoma

After a tooth injury, there is a possibility of getting a hematoma, that is, bleeding into the dentin. The crown acquires a reddish tint and painful sensations occur when pressure is applied. However, a bruise that has not turned into pulpitis or necrosis does not need treatment and goes away on its own over time.

Caries

Through the smallest cracks in the tooth cavity, infection and pathogenic bacteria penetrate into the pulp. Advanced caries is one of the most common causes of pulpitis.

Clinical picture of initial K04.00

There is no history of spontaneous pain. When interviewed, it turns out that pain comes from various irritants, which quickly goes away after they are eliminated. A painful attack is provoked by cold and hot stimuli (temperature). Almost always the patient points to the causative tooth.

Pain from temperature stimuli quickly (within a few seconds) goes away. When talking with the patient, it turns out that the tooth has not hurt before.

• The tooth cavity is not opened.
• Percussion is painless.
• Probing is painful at one or more points.
• Electroodontometry - 10-12, and sometimes 20 microns (normally 2-6 microns).
• X-ray – no changes.

Therapeutic methods for treating dental pulp

Therapeutic or conservative are methods of treatment that make it possible to do without removing tissue. These methods of preserving dental pulp are not available to all patients; there are certain indications:

• age not older than 40 years;
• deep caries;
• acute serous-purulent or fibrous pulpitis;
• opening of the dental pulp due to trauma;
• lack of medical intervention in the inflammation process to date.

As a rule, the dentist treats the surgical field with antiseptic solutions, removes the affected tissue and places the drug into the cavity. There are two methods for performing this procedure.

1. Indirect covering of the dental pulp.
   An antibacterial agent is placed at the bottom of the cavity to stimulate the production of bone substance. Regeneration occurs naturally.
2. Direct covering of the dental pulp.
   The medication is applied directly to the soft tissue to preserve the viability of healthy cells, then isolated with a pad.

Next, the tooth is restored with temporary materials, and after a secondary examination, it is finally restored.

Treatment and primary filling of canals

Treatment will not give a positive result if the tooth canals are poorly processed and sealed. To fill them correctly and to the required level, the doctor will first expand their cavity with special devices - K-files or reamers. Expanding the canals to the required level, the dentist will wash them from time to time with an antiseptic: this is necessary to completely wash out pathogenic microflora from the cavities.

When the specialist prepares all the tooth canals for filling, he will dry their cavities from moisture and place in them pads soaked in medicine that can completely eliminate and stop the inflammatory process. The tooth is then closed with a temporary filling, and the patient goes home.

Surgical methods for treating dental pulp

In cases where therapeutic methods are powerless, the only option left is to remove the dental pulp. This option is used in cases where the patient’s immunity is weakened, the disease is at an acute stage, or the tooth will be used in the future as a support for prosthetics. Surgery involves amputation or extirpation of the dental pulp.

1. Amputation of the dental pulp
   - during the procedure, only the coronal part is removed. Prescribed for acute pulpitis or mechanical damage to the dental pulp.
2. Extirpation
   is the complete removal of the pulp. Used for all forms of pulpitis.

The pulp can be removed vitally, that is, under anesthesia without prior killing. If this method is not possible, the doctor resorts to devitalization of the dental pulp - the toxic substance is left in the cavity for about a day, after which the dead tissue is painlessly removed. Means for devitalizing dental pulp include arsenic or paraformaldehyde paste.

Signs of illness

Typically, pulpitis manifests itself as a pain syndrome, which can have varying severity.

Depending on the manifestations of the disease, pulpitis is distinguished:

• acute - accompanied by severe paroxysmal pain (they intensify at night), occurring both spontaneously and as a result of exposure to cold or heat, the pain often radiates to the neck, ears, temples and does not go away even when taking analgesics;
• chronic – the pain is aching, almost imperceptible, and appears quite rarely.

Acute pulpitis can be serous and purulent. If a purulent process develops, the pain becomes constant and acquires a shooting and pulsating character.