Pulpitis – the inflammatory process affecting the soft fabrics with neurovascular educations filling a tooth cavity. It is characterized by the pristupoobrazny progressing pain quite often extending to all jaw giving to an ear and a temple amplifying at night. Demands urgent treatment from the stomatologist, it is frequent - a tooth depulpirovaniye (removal of a nerve). At timely treatment – an outcome favorable. Otherwise can cause development of periodontitis, formation of an okolokornevy cyst of tooth.
Pulpitis call an inflammation of a pulp of tooth which reason pathogenic microflora - generally streptococci and staphylococcus is. The main clinical manifestation of a pulpitis is the strong pain syndrome. Patients note morbidity as at rest, so from irritants, at influence of temperature irritants pain amplifies. A characteristic sign of a pulpitis is the toothache which is becoming aggravated at night.
Reasons of development of a pulpitis
Uncured caries or poor sealed up carious cavities are entrance gate for pathogenic microorganisms. Products of their activity also become the main reason for a pulpitis. The most part of pulpitises is caused by a hemolytic and not hemolytic streptococcus therefore at streptococcal quinsy and existence of uncured caries, there can be a complication in the form of a pulpitis. Stafilokokki, lactobacilli and other microorganisms become more rare the pulpitis reason.
Inflammatory process begins with already infected site which is near a carious cavity, further microbes and toxins get into a root pulp. Tooth injuries are other reason of pulpitises, generally it is otloma of parts of a crown, chips of enamel and fractures of tooth. Less often pulpitises arise under the influence of aggressive temperature and chemical factors.
Clinical manifestations of pulpitises
The general symptom for all types of pulpitises is strong morbidity, especially at change of temperature and the continuous or interrupted toothache at night.
The sharp focal pulpitis is characterized by pristupoobrazny pains, with accurate localization and long intervals of an intermissiya. Pain attacks at a sharp focal pulpitis generally short-term, pain comes from influence of temperature irritants. Morbidity amplifies at night that is a characteristic symptom for all pulpitises. At inspection the deep carious cavity is found, the cavity bottom during sounding is painful. Electroexcitability of a pulp is lowered from that party in the field of which the focal pulpitis is localized.
At a sharp diffusion pulpitis pain attacks more long, light intervals are insignificant. The diffusion pulpitis differs from focal in more intensive pains at night. Morbidity amplifies in lying situation, pains can irradiate to various sites, depending on location of a painful tooth. At survey a carious cavity deep with morbidity on all bottom during sounding. Response to temperature irritants at a sharp diffusion pulpitis is sharply painful, but in certain cases cold reduces pain. Percussion of the tooth affected with a pulpitis is generally painless. Electroexcitability of a pulp is reduced in all sites including at the bottom of a carious cavity. These electroexcitabilities help to establish type of a sharp pulpitis precisely.
Chronic pulpitises have less expressed symptomatology and the erased clinical picture. So at a chronic fibrous pulpitis attacks of pain from various irritants are insignificant and short. During the poll of the patient it becomes clear that tooth hurt earlier, and the symptomatology of pains corresponded to a sharp pulpitis. At a chronic pulpitis spontaneous pains happen seldom, generally because of exudate outflow violation. Reaction to cold is slowed down, morbidity at sharp change of ambient temperature is sometimes observed.
Sounding of a bottom of a carious cavity confirms existence of the message between a carious cavity and a cavity of tooth. Electroexcitability of tooth with a chronic fibrous pulpitis is reduced, and the radiological picture confirms depression of a bone tissue at a root top.
The chronic gangrenous pulpitis is clinically shown by tooth pains during reception of hot food or at influence of other temperature irritants. Patients with a gangrenous pulpitis show complaints to rare spontaneous pains and to an unpleasant putrefactive smell from a mouth. In the anamnesis there are complaints to sharp pains of pristupoobrazny character with irradiation on the course of a trigeminal nerve. During survey of tooth with a chronic gangrenous pulpitis it is found out that the carious cavity is widely reported with a tooth cavity. Sounding of a carious cavity is painful at all depth of both a koronkovy, and root pulp. Depth of defeat is defined by degree of prevalence of a gangrenous pulpitis and, the defeats at a gangrenous pulpitis are deeper, the degree of electroexcitability of a pulp is lower. In a half cases at a gangrenous pulpitis in radiological pictures destructive changes of okoloverkhushechny fabric are defined, degree of expressiveness of destructions depends on pulpitis depth.
At a chronic hypertrophic pulpitis subjective feelings are practically absent. Patients show complaints to bleeding of the expanded fabric of a pulp and to insignificant pain during meal. In the anamnesis there are complaints to acute pristupoobrazny pain which is characteristic of a focal or diffusion pulpitis. At survey of the tooth affected with a hypertrophic pulpitis it is well visible that the crown of tooth is destroyed, and from a carious cavity the changed pulp vybukhat hypertrophic. Superficial sounding almost without serious consequences, at deep sounding pain amplifies. The Periapikalny crack in a radiological picture without changes.
During aggravations of a chronic pulpitis there are spontaneous pristupoobrazny pains. Often patients during a recurrence show complaints to long intensive pains from various external irritants. Pains irradiate on the course of a trigeminal nerve, at rest pain of usually aching character which at a nakusyvaniye tooth antagonist amplifies. At the anamnesis of the patient there are manifestations of a sharp and chronic pulpitis. During survey it becomes visible that the carious cavity and a cavity of tooth make a whole, the cavity is open, and sounding of a pulp is sharply painful. At an aggravation of a chronic pulpitis electroexcitability of a pulp is reduced, and on the roentgenogram expansion of a periodontal crack is well noticeable. Depression of a bone tissue in a periapikalny zone is characteristic manifestation of a chronic recidivous pulpitis.
Diagnostics of a pulpitis
The pulpitis is diagnosed on the basis of subjective complaints and tool survey of the stomatologist. During tool survey the carious cavity with the softened dentine, painful reaction of the affected tooth to change of temperature comes to light. Percussion at a pulpitis is almost always painless. Sharp morbidity is observed in the place where the carious cavity as much as possible contacts to a pulp. These electroexcitabilities (elektroodontodiagnostika) and radiological researches allow to specify character and depth of a pulpitis.
Treatment of a pulpitis
The purpose of treatment of a pulpitis - to restore functionality of tooth therefore the main method of therapy is conservative or biological. It is applied when the inflammatory phenomena at a pulpitis are reversible, at a traumatic pulpitis or at casual opening of a cavity of tooth. Technology of treatment of a pulpitis the same, as at treatment of a carious disease, but pay to medicamentous processing and disinfection of a cavity of tooth more attention. For processing use antibiotics, antiseptics and proteolytic enzymes.
The main stage of treatment of a pulpitis is imposing of the medical anti-inflammatory and regenerating pastes on a cavity bottom, the cavity is closed for 5-6 days and further in the absence of complaints seal up. After the carried-out treatment it is recommended to pay more attention to care of an oral cavity and to treat in due time caries of teeth.