Sharp pulpitis - acute inflammatory vascular and fabric reaction of a pulp of tooth on the damaging action of infectious and other irritants. Spontaneous short-term or long attacks of the toothache amplifying at temperature changes and at night are characteristic of a sharp pulpitis. The sharp pulpitis is diagnosed according to the anamnesis, subjective complaints, tool survey of an oral cavity, an elektroodontodiagnostika, tooth X-ray analysis. The sharp pulpitis is treated by conservatively biological method and quickly – by means of amputation or an extirpation of a pulp of tooth.
Sharp pulpitis - the inflammatory process affecting anatomical structures of the pulpovy camera of a crown and channels of a fang. The pulp fabric containing a large number of the nervous terminations, blood and lymphatic vessels is a serious anti-infectious barrier and answers with inflammatory reaction with development of a sharp pulpitis action of aggressive factors. On distribution frequency in therapeutic stomatology pulpitis takes the second place after caries. Incidences of a sharp pulpitis are equally subject both men, and the woman. Because of features of a structure of zubochelyustny system the sharp form of a pulpitis occurs at children much less often than chronic.
Reasons of a sharp pulpitis
Various types of irritants among which the leading role belongs to the infection getting into pulp fabrics from a carious cavity of tooth (the descending way) from the centers of top periodontitis, a periodontal disease, antritis, osteomyelitis (the ascending way), and also at acute infectious diseases, sepsis (a hematogenic and limfogenny way) act as Etiologichesky factors of a sharp pulpitis.
Sharp pulpitis - a frequent complication of average and deep caries which activators are associations of streptococci (hemolytic and not hemolytic), stafilokokk (golden), grampolozhitelny sticks, fuzobakteriya, actinomycetes and drozhzhepodobny mushrooms. Virulent microorganisms and their toxins get from a carious cavity to the pulpovy camera through dentinny tubules or the softened dentine. Proceeding usually in the closed tooth cavity, the sharp pulpitis leads to violations in system of microcirculation (venous stagnation, small hemorrhages, a tromboobrazovaniye), to a hypoxia, a dismetabolizm, dystrophic changes of nervous fibers and all structural elements of a pulp.
To a sharp pulpitis can bring a sharp injury of tooth - an incomplete dislocation and a complete dislocation of tooth, a crack, a crown chip, a tooth fracture in a root or koronkovy part. The sharp pulpitis can be a consequence of wound of a pulp dental tools, violations of the rules of preparation of teeth (vibration, high speeds, lack of water cooling), educations dentikly and petrifikat in a tooth cavity.
In development of a sharp pulpitis a part is played by toxic effect of the chemicals used in stomatology (alcohol, air, phenol, sealing and pro-masonry materials, cements, components of bondingovy systems and pro-grasses).
Classification of a sharp pulpitis
On kliniko-morphological features distinguish: focal (serous and purulent) and diffusion (purulent and necrotic) sharp pulpitis. Depending on an etiology pulpitises subdivide on infectious (bacterial) and aseptic (traumatic, chemical, etc.). On localization allocate a koronkovy, root and total pulpitis; on an outcome - reversible (with regeneration of a pulp) and irreversible.
In development of sharp forms of a pulpitis the ekssudativny stage with increase of hypostasis, emergence of the serous exudate which is often transformed in serous and purulent or purulent has paramount value. At a focal purulent pulpitis the acute inflammation has limited character (pulparny abscess), at diffusion - exudate fills a koronkovy and root pulp with development of a flegmoyona.
Symptoms of a sharp pulpitis
The pristupoobrazny, spontaneously arising toothache caused by violation of outflow of the accumulated inflammatory exudate and its pressure upon the nervous terminations of a pulp is characteristic of a sharp pulpitis. The sharp serous focal pulpitis is followed short-term (10–20 min.), accurately localized painful attacks, long (till several o'clock) by light intervals. Pain aching amplifies from change of temperature, is more often from cold water and food, and does not pass after elimination of the reason. During the night pain has more intensive character. The sharp serous pulpitis quickly enough (in 1-2 days) passes in diffusion at which the pain syndrome becomes more intensive and long with gradual shortening of light bezbolevy intervals.
The pulsing toothache can irradiate in various zones: on the course of branches of a trigeminal nerve, a temple, an eyebrow, an ear, a nape; to amplify at stay in horizontal position. Reaction of tooth to temperature irritants painful and long. Reduction of characteristic intensive pain at late stages of a sharp diffusion purulent pulpitis is connected with destruction of nervous fibers. Duration of a current of a sharp pulpitis makes from 2 to 14 days.
Diagnostics of a sharp pulpitis
The diagnosis of a sharp pulpitis is made by the stomatologist, proceeding from data of the anamnesis, tool survey of an oral cavity, elektroodontodiagnostik (EOD) of a pulp of tooth, a X-ray analysis (a radioviziografichesky research).
At a sharp serous pulpitis the deep carious cavity and morbidity of area of a bottom when sounding comes to light; percussion of tooth is painless. At a purulent form of a sharp pulpitis sounding can be without serious consequences, and percussion of tooth to cause pain. EOD fixes gradual decrease in value of electroexcitability; a reodentografiya and the laser Doppler floumetriya (LDF) - change of blood supply of a pulp of tooth. Data of the thermal test, a tooth X-ray analysis can confirm a sharp pulpitis.
Laboratory researches are in addition conducted: blood tests (clinical and biochemical, immunological); determination of level of immunoglobulins in oral liquid. The sharp pulpitis needs to be differentiated from deep caries, sharp periodontitis, an alveolit, a papillit, neuritis of a trigeminal nerve, sharp antritis. At difficulty of verification of a sharp pulpitis consultations of the neurologist, the surgeon, the otolaryngologist are shown.
Treatment of a sharp pulpitis
Treatment of a sharp pulpitis is directed to knocking over of an inflammation of a pulp and whenever possible - restoration of its normal functioning. For removal of a pain syndrome analgetics are appointed. At an aseptic sharp serous pulpitis at persons of young age pulp fabric preservation with application of a conservative (biological) method is possible. After mechanical and medicamentous processing of a carious cavity with application of unirritating anti-septic tanks, antibiotics, proteolytic enzymes on its bottom the medical anti-inflammatory and regenerating paste with statement of a temporary seal for 5-6 days, and further - final tooth filling in the absence of complaints is imposed from the patient. In some cases use of physiotherapy – laser therapies, flyuktuorization, an apex-foreza is possible.
The sharp serous and purulent and purulent pulpitis is led to irreversible changes and loss of functional ability of a pulp that demands its removal: partial (amputations) or full (extirpation) which is carried out under local conduction or infiltration anesthesia (vital) or after application of the devitalizing means (devitalny).
Vital amputation (pulpotomiya) is directed to preservation of viability of a root pulp and shown at a sharp focal pulpitis of multiroot teeth and a casual exposure of a pulp. Opening of a cavity of tooth with removal of a koronkovy and estuarial pulp, imposing on a stump of dentinostimuliruyushchy paste and sealing of the pulparny camera is carried out. The vital extirpation (pulpektomiya) consists in careful medicamentous and tool processing of root channels with full removal of a nekrotizirovanny pulp and restoration of tooth a seal.
The Devitalny extirpation of a pulp is carried out at a sharp diffusion pulpitis with preliminary imposing on the opened pulp of the devitalizing paste containing arsenous or other connections (in single-root teeth on 24 h, to multiroot - on 48 h) and statement of a temporary seal. Full removal of a pulp, processing of root channels with their sealing and imposing of a constant seal is carried out at the following visit. Results of endodontichesky treatment are controlled radiological.
Forecast and prevention of a sharp pulpitis
The outcome of a sharp pulpitis depends on character and prevalence of inflammatory process in a pulp. It can be regeneration of a pulp - at an aseptic serous pulpitis or a pulp necrosis with development of an odontogenny infection, or transition to a chronic form - at a purulent diffusion inflammation. At treatment of a sharp pulpitis – the forecast, as a rule, favorable.
Prevention of a sharp pulpitis consists in timely identification and treatment of the carious centers in milk and second teeth, observance of rules of preparation of teeth.