Chronic pulpitis – the current inflammation of a neurovascular bunch of tooth leading to its functional and structural changes is long. Various kliniko-morphological forms of a chronic pulpitis proceed with the periodic painful attacks arising from action of thermal and mechanical irritants, existence of a carious cavity in tooth. Diagnostics of a chronic pulpitis is promoted given tool survey, an elektroodontodiagnostika, a X-ray analysis. Treatment of a chronic pulpitis assumes carrying out an extirpation (more rare – amputations) pulps with the subsequent sealing of channels and restoration of a shape of tooth.
Chronic pulpitis – the chronic inflammatory process in a tooth pulp leading to its proliferative, fibrous or gangrenous changes. Most often patients of age category from 20 to 50 years suffer from pulpitises. Chronic pulpitises are diagnosed in stomatology approximately by 3 times more often than sharp pulpitises (75,5% and 24,5% respectively). At the same time in the general structure of chronic forms of a disease the fibrous pulpitis is diagnosed in 69% of cases, gangrenous – in 2%, hypertrophic – in 0,5%, konkrementozny – in 1% and an aggravation of a chronic pulpitis in 3%. At children, both in temporary, and in second teeth with not created roots, forms of a primary and chronic pulpitis prevail.
Reasons of a chronic pulpitis
The chronic pulpitis can be an independent form or an outcome of an acute inflammation. It is considered to be that transition of a sharp phase of an inflammation to chronic comes in 12 weeks and it is caused by incomplete elimination of the damaging factors.
In most cases the chronic pulpitis is caused by biological agents – different pathogenic microorganisms and their toxins. Through dentinny tubules, a blood-groove and a lymph flow they are transferred to a tooth pulp. As the contributing factors deep caries of tooth or its low-quality treatment (absence or the wrong imposing of the medical isolating laying), a sharp pulpitis, a periodontal disease, premature erasability of teeth, a tooth injury with an exposure of a pulp and damage of a neurovascular bunch can act. Retrograde penetration of microbic activators happens through a root top opening at periodontitis, a periostita, osteomyelitis of jaws, antritis.
Classification of a chronic pulpitis
Allocate 3 kliniko-morphological forms: fibrous, hypertrophic (granulating, polipozny) and gangrenous (ulcer and necrotic). As a separate version the aggravation of a chronic pulpitis is considered.
- The chronic fibrous pulpitis is characterized by growth in all departments of a pulp of coarse-fibered connecting fabric with the centers of a gialinoz and a petrifikation, a dentiklyama. The changed pulp macroscopically represents dense cicatricial white-grayish color. When progressing a fibrous pulpitis microabscesses, phlegmon or gangrene of a pulp can develop.
- The chronic hypertrophic pulpitis is followed by formation of granulyatsionny fabric, a rassasyvaniye of dentine and its replacement with osteodentine. At the granulating form of a chronic pulpitis excess granulations support limits of the pulparny camera in a carious cavity; at polipozny – fungoid growth with an izjyazvlenny surface is formed (polyp). The aggravation of a chronic hypertrophic pulpitis, as a rule, leads to pulp gangrene.
- The chronic gangrenous pulpitis is a necrosis and an ulceration of a pulp. In the opened cavity of tooth it is found fabric detrit gray-black color; viability of a part of a pulp can be kept.
Symptoms of a chronic pulpitis
The current of a chronic fibrous pulpitis is characterized by emergence of painful attacks in response to action thermal (first of all, cold) irritants. Characteristic feature is the delayed nature of emergence and subsiding of pains, i.e. pain develops and passes not at the time of action or cancellation of an irritant, and after a while. Out of painful attacks in the affected tooth weight can be noted.
In clinic of a chronic hypertrophic pulpitis the pain syndrome, as a rule, is absent. The main complaints are connected with growth in tooth of foreign fabric which is injured and bleeds during meal. Unsharply expressed morbidity connected with pressure upon tooth or chewing is in some cases noted.
The symptomatology of a chronic gangrenous pulpitis has more expressed character. Patients are disturbed by the localized aching pains from chemical and temperature irritants (it is more from hot). After elimination of irritants of pain do not stop a long time. Owing to putrefactive disintegration of a pulp the unpleasant smell from an oral cavity appears. Tooth enamel dim, grayish color.
At an aggravation of a chronic pulpitis painful attacks arise spontaneously, without the previous action of irritants, quite often at night. Painful episodes alternate with short-term "light" intervals. The toothache is strong, long, irradiating on the course of branches of a trigeminal nerve. Puffiness of a gum and a positive symptom of a vazoparez can be noted.
Diagnostics of a chronic pulpitis
At inspection of the patient with a chronic pulpitis the stomatologist is interested in the nature of a toothache, its communication with the visible reasons, duration and sharpness of attacks, existence of sharp painful episodes in the anamnesis. Methods of objective inspection include survey of the affected tooth and sounding of a pulp.
In all cases of a chronic pulpitis at survey the deep carious cavity which is reported with the pulpovy camera (at a fibrous pulpitis the pulp horn is, as a rule, not opened) is found. When sounding the pulp is painful, easily bleeds. At a hypertrophic pulpitis from a carious cavity granulyatsionny (polipozny) fabric vybukhat.
The reaction of a pulp defined by an elektroodontometriya varies of 20-25 a mk (at fibrous), till 40-50 a mk (at hypertrophic) and 60-90 mk (at gangrenous) a chronic pulpitis. By means of a X-ray analysis of tooth changes in a type of expansion of a periodontal crack or depression of a bone tissue can come to light. The chronic pulpitis needs to be differentiated from a sharp pulpitis, an exacerbation of chronic periodontitis, deep caries.
Treatment of a chronic pulpitis
As priorities at treatment serve knocking over of a pain syndrome and inflammatory process, the prevention of damage of periodontal fabrics, restoration of anatomic integrity and functional full value of tooth. Treatment of a chronic pulpitis is carried out by methods of vital amputation / extirpation or a devitalny extirpation of a pulp of tooth.
Vital amputation of a pulp of tooth is, as a rule, used at a fibrous pulpitis of multiroot teeth at patients more young than 40 years and assumes removal of a koronkovy and estuarial pulp with the subsequent imposing of medical laying and a seal. In addition to the main treatment the UVCh procedures, microwave therapy are appointed.
The vital extirpation of a pulp can be carried out at any form of a chronic pulpitis. Both of these methods are carried out under local anesthesia without preliminary nekrotization of a pulp. After preparation of a carious cavity removal of a koronkovy and root pulp, mechanical and medicamentous processing of channels, sealing of channels, restoration of a crown of tooth is made.
The method of a devitalny extirpation at a chronic pulpitis assumes removal of a pulp after its nekrotization by means of preliminary imposing of arsenous paste for 24-48 hours. In the following visit treatment of a pulpitis continues according to the above described scheme.
Forecast and prevention
Competent and timely treatment allows to keep tooth as the functioning unit, for many years. The started chronic pulpitis can lead to development of odontogenny complications - periodontitis, a gnoyyony periostit, osteomyelitis with heavy, sometimes unpredictable consequences.
The most effective way of the prevention of a chronic pulpitis - prevention and timely treatment of caries at children and adults. Also it is not necessary to suffer for the first time from the arisen toothache testifying to an acute inflammation of a pulp. Regular visits of the stomatologist, routine inspections, professional hygiene will help not to allow development of a chronic pulpitis.