Can a tooth with a removed nerve hurt and why?

Symptoms of pulpitis

• monotonous and aching pain at the initial stage of the disease,
• very strong and acute pain, which worsens closer to night. Unlike ordinary caries, the pain does not decrease, even if the irritant is removed, i.e. stop eating, drinking or brushing your teeth,
• reaction to temperature stimuli - hot and cold, and quite strong and pronounced,
• pain and acute reaction when tapping on the tooth.

Pulpitis is quite difficult to confuse with other diseases precisely because of the specific pain that accompanies the acute course of the disease. As a rule, black carious spots are present on the tooth at the same time, including they can be located under the filling (in this case it becomes dark), as well as under the crown (if the nerve has not been removed, however, in such a situation, carious inflammation will not be visible) .

Reasons for the development of the disease

• untreated caries or poor quality of filling, when an inflammatory process has developed again under the installed filling,
• preservation of the nerve under the crown - in this case (if the tightness of the prosthesis is broken, there is inflammation underneath) there is a high risk of pulp inflammation,
• tooth injury – inflammation penetrates from the outside, i.e. through cracks and chips that are located on the root or in close proximity to it,
• exposure to aggressive stimuli - temperature and chemical, for example, during previous canal treatment, naturally, with an incorrectly selected dosage of the drug.

How to relieve toothache at home

If toothache is unbearable, medications can help relieve the pain.

• Ibuprofen (Mig-400, Nurofen) - reduces pain after 15 minutes, but does not last long.
• Ketorolac (Ketanov, Ketorol) - a pronounced and long-lasting analgesic effect develops 30-60 minutes after taking the tablet.
• Movalis (Meloxicam) - relieves pain and inflammation, but can cause a burning sensation in the stomach.
• Paracetamol is the safest drug from the NSAID group, approved for children and pregnant women.
• No-spa (Drotaverine) - an antispasmodic enhances the analgesic effect of non-steroidal anti-inflammatory drugs.
• Spasmalgon, Baralgin - analgesics related to Analgin are used as an antispasmodic.

Important! Painkillers are taken strictly according to the instructions, observing the age-specific dosage and frequency of administration. If you do not have the above-mentioned drugs on hand, you can take regular aspirin.

Relief of throbbing pain with medications is supplemented with home remedies:

• cold compress on the cheek
• “mouth baths” (not active rinsing) with sage or chamomile infusions,
• rinsing the mouth with a soda-saline solution (1/3 tsp per glass of lukewarm water),
• apply a cotton wool moistened with eucalyptus oil to the gum,
• chew propolis.

Painkillers will only temporarily relieve pain. Remember that throbbing pain in a tooth is a sign of a disease that necessarily requires treatment. Do not delay your visit to the dentist - the longer the disease develops, the more difficult and expensive the treatment will be.

Sources used in writing the article:

• “Local anesthesia in outpatient dentistry”, Kononenko Yu. G., Rozhko N. M., Ruzin G. P.
• “Modern technologies of local anesthesia in dentistry”, Rabinovich S.A.
• “Emergency conditions in dental practice”, M. Panchishin, I. Got, 3. Masny

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Stanislav Mezheritsky

Chief physician, surgeon, orthopedist

The author of the article is Stanislav Mezheritsky, a practicing dentist with 19 years of experience, chief physician and one of the founders of the Matisse Dent clinic. The main focus is orthopedic and surgical dentistry. Author of numerous publications, regular participant in specialized seminars.

Complications of pulpitis

If you do not consult a dentist in a timely manner, pulpitis can develop into a more serious disease - periodontitis, cyst or granuloma, periostitis. That is, the inflammation will go deeper and go beyond the tooth root. Such complications can lead to tooth extraction, after which neighboring teeth will begin to shift, leading to malocclusion. Since the disease causes some discomfort while chewing food, the patient may face serious gastrointestinal problems.

Treatment methods

Treatment of pulpitis is carried out in a complex: as a rule, the nerve is removed (only in rare cases, when there is slight inflammation, it can be treated with medication and thereby kept alive for some time). After this, the canals are filled and the coronal part is restored if it is destroyed. Diagnosis and treatment monitoring are necessarily carried out using an x-ray - a targeted image of one tooth.

Dental canal treatment The dental canals are cleaned using special instruments and medications. The treatment takes 2 visits - during the first, the nerve is removed and the cavity is thoroughly cleaned. In the second, the quality of the treatment is assessed, the temporary filling is removed and a permanent one is placed.

Price:
from 4,500 rubles more details about the solution
Installation of a core tab After cleaning the dental canals, if the crown is almost completely destroyed, i.e. under the root, it is necessary to restore the tooth. An inexpensive option is to install a pin, but a more rational option is to make a stump tab that completely replicates the structure of the root system. This way the load is distributed more evenly, so the tooth will last longer. Next, you can install a crown or line the top of the inlay with a composite material.

Price:
from 5,000 rubles more details about the solution
Installing a crown Installing a crown after treatment of pulpitis may be necessary if the apex of the tooth is destroyed by more than half. For the lateral teeth, the best option would be to use metal-ceramics, for the front teeth - pure ceramics. In both cases, a crown made of zirconium dioxide is suitable, since it is characterized by increased strength and at the same time has a snow-white tint. A single prosthesis can be attached to the tooth itself (if there is something left of it), or to a pin or core tab.

Price:
from 11,000 rubles more about the solution

Should I remove the nerve in the tooth or not? That is the question!

Agree, it is quite a common situation when, after treating caries with a therapist or treating a tooth with a crown by an orthopedist, the latter may begin to bother you. One of the controversial questions that patients have to face at this moment is when to remove the nerve in a tooth , and under what circumstances is there a chance to keep the tooth alive? In reality, this question is not always clear-cut for dentists either. In this article we will try to figure out what the difficulty is here.

Firstly, you need to immediately decide that a “living” tooth is always and definitely better than a “dead” one. Because under the “nerve” there actually lies an entire organ, consisting not only of the nerve, but also of blood vessels and other tissues and cells needed by the tooth. And all this is called pulp. It provides the tooth with both nutrition and protection from any external influences. And therefore, without it, it is difficult for our teeth to count on a long and happy life.

But often as a result of caries, injury or dentist intervention (for example, when grinding living teeth for crowns), an inflammatory process can occur - pulpitis . And here it is very important how reversible this process is. This is what is important for the doctor to determine when rendering a verdict on the pulp - to execute it (i.e., depulpate the tooth) or to pardon it (leave the tooth “alive”).

And here we can say that 100% reliable methods for diagnosing the reversibility of the inflammatory process in the pulp do not yet exist. If we had the opportunity to look inside the tooth with a microscope, then determining the vitality of the pulp would not be difficult. But it is impossible to do this on a living patient; such an opportunity is currently available only to pathologists. As a rather cynical saying goes, this is why these doctors are least likely to make a mistake in diagnosis. So what remains for practicing dentists? How can they avoid making mistakes? Which path should you take? You can only rely on much less informative indirect signs and use your experience and intuition.

Let us briefly examine what is still available to us when making a decision.

Patient complaints.

Of course, one of the most subjective signs, however, sometimes very informative. Therefore, it is often enough to listen to your feelings to understand how bad things are with your tooth. Depulpation certainly cannot be avoided if:

- You feel a fairly strong aching pain that occurs without any apparent reason and does not go away for a long time. At the same time, it can intensify when changing the position of the body (mainly when trying to bend over or lie down), and also noticeably intensifies at night. Usually in such a situation, many people run to the pharmacy for a pack of painkillers, although the most correct thing in this situation is to call your dentist with a request for an urgent appointment...

- You do not feel aching pain all the time, but only from some irritant (most often from cold ). The important point is that this pain does not go away immediately after removing the irritant for some time (from several seconds or more).

If, upon contact with cold, you feel only a short, instantly passing pain, then, most likely, everything for the pulp, maybe not right away, will end well. Any other sensations of discomfort, for example, painful biting or sensitivity when touched by a brush when brushing your teeth, are usually associated with completely different things and do not talk about the condition of the pulp.

Cold test.

This point smoothly follows from the first and is based on the inadequate reaction of the inflamed pulp to irritation (primarily to cold). This can be used for diagnostic purposes and, so to speak, to conduct reconnaissance in force. The technique is simple, but with a touch of slight sadism. The doctor cools the cotton ball with a special spray and touches the “suspected” teeth with it one by one.

The resulting response is compared with that of obviously healthy teeth that are 100% above suspicion (i.e., they are on the other side, on the other jaw and do not have carious holes or any traces of previous treatment). If suddenly someone wants to “play dentist” and can’t wait to find a bad tooth themselves, then at home you can do this test yourself by applying, for example, an ice cube from the freezer to different teeth one by one.

In general, self-diagnosis is pointless, but in this case it can still be useful to understand your own feelings, and then more confidently poke the doctor at the problem tooth.

It should be noted that this method is good primarily only in order to understand which tooth is actually bothering you. After all, pulp pain is quite poorly localized, and the patient often cannot say which tooth is bothering him. It even happens that the pain from the causative tooth radiates to the opposite jaw. This happens especially often with pulpitis of 8 teeth (wisdom teeth). Therefore, if in such a situation you trust only the feelings of the patient himself, you can break a lot of wood and depulpate innocent teeth for no reason. It is almost impossible to judge the severity of the inflammatory process and its reversibility using a cold test. For each patient, “oh-yoyoy” and “ah-yayayy” can mean completely different things. Although, as in the first point, by the duration and severity of the pain reaction, the doctor can indirectly judge the hopelessness of attempts to keep the pulp alive.

X-ray.

Another highly informative technique for most cases, which is completely useless for determining the neglect and reversibility of the pulpitic process. X-rays can also only indirectly help identify a problematic tooth if there is any doubt about the “culprit” of the pain. The pulp itself, like soft tissue, does not show any changes on x-ray if it is inflamed. What signs can help a doctor suspect something is wrong?

— location of the previously installed filling close to the pulp chamber

In this image: the red line marks the border of the filling, the blue line marks the border of the pulp. As you can see, they are located quite close to each other.

- hidden, invisible during visual inspection, deep carious cavity in the interdental space

In this picture: the black arrow shows a hidden carious cavity that formed on the back side of the lower 7th tooth under the gum level and led to inflammation of the pulp. The reason in this case was the 8 (wisdom tooth) that was not removed in time.

-presence of denticles in the pulp chamber or root canals

In this image: the yellow line marks the border of the filling, which is close to the pulp (its borders are marked in red). A denticle has formed in the thickness of the pulp due to chronic irritation (marked in blue).

-small reactive expansion of the periodontal fissure around the apex of the tooth root

Electroodontometry (EDO).

This is an old, if not ancient, way to check the condition of the pulp using essentially the same method as with the cold test. Those. irritate her. Only in this case it is no longer a low temperature, but an electric current. This time, nothing sadistic, as everyone usually thinks when explaining the essence of the technique. To carry it out, it is not at all necessary to pass current through the entire patient in some kind of electric chair. It is enough to connect a special small device to the tooth, which generates rather weak microcurrents.

By the value to which the tooth “responds” with slight tingling and pinching, one can judge (again, very approximately, unfortunately) the degree of pulp viability. The advantage of this method compared to the cold test is that instead of “ouch” and “ouch”, the doctor deals with impartial readings from the device. Another thing is that 100% of these indications can only be used to judge whether the pulp is alive at all, or whether it died a hero’s death. Everything else, again, is very conditional.

In the end, what do we have? There are 2 main problems with teeth suffering from pulpitis (or very similar pain : difficulties in some clinical cases in determining the source of pain, and difficulties in making a decision about preserving/removing the pulp. As we have seen, it is not easy for even an experienced and knowledgeable doctor to objectively understand these issues in all cases. If with the first question mistakes can almost certainly be avoided, then with the second... while there are no methods for objectively assessing the condition of the pulp, each doctor will make decisions at his own discretion. Someone, playing it safe, depulps all the teeth in a row indiscriminately. Someone is trying to keep them alive. The more data a doctor can collect and interpret correctly, the risk of making an erroneous decision will be minimized. In general, this is an iron law of medicine: the better and more thorough the diagnosis, the more correct and effective the treatment.

What happens if a mistake is made? I'll tell you one example from my practice. A young girl went to the doctor complaining of aching pain in her teeth “somewhere on the right side.” Without any special diagnostics, treatment began... First, one tooth with a deep filling was depulped, which seemed the most suspicious to the doctor. The pain remains. Then - the next one, the pain did not go away. Then both right normally erupted wisdom teeth were removed. The pain even intensified for a while... Instead of stopping and thinking at that moment, the doctor depulped another 3 (!!!) completely intact (i.e. untouched) teeth on this side, but on the other jaw. When the pain did not go away even after that, the girl, suspecting something was wrong, went to look for reasons in other places. Ultimately, she was diagnosed with trigeminal neuralgia, which, although it is not always well and quickly treated, in her case it was released quite quickly due to the treatment prescribed with the help of a neurologist. The result of the diagnosis using the “finger in the sky” method was 5 completely needlessly killed teeth.

Therefore, it is so important to collect as completely as possible all possible subjective and objective information if the situation is confusing. In this case, the probability of making a wrong decision will tend to zero. In addition, you should strive to preserve the pulp in the tooth, and do not rush into radical decisions if in doubt. At the same time, in borderline cases, you should always monitor the result of treatment, even if the pain has subsided. A cold test, x-rays, and odontometry will be able to promptly identify asymptomatic (“silent”) pulp death and the need for its removal. Otherwise, a cyst may grow completely unnoticed near the root of the tooth. And then there is a risk of losing the entire tooth.