Methods of treatment of acute pulpitis

1 Physiology and causes of the disease

Teeth are designed to grind solid foods, while facilitating the digestive process. That is why the top layer of the tooth - tooth enamel - is quite solid. Under it is dentin - the bulk of the tooth. The root is covered with dental cement, which protects it from damage, and all parts of the tooth are connected with a special tissue - a pulp, in which there are many blood capillaries and nerve fibers.

Damage to any part of the tooth( except the root) often passes unnoticed for a person, but if the inflammatory process or other irritants through the destroyed outer shells reach the pulp in the pulp chamber, then it is impossible to notice this because of attacks of acute painnerve fibers from the root canal through the apical opening).

Actually acute inflammation of the soft tissues of the tooth rarely occurs if its outer shells are not destroyed and infected. The only exception is the bacterial form of the disease, caused by the entry of microbes into the pulp with blood flow from the internal foci of infection( tonsillitis, maxillary sinusitis, otitis).This is the most insidious cause of the disease, which makes it difficult to diagnose without using an X-ray.

Usually acute pulpitis occurs for the following reasons:

• a long carious process that has not been treated or treated improperly;
• insufficient water cooling in the process of tooth filling( aseptic pulpitis);
• incomplete removal of carious patches during filling( under microbes become even more active);
• consequence of a tooth or crown injury( this is the most common cause of pulpitis of a baby tooth due to wide dentinal canals in children's teeth);
• exposure to temperature or chemical irritants( frequent use of hot drinks, acidic, alkaline food, some medicines can destroy enamel, giving access to the pulp).

Whatever the cause of the inflammation, but to treat the acute form of the disease should be immediately, however, the pain will lead the patient to the dentist, and wait for a long time she will not force.

2 Varieties of the disease

Modern dentists classify acute pulpitis depending on some of its signs. First, because of the onset:

• is infectious( bacterial);
• aseptic( traumatic or chemical).

The clinical picture of the disease development underlies the classification of pulpitis on:

• acute focal pulpitis( it in turn is divided into purulent and serous, which is the initial stage and provokes the diffuse form of the disease);
• acute diffuse pulpitis( its varieties are purulent and necrotic).

Localization of the inflammatory process makes it possible to talk about root, coronary and total pulpitis. Each variety is symptomatic and requires different methods of treatment.

3 Symptomatology of different types of

disease The onset of paroxysmal spontaneous pain in the tooth makes it possible to diagnose acute focal pulpitis. The nature of pain with aseptic and infectious pulpitis is practically the same. Painful sensations arise on the exudative stage of the disease, when the growing swelling is seen as a consequence of the accumulation of serous exudate. When the latter forms a purulent cavity, then there is a purulent pulpitis.

The pain arises from the fact that the outflow of the inflamed exudate, which presses the nerve endings in the pulp, is disturbed. Acute focal pulpitis is characterized by paroxysmal pain of lower intensity, since inflammation is limited only by pulp. Acute diffuse pulpitis gives severe pain, because the entire root and coronal pulp is filled with exudate.

Attacks of pain in acute focal pulpitis last approximately 30 minutes and intensify at night. If the disease is not treated, the seizures become longer( up to 1 hour).Pain occurs only in the area of ​​the inflamed tooth and does not spread further, because the acute focal pulpitis involves only a part of the neurovascular bundle in the process.

If the patient is difficult to indicate which tooth it hurts, then the exudate is already produced in the pulp, and an acute diffuse pulpitis begins. With it, the pain lasts for several hours, and at night it becomes unbearable.

If an inflammation occurs in the tooth of the lower jaw, the pain extends to the ear and occiput, the upper part to the temple and the superciliary area. Both focal and acute diffuse pulpitis give strong pain sensations when probing the dental cavity, sometimes the patient may even lose consciousness. But in the diffuse form, it is easy to detect an exudate that has permeated the entire soft tissue area, which exits through the damaged and broken vessels.

Purulent pulpitis causes continuous pulsating pain, which is wavy in nature and spreads along the branch of the trigeminal nerve. The pain does not completely disappear, it can only temporarily subside. This can be achieved through the application of cold, and heat, on the contrary, increases pain. To alleviate the suffering can and dissection of the body cavity.

Symptoms typical for varieties of acute pulpitis give an opportunity to already diagnose at the examination and begin therapy in order to avoid the spread of the inflammatory process and to alleviate the condition of the patient.

4 Therapeutic procedures

Depending on whether there is an acute diffuse pulpitis, purulent or focal, apply different methods of treatment.

1. Conservative( biological) method is aimed at preserving the pulp and begins with anesthesia. Further, the necrotic dentin is removed and the tooth cavity is opened. The next step is antimicrobial treatment and application of the drug. When it works, the tooth cavity is sealed. This requires two visits to the dentist;sometimes treatment in one stage is possible. The method is used to treat a tooth for young people with focal serous pulpitis. Sometimes proteolytic enzymes, regenerating tissues and preparations of calcium hydroxide, stimulating dentine formation are used. They are closed in the cavity of the tooth for 3-5 days, then it is sealed.
2. Surgical method of acute pulpitis treatment also begins with first aid - pain relief. The diseased organ is opened, the damaged pulp is removed, the necessary medicines are introduced. Next followed by antiseptic treatment and filling of the dental cavity.

Diffuse pulpitis, especially serous purulent, is an indication for choosing a surgical method of treatment, which most often occurs in two stages:

1. anesthesia and the removal of dead tissue, arsenic use to kill the nerve, the use of anesthetic and temporary fillings( on single root teeth arsenic holdday, on multi-rooted - up to 48 hours).
2. extraction of arsenic and the installation of a permanent seal.

Treatment of acute pulpitis in any case requires prior anesthesia by means of trimecaine or lidocaine, otherwise the patient will not survive manipulation.

If after the treatment of the tooth there are painful sensations as a reaction to cold or hot, sensitivity when biting solid food, then we can say that the purulent pulpitis gave complications. They are eliminated by means of fluctuating currents and a 2-5% solution of anesthetic. With relapse, a medicine inserted into the tooth cavity is replaced. If therapy is unsuccessful, and painful sensations become more intense, then the organ must be removed.

To avoid complications, it is better to linger with tooth filling. In its cavity it is necessary to put a turunda with essential oil. If the tooth does not disturb for several days, you can complete the treatment. The seal must meet all the requirements, and the firm where it is acquired must have the appropriate licenses. Today, such drugs as zinc-eugenol and sulfosalicylic paste, endometasone are popular. To prevent complications, carefully dry the treated tooth canal.

As prophylactic measures, careful oral hygiene is recommended, use of dental floss. Teeth are cleaned twice a day. It is better to consult a specialist who will help to choose the right hygiene products, a toothbrush.

If any pain occurs, even the smallest, immediately consult a doctor. This will help to keep the tooth, to avoid the consequences of such a disease as acute diffuse pulpitis. In case you delayed a visit to the dentist, do not insist that the tooth is removed. Proper therapy will save you from suffering, and the dentist always tries to keep the dentition.

Timely diagnosis of pulpitis is the key to successful treatment.