Inside the tooth, under a layer of enamel and
dentin is the pulp. It houses the vessels and nerves
endings This is a soft fabric with high sensitivity:
penetrating the infection, it inflames and causes severe pain, it is
and called pulpitis. With развитии заболевания зуб начинает
react to temperature and mechanical stress
Пульпит — это воспаление в нервно-сосудистом пучке tooth. It
caused by neglected caries when a tooth is destroyed
so severe that the infection gets into the pulp and from there it affects
nerve. One symptom is a strong persistent or discontinuous.
toothache, and the only effective prevention of this
diseases – timely treatment to the dentist if available
caries and annual inspection.
However, the development of caries
– not the only cause of pulpitis. Sometimes he
arises due to incorrect actions of the dentist, for example,
installation of poor quality fillings, improper operational
вмешательстве, затронувшем пародонт, или неправильной обточки tooth.
Another reason is the negative effects of chemicals. With
retrograde pulpitis infection occurs through the apical
Pulpitis occurs due to the impact on the nerve of bacteria living in
the depth of the carious hole. It may be streptococci
staphylococcus or lactobacillus. Toxins they produce, their products
vital activity and the breakdown of dentin also adversely affect
general condition of the tooth, causing pain and inflammation.
Infection into the pulp can also enter through the dentinal tubules, and
из-за травмы, которая часто появляется при переломе tooth. it
Especially true for children, because they often break the front
teeth, and even breaking off a small part can cause infection.
If the injury is so deep that it exposes the pulp, the inflammation
starts after a few hours. With травмировании зуба помощь
must be rendered within 6 hours. More time passes
the greater the likelihood of infection, due to which
придётся удалять nerve. Infection in the tooth – mandatory
condition of pulpitis. In very rare cases, it can
develop without caries.
Types of disease
The treatment and symptoms of pulpitis depend precisely on what form
The disease has developed in a patient. Localization emit
By the nature of the disease share:
Acute and chronic pulpitis have their own stages of development and
proceed in different ways. With обеих есть шанс сохранить полную
vitality of the tooth, if you consult a doctor in time.
Acute form occurs near carious
cavities, usually deep caries, and causes it
occurrence. It appears as a focal lesion, inside
which inflammation occurs. With этом образовывается отёк со
скоплением лейкоцитов и гипермия сосудов, а также
minor dystrophic changes in nerve fibers.
itт период болезни протекает обычно не дольше двух дней, затем
neutrophil migration and myelin decay are observed, leading to
dystrophy of nerve pulp fibers. These changes entail the development
Diseases in purulent focal or diffuse (spreading)
Focal purulent pulpitis localized, it is characteristic
purulent filling and subsequent abscess formation. Diffuse
the form of purulent pulpitis can be filled with a coronal,
and the root of the pulp. Because of this, her defeat appears
Due to the presence of a connection with the carious cavity and penetration
Anaerobic bacteria can develop pulp gangrene. With этом она
It becomes a gray-black unstructured mass with a putrid odor.
In some cases it may be grainy. After going to
root part begins apical periodontitis. Acute form
lasts from three to five days.
Chronic pulpitis develops as an independent disease
or on the background of acute. It can last for several years, the pulp at
this often bleeds, and the hard tissues of the tooth are destroyed. Pain
sometimes dulled and does not cause concern until
the tooth will not prove to be pressure. Therefore, the patient can not chew
food on the side with the affected tooth. According to morphological
featured disease progression is divided into the following stages:
(hypertrophic). itт вид пульпита воспаляется так же, как
chronic. Carious cavity connects with pulp,
granulation tissue grows and a polyp develops that occupies
free space. It hurts and bleeds only when pressed, in
The rest of the time there may be weak pain.
- Fibrous. With нём в большей части образовавшейся полости
collagen fibers, plasma cells, cellular
infiltrates. This form is considered to be the initial for chronic
pulpitis Strong pain does not occur, a large tooth appears
carious cavity, which is not always connected with the pulp chamber.
Pain appears only when exposed to the affected tooth.
- Gangrenous pulpitis. It occurs on the background of a fibrous form,
often occurs with partial loss of pulp. The rest of it
inflamed, granulation tissue begins to form, due to
this pulp becomes dirty gray. The pain is getting
stronger, there is an unpleasant smell.
When exacerbation of chronic pulpitis signs appear
both acute and chronic forms. There are sharp pains,
which are intensified by pressure on the tooth, the bone tissue is destroyed,
there is a high risk of infection of the periodontium. This is the last stage
and if you do not turn to a specialist before it starts, there is a risk of losing
the tooth is full.
Most common is chronic fibrous pulpitis, least often
– gangrenous. Chronic disease in most cases.
irreversible, because there is a long and systematic destruction
tooth pulp dies, vessels grow. In such cases
the only way out is to remove the pulp. In acute forms of the disease
A chance to relieve inflammation and keep the tooth completely higher.
Symptoms for each case
The main sign of pulpitis
tooth – severe pain – at night becomes more pronounced. Initial
stage of the disease is characterized by mild aching pain, as
development of the disease, it becomes more pronounced, pulsating.
In chronic and purulent forms of pain occurs only in the period
aggravations, but appears at the slightest tapping in the area
With diffuse and acute focal pulpitis, the pain is very strong,
have a pervasive nature. Strengthened by the evening. Have
own frequency. The tooth becomes very sensitive to
irritants, the pain does not become less and does not subside even after their
eliminate. When tapped, the tooth is insensitive or
weakly sensitive. Chronic fibrous pulpitis leaks
asymptomatic. Occasionally a patient may notice discomfort
not causing severe discomfort.
Hypertrophic chronic pulpitis occurs after fibrous.
This usually happens when the crown is badly damaged and
on the pulp is a regular mechanical effect, due to
whom she is infected with. When tapping, the tooth is sensitive, but
This feature is not determinative. Radiograph shows
that changes in the bone tissue of the tops of the roots did not begin, and
temporary teeth in 55% of cases detected the presence of destructive
changes in the tissues around the tooth. Gangrenous chronic pulpitis
causes severe pain. If hot food gets on the tooth
intensifies, from cold, on the contrary, calms down.
With exacerbations of any type of chronic pulpitis occur
arbitrary pain. They arise on their own, regardless of
effects on pulpit tooth. May have persistent pain
sensations of pervasive nature. This is typical of cases
when the tooth cavity is open, pain appears when exposed to
If untreated, poor treatment of root canals and
lack of tightness can cause complications in the form
periodontitis. Treatment complications are much more expensive, and
Treatment of pulpitis is divided into several methods: conservative and
surgical. Its main purpose is the elimination of inflammation and
warning of its transition to the upper layer of the periodontium. Early
treatment allows you to save the nerve, which is needed for full
Conservative (biological) method
With this treatment, the pulp is preserved, and the inflammatory process
removed with the help of medicines. Often it is used to treat
young people, however, only with the reversibility of the disease of the pulp.
These cases include:
- accidental opening of healthy pulp in the treatment of caries;
- the initial stage of the disease (hyperemia);
- tooth injury.
When treating, it is important to carefully treat with medication.
affected cavity. To do this, use antibiotics, antiseptics and
proteolytic enzymes. Do not use drugs enhanced
actions, such as alcohol.
Conservative treatment can be performed in two ways.
The first is direct coverage. If an autopsy is found, then
you first need to make sure that the pulp is viable. Believed
that if the bleeding lasts longer than 4–6 minutes, then it already
irreversible changes have occurred and this type of therapy will not work.
Stages of treatment using direct
- Rinse the tooth (including the cavity) with sterile water and dry
using a tampon.
- Calcium preparations are applied to the place of pulp opening.
- The cavity is closed with an insulating gasket and set
After such treatment, you need to visit the dentist every two or three
months to assess the state of the pulp and track the possible
negative dynamics. If present, you will need to accept
adequate treatment measures.
Indirect coating is performed if there is a risk of pulp opening.
camera in the process of treatment of deep caries. After the cavity
washed and dried, calcium is placed at its deepest point
then install the isolating прокладку и permanent seal. With
If necessary, the calcium gasket is replaced every two to three weeks.
several months and only then sealed.
The conservative method is very complicated, and therefore unpopular. For
In order to successfully apply it, the doctor must take into account a lot
factors, including the patient’s age, his state of health
and the presence of infections, the need to maintain the fullest
sterility during the procedure and many others. In spite of this,
the chance of re-inflammation remains even with successful
With этом способе лечения воспалённая пульпа полностью удаляется.
Root canals are filled with filling material.
The pulp is removed in two ways:
- Vital. This removal method is possible in any form.
diseases carried out under local or general anesthesia.
- Devitalny. For применения этого способа сначала умерщвляют
Both of these methods are carried out by two methods – amputation or
exirpation The most suitable depends on the condition of the tooth and
nature of pulpitis. Vital amputation (pulpotomy) is
removal of coronal pulp with preservation of the root. This method
applicable only to teeth with unformed roots.
It is performed as follows:
- Held local
- Scale is removed from the tooth surface.
- An autopsy of the carious cavity, then pulp
cameras. The latter must be expanded.
- Removed coronal pulp. Usually for this use
excavator or large spherical forest.
- The cavity is rinsed with water, dried using sterile
- Calcium preparations are placed at the entrances to the root canals.
- Устанавливают изоляцию и permanent seal.
Devital amputation is very rare. Only
indicator to its use – poor cross channel
patients with severe somatic pathology.
In the first reception when carrying out this procedure, the pulp is completely
is killed by special devitalizing preparations. In the second
visit remove the crown of the pulp, lay
mummifying paste, set gasket and permanent
The vital extirpation, or pulpectomy, is the most
common treatment. With нём полностью удаляют все части
pulp and fill the cavity with filling material. This method
suitable for any form of irreversible pulpitis. Algorithm
- Patient do
- The tooth is cleaned from all types of deposits.
- Opened and expanded tooth cavity, held
preparation of carious cavity.
- Removed coronal pulp.
- Then the doctor passes the root canals, removing the pulp from them.
- The channels are mechanically and drug treated.
- The canals and the coronal cavity of the tooth are sealed, installed
gasket and permanent filling.
To avoid incomplete filling of root canals, after
procedures need to do an x-ray of a tooth. This will help make sure
quality of work performed.
Devital extirpation implies complete removal of pulp
after preliminary devitalization. The procedure is contraindicated in
гнойном воспалении и аллергии на девитализирующую пасту.
- pulp inflammation;
- allergic to anesthetics, since it can not be carried out
- no result after conservative treatment;
- lack of time to conduct another treatment when
On the first visit, preparations are made for
removal. Algorithm действий следующий:
- the tooth is first cleaned;
- the carious cavity is dissected and the pulp is opened
- devitalizing paste is applied;
- set a temporary seal.
In the second step, the pulp itself is removed. Order
- Remove the temporary filling and
expand the tooth cavity, simultaneously clearing access to the root
- Mechanically clean the canals by hand or machine to
remove residual pulp and softened canal walls, smooth and
- After cleansing, treatment with antiseptics.
- Channels are fully sealed.
- Устанавливается изолирующая gasket and permanent filling.
In some cases, the seal is installed during the third
visits After treatment, you must make an x-ray
Pain after depulpation
The patient may experience discomfort in the tooth after
how the pulp is already removed and the filling is set. Consensus that
why is this happening, no. Some doctors believe this
occurs due to a dentist error, even if an x-ray shows,
that everything is done correctly, others believe that pain is
weeks – the body’s natural reaction to the intervention.
According to the recommendations of the dentists, you need to seek treatment
re, if the pain in the pulpless tooth remains even through
a week after the procedure. In this case, the doctor again
check the installation of the seal and hold the necessary
treatment. There are several common reasons.
the occurrence of pain:
- Patient allergy.
It happens that the filling materials or laid
the calcium drug appears allergic reaction in the form of edema,
swelling of the lips and / or cheeks and prolonged pain in the tooth. If so
happened in a patient for the first time, then predict the reaction of his body
in advance the doctor could not. The only solution in this case is to make
seal again using other materials.
- The material went beyond the tip of the tooth root. Pain can last
very long, it all depends on how much material you’ve got
into soft gum tissue. It is diagnosed only
- Dental root damage. If the dentist is not experienced enough
then he can make a hole in the root of the tooth during the manipulation.
Because of this, there is bleeding and pain, which at first
invisible due to anesthesia. However, after her action
will end, the tooth starts to hurt. Pain can hold more than 3
weeks, sometimes there is suppuration near the roots.
- Sealing held in violation of technology. The problem is in
this case may occur in a few months or years.
Only выход — поставить новую filling.
If, despite the pain, an x-ray shows that the procedure
held correctly and the tooth looks completely healthy, the doctor
prescribes physiotherapy treatment: exposure to ultrasound
or microcurrents, electrophoresis, analgesics, or laser therapy.
With появлении подозрений пациент должен обратиться к врачу, потому
which is not always able to distinguish the normal state from