Pulpitis - symptoms, diagnosis and treatment methods for pulpitis

Pulpitis is one of the most common dental diseases, which in most cases can be effectively treated.
The main condition for the effectiveness of the measures taken is a timely visit to a dentist-therapist. If you feel painful symptoms, you should not postpone your visit to a specialist - the sooner you go to the clinic, the greater the chance of saving the tooth. Pulpitis is characterized by an inflammatory process in the inner part of the tooth, called the “nerve.” This determines the severity of the symptoms - the pain with pulpitis is very noticeable. In most cases, the disease develops as a result of caries if the patient does not consult a doctor in time. In rare cases, pulpitis is associated with improper treatment of caries, violations of the tooth preparation process or other manipulations, and it can also be the result of injury.

Types and symptoms of pulpitis

Symptoms, as well as treatment tactics for pulpitis, depend on the type of disease. The following classification of the disease is currently used:

Spicy. Often this type of pulpitis is the result of untreated caries. If the patient does not pay attention to tooth decay, after some time the infectious process reaches the internal structure - first dentin, and then pulp, provoking its inflammation. Symptoms of this form of the disease include acute throbbing pain, which intensifies significantly when exposed to chewing, contact of the tooth with food or high-temperature drinks. The pain often gets worse at night. Acute pulpitis, in turn, is divided into two types:
diffuse - pain sensations spread to one or another area of the jaw as a whole.
Chronic. It results from ignoring the symptoms of an acute form of the disease. As a rule, about 2 weeks pass from the onset of inflammation until the disease becomes chronic. Painful sensations become less pronounced, severe discomfort disappears. However, the pain continues to persist and intensifies when exposed to the causative tooth. The tooth is destroyed, and the acute pain returns from time to time.

Causes

Treatment of the disease primarily depends on the causes of its occurrence. Factors that often lead to inflammation:

Untreated caries in a timely manner. In a mild form, the disease does not affect the pulp in any way, since the carious lesion extends only to the superficial tissues. As the crown is destroyed, caries affects all cellular structures and reaches the roots.
Chronic periodontitis (except for mild forms). Deep periodontal pockets that form with this pathology reach the root plexuses. Pathogenic microorganisms that multiply in these cavities spread throughout the tooth and reach the pulp.
Injury. Impact, bruise and other external influences contribute to the disruption of the established blood supply process and lead to a pathological process.
Poor quality dental treatment. If the dentist did not clean the tooth cavity well before placing the filling, leaving carious particles, they will spread into deeper layers and reach the neurovascular bundle. Also, due to the fault of the doctor, the patient may receive a thermal burn of the pulp if the specialist neglected the rules while drilling the crown and did not cool it enough with water. The disease is also provoked by overdrying of the dentinal tubules by air flow.
Exposure to acids, alkalis, medications, toxic filling compounds and other chemicals.
Blood infection. Infection can penetrate into the pulp not only through carious holes, but also during sepsis.
The patient's individual predisposition to tooth wear and the formation of mineral deposits in the pulp chamber.

Types of pathology

There are 2 main forms of the disease: acute and chronic. In the first case, a person suddenly experiences a sharp, paroxysmal pain (most often at night), which does not depend on external factors and does not go away when the irritants are eliminated. At first, a dark hole appears on the enamel, which grows over time and affects deep tissues, including reaching the canals.

If the inflammation does not go away after 3 weeks, the disease becomes chronic. Dull aching pains appear with a certain frequency and are disturbing not only at night.

Types of acute pulpitis:

Focal. It is observed only for a few days. The pain lasts up to 20 minutes, with the intervals between attacks being about 2-3 hours. There is swelling of the gums.
Diffuse. It extends to the coronal part, nerve endings and root. There is a disruption in the blood supply to tissues. The pain becomes throbbing and lasts much longer than with the focal form.
Purulent. The cavity of the affected unit fills with pus. A painful pulsation is felt. The patient's condition is constantly deteriorating.
Serous. Most often, this type is observed in children (pulpitis of temporary teeth). This is a pathology of infectious etiology, which is accompanied by short attacks of pain.

Classification of chronic dental pulpitis:

Fibrous. Is a consequence of acute. It can proceed latently for several months with periodic periods of exacerbation. The gums are not swollen, the pain is aching and occurs infrequently.
Gangrenous. This is a complication of acute fibrotic disease, in which the death of pulp tissue and destruction of the coronal part occurs.
Hypertrophic. In the carious cavity, tissues of a bright red hue are clearly visible, which constantly bleed, especially when pressed.

Symptoms

Despite the fact that each type of disease has its own distinctive features, there is a list of symptoms characteristic of all forms of pathology. At the initial stage of the disease, the tooth begins to react painfully to cold and hot, as well as to other irritants. Then a sharp throbbing pain appears, which intensifies at night and when lying down. Soreness occurs spontaneously or under the influence of irritating factors.

External manifestations of the disease, regardless of its type:

darkening of the enamel;
tooth mobility;
bleeding;
redness of the gums;
swelling of the tissues around the diseased tooth;

The chronic form of pulpitis can be asymptomatic. It is characterized by a putrid odor from the mouth and aching pain.

Important! Very often the patient cannot understand which tooth hurts. The pain may radiate to the neck or ears. To determine the location of inflammation, a doctor’s examination and additional diagnostic tests are necessary.

Diagnostic methods

To make an accurate diagnosis, the dentist conducts and prescribes the following studies:

inspection of the damaged cavity using a mirror and probe;
checking the tooth’s reaction to temperature fluctuations (thermometry);
exposure of the crown to a weak electric current (electroodontodiagnosis), with the help of which one can distinguish the disease from deep caries and determine in what form it occurs;
X-ray.

Features of treatment

The therapeutic regimen directly depends on the stage of the disease and the location of inflammation. Treatment methods for pulpitis used in dentistry:

Is it possible to cure a disease with folk remedies?

Pulpitis requires qualified medical care and cannot be treated on its own. Home methods for relieving pain and reducing inflammation can only temporarily alleviate the patient’s condition. Without timely conservative or surgical treatment, severe complications are possible.

Possible complications

If you do not receive treatment on time or do it incorrectly, the risk of complications increases, such as:

periodontitis (damage to hard tissues around the tooth root with pulpitis);
periostitis (inflammation of the periosteum, or flux);
abscess (purulent inflammation accompanied by intoxication of the body);
sepsis (blood poisoning);
chronic pathologies of internal organs and systems.

Preventive measures

In order to avoid long-term treatment and surgical intervention, you need to take care of the prevention of pulpitis by adhering to the following rules:

brush your teeth 2 times a day, rinse your mouth after eating, remove plaque and tartar in a timely manner;
visit the dentist for preventive examinations at least once every six months;
do not use toothpicks or other traumatic devices;
eat a balanced diet, ensure that the body receives a sufficient amount of vitamins and minerals;
give up bad habits (smoking, drinking alcohol), large amounts of sugar and junk food;
treat caries and other dental pathologies in a timely manner, without bringing them to severe stages.

Sharp pain radiating to the neck, temples or ears is a reason to urgently visit a dental clinic. If treatment is not started in time, serious complications are possible, including complete tooth loss and a septic process.

By following preventive measures, you can protect yourself from the occurrence of pulpitis and other oral diseases.

What happens if pulpitis is not treated?

It can be difficult for a modern person to find time to visit a dentist in his busy schedule. The most common mistake is to try to ignore painful symptoms by “masking” them with a large number of painkillers. You should know that even if the pain was calmed, treatment of pulpitis still cannot be avoided - pathogenic organisms in the pulp chamber continue to multiply, destroying the tooth and surrounding tissues. Changes occur inside the tooth that lead to the death of the pulp, its decomposition with the formation of pus.

Subsequently, the pus extends beyond the root and a flux, known to many, occurs - inflammation of the periosteum. This is accompanied by severe symptoms - high body temperature, severe swelling and facial asymmetry, and also entails not only unpleasant, but also life-threatening consequences. In advanced cases, we are no longer talking about preserving the tooth, but about preserving health - there is a possibility of developing phlegmon, damage to the bone tissue of the jaw, and blood poisoning.

Chronic pulpitis can occur with the preservation of the tooth for up to several years, especially at a young age, but this does not mean that the symptoms can be ignored - it is better to visit a dentist in a timely manner in order to save the tooth and prevent serious complications.

Types of antibiotics for toothache

Doctors use antibiotics in dentistry, which have a wide range of applications, to stop the growth and reproduction of mixed bacterial infections in the oral cavity. Drugs are divided into the following types:

Should I take an antibiotic for dental inflammation?

What to do if the gums become inflamed after the removal of a wisdom tooth, due to trauma, or with advanced caries? How to treat a complicated form of periostitis and periodontitis? The effectiveness of therapy largely depends on the selection of the optimal type of antibacterial drug to suppress the pathological process. It is useful to know when an antibiotic is prescribed for dental inflammation, which groups of drugs are most often used in dental practice.

Diagnosis of pulpitis

The diagnosis is made by a doctor based on a survey and examination of the oral cavity. As a rule, pulpitis precedes developing caries, so there is a carious cavity in the causative tooth. The doctor performs probing - places an instrument into the cavity to assess its depth and reaction. Tapping is a method that also helps the doctor find out how the tooth reacts to mechanical stress. The main task of the specialist is to determine the difference between pulpitis and deep caries - treatment tactics depend on this.

An X-ray examination is necessary in order to assess the nature of the disease, as well as determine the structure of the root system - the doctor will need this information for further endodontic treatment of tooth pulpitis (treatment and filling of canals).

Why does purulent pulpitis occur?

Precursor of purulent pulpitis in children

and adults is acute pulpitis. The formation of pus occurs from the serous exudate that is present in the nerve. Due to an increase in its volume, metabolic processes occurring in the nerve suffer, which stimulates the accumulation of lactic acid and, as a result of this process, a decrease in the protective function of cells. It is accompanied by tissue breakdown and abscess. The infection that provokes the development of purulent pulpitis penetrates the pulp in different ways:

from a carious cavity in the absence of treatment;
during the treatment of periodontitis with dissection of the gums;
through blood and lymph in infectious diseases.

Treatment of pulpitis

To avoid complications of pulpitis, it is important to start treatment in a timely manner. In rare cases, this allows you to save the pulp and avoid its extraction from the canal, but partial or complete removal of the neurovascular bundle is still more often practiced, and here’s why.

Removing the pulp allows you to completely eliminate the source of inflammation, which means preventing the spread of pathogenic microorganisms into the tissue surrounding the tooth. This is the basic principle of preserving the tooth and tissues from possible complications.

Treatment methods for pulpitis are divided into two broad categories:

treatment that involves preserving living pulp;
treatment of pulpitis of permanent teeth with pulp removal - complete or partial.

The decision to choose a method falls on the shoulders of the doctor - he assesses the condition of the pulp. The biological method (implying preservation) is used only when inflammation is observed at a very early stage, and it is also more often applicable to young patients who do not have other oral diseases.

Extirpation, or complete removal of the pulp, is the most common practice and is an effective and reliable method. It can be vital and devital - the difference is that in the first case the doctor removes the pulp under local anesthesia, and in the second, he first kills it using special means. Devital extirpation can be carried out without anesthesia, since the neurovascular bundle will no longer react to irritation, which means there will be no painful sensations. However, in practice, even in this case, an anesthetic is often given to avoid discomfort.

Preliminary devitalization consists of the fact that during the first visit, the doctor removes the destroyed tooth tissue, treats the cavity, and puts a special paste into the canals. Previously, in domestic dentistry, the method of devital amputation was used, which consisted of removing the neurovascular bundle inside the crown, while preserving the root pulp. For it, strong solutions were simply used to dry it out, but the voids in the root canals with pulp residues acted as fertile ground for the further development of the inflammatory disease. That is why today most often the pulp is completely removed - this is a reliable and effective treatment method.

A combination therapy method is the use of two or more methods. For example, removal of the entire root pulp from normal canals and partial removal (amputation) from those that have complex anatomy and are strongly curved. The prognosis in this case is more favorable than in the case of devital amputation, however, this is only true if certain conditions are met: most of the canals must be reliably sealed along the entire length, and high-quality materials must be used for this.

Modern dentistry offers a lot of opportunities for improving the method of treating pulpitis through vital extirpation. Pulp removal is carried out without first killing it, and for this purpose a rich arsenal of tools, equipment and means is used. They are designed to facilitate the process of pulp removal and canal treatment, as well as to prevent possible errors and ensure the convenience of the specialist’s work.

Modern anesthetics and devices for their controlled administration make it possible to avoid the need for devitalization - they provide effective anesthesia even for complex lower molars.

List of effective antibacterial agents for dental infections under the crown

After endoprosthetics and implant installation, some patients complain of discomfort. Pain and inflammation are a consequence of a violation of the technology for fixing artificial teeth and crowns: the dentist did not completely fill the cavity inside the problem unit or mechanical damage to the canal walls occurred. If the implantologist is poorly qualified, the pin may be installed incorrectly. Perhaps the smallest parts from dental instruments remain inside the canal.

There are several causes of the pathological process and pain syndrome:

swollen gums or gumboil (acute inflammation);
cyst - a cavity with fluid near the root of a problematic unit of the dentition;
inflammation of the submandibular salivary glands;
dental granuloma;
a fistula on the gum is a hole through which purulent masses are released.

With the development of inflammation in periodontal tissues, an abscess forms at the root apex. Painful sensations are a consequence of the active accumulation of exudate and pressure on neighboring areas.

The main condition for eliminating discomfort is a timely visit to the dentist to remove the crown, clean the root canals, and eliminate the cause of the inflammatory process. Uncontrolled use of antibiotics can harm the body.

Before treating the canals, the doctor makes an injection into the gum, removes the prosthesis, and examines the affected area.

Effective antibiotics are prescribed to suppress the infection:

After the removal of a wisdom tooth, there is an increased risk of not only inflammation, but also bleeding from the socket.

If the patient takes the drug Warfarin to prevent thrombosis, then you need to warn the dentist: the doctor temporarily stops taking the medication for several days before and after the extraction of the “eight”, be sure to coordinate this action with the cardiologist.

It is important to know how to combine an antithrombotic agent with antimicrobial compounds.

Stages of pulpitis treatment

The doctor performs anesthesia and drills out tooth tissue softened by caries, providing access to the internal structures.
Removing the pulp - first, the doctor amputates the pulp using a bur or excavator, then performs extirpation - removes the neurovascular bundle from the root canals using thin instruments.
Channel processing. Using small “needles” - files, reamers - the specialist passes the canals along their entire length, expanding and at the same time treating their walls with antiseptics. In this case, everything “unnecessary” is consistently washed out of the canals: bacteria, canal particles, pus, blood impurities, pulp residues, etc. Drug treatment ensures sterility - the likelihood of complications in the future depends on how carefully it is carried out. After treatment, the doctor dries the canals, places cotton pads impregnated with antiseptics there and installs a temporary filling.
Filling. During the second visit, the dentist removes the temporary filling and medications from the canals. The treated root canals are filled to the apex - a natural narrowing or the narrowest point. For this purpose, pastes and gutta-percha pins are used that are mixed with the patient.
Control. X-ray diagnostics are performed to assess whether the canals are filled correctly and along their entire length. Then the doctor places a filling or inlay on the crown of the tooth.

Control makes it possible to prevent some serious errors in endodontic treatment. Removal of the filling material beyond the root apex or insufficient filling are causes of possible complications in the form of the spread of the inflammatory process to the peri-root tissue, so it is important to monitor compliance with the treatment technology.

Pulp removal with preliminary devitalization is carried out according to the same principle, but in this case an additional stage is added and two visits to the doctor are required. On the first visit, the doctor applies a special paste - arsenic or arsenic-free - to the exposed pulp horn. In the first case, you need to come for an appointment within 24 hours, and if devitalization of the pulp of a multi-rooted tooth is carried out, after 48 hours. This type of therapy is more difficult to control by the doctor, because the patient may come for an appointment later than scheduled, which increases the risk of toxic effects of arsenic on the tooth root. That is why modern dentistry suggests using alternative solutions - using a paste without arsenic in the composition.

Names of antibiotics used for inflammation of the dental nerve and root

The dentist prescribes medications to suppress infection based on the results of an examination of the problem area. When the nerve is inflamed, it is difficult to eat and drink; throbbing or aching pain accompanies a person throughout the day and intensifies at night.

Before starting therapy, the doctor conducts an allergy test and interviews the patient to identify contraindications.

Antibiotics help eliminate inflammation of the root and dental nerve:

Ciprofloxacin.
Azithromycin.
Amoxiclav.
Azithromycin.
Ampiox.
Doxycycline.
Digital

Additional methods of treating pulpitis

Today, it is possible to ensure impeccable disinfection of root canals during treatment using modern equipment - ultrasonic, laser.

In addition, copper-calcium hydroxide depophoresis is an effective method of therapy. It has a bactericidal and fungicidal effect - it destroys pathogenic bacteria and fungi.

Physiotherapy for pulpitis is more often used as a means of treating pain after filling - it can occur due to adaptation to the material. In general, physiotherapy is used relatively rarely.

Cost of pulpitis treatment

The cost of treating pulpitis is determined by several factors, including the geography of the clinic. In a good clinic, the price already includes anesthesia, canal treatment, fillings and other materials.

The total amount is added up taking into account the number of root canals, their anatomical features, the degree of destruction of the crown and the method of its restoration, if we are talking about caries. You can find out the exact cost during a consultation with a dentist-therapist at the Dentist-K clinic.

It is important to remember that you can avoid expensive treatment by consulting a doctor in a timely manner. It is necessary to maintain hygiene and undergo professional teeth cleaning on time - this will avoid the need for pulpitis treatment.

How does tooth pulpitis manifest?

The most important sign by which this disease can be suspected is pain. As soon as the infection enters the pulp, the inflammatory process begins. During it, the patient experiences pain when eating cold or hot food. The inflammation progresses and leads to acute pain - it is characterized by severe pain attacks, especially in the evening and at night.

If even with such symptoms the patient does not consult a doctor, the disease progresses further. The pain becomes unbearable, it spreads to the upper/lower jaw, ears, throat, neck. During the examination, the dentist can recognize pulpitis by blowing cold air on the tooth and based on complaints.

Initial consultation

The dentist determines whether treatment is required immediately after the consultation. Often, a tooth can be treated in one visit. What procedures are performed during treatment, whether it hurts and how long it takes depends on each specific clinical case.

Diagnosis of pulpitis

A visual examination and x-ray help the doctor detect pulpitis. If necessary, additional diagnostics are prescribed.

Treatment of pulpitis after differential diagnosis

It consists of:

injection of an anesthetic solution in the area of the tooth (if required, the injection site is also anesthetized, for example, with a low threshold of pain sensitivity);
then the dentist removes all infected tissue, puts a medicine into the tooth that “kills” the pulp, or immediately begins removing the nerve, cleaning the root canals and filling;
If for some reason it is not possible to treat the tooth immediately, then another visit is scheduled.

Treatment over several visits is indicated when the inflammatory processes have spread beyond the nerve. Everything will depend on each specific case, on the individual characteristics of the organism. A surgical technique, laser therapy, treatment using a dental microscope, or a biological method may be required. During his manipulations, the doctor may conduct x-ray examinations to monitor treatment.

Contraindications for the treatment of pulpitis

Allergies and individual intolerance to drugs that will be used during treatment are the main contraindications. You should tell your doctor about your body characteristics and existing diseases during your initial consultation.

The presence of a large number of carious teeth in the mouth, severe forms of pulpitis, cervical caries, complex anatomy of root canals, and general serious diseases of the body may be contraindications to conservative treatment of pulpitis.

How to avoid pulpitis

To prevent the development of this disease, you need to follow a number of simple recommendations, namely:

systematic preventive examinations at the dentist: they will help detect caries, and accordingly, pulpitis will not develop;
good home hygiene: brushing your teeth at least 2 times a day using a toothbrush and paste.
A healthy lifestyle and proper nutrition are the key to the health of the entire dental system.

But if you feel pain in your tooth or discomfort when eating cold/hot food, then you should contact your dentist immediately. At the Good Dentist clinic you will receive highly qualified dental care and effective tooth treatment. In addition, the dentist will help you choose individual products for oral hygiene and teach you how to properly brush your teeth, because regular hygiene is one of the factors that will help maintain the health of your teeth.