Different variants of definition and classification of pulpitis

1 Classification of the ICD and WHO

The classification of pulpitis according to ICD-10( International Classification of Diseases), established in 1997 under the guidance of WHO( therefore also called the WHO classification), includes the following forms. All of them are grouped together with code K.04 - diseases of pulp and periapical, that is located around the tip of the root of the tooth, tissues.

• K04.00 - initial, or hyperemia of the pulp, according to other systematizations, this condition is referred to as deep caries, reversible inflammation, preceding pulpitis.
• K04.01 - acute - pain occurs in response to cold or hot, but also by itself, often at night, the attack lasts from several minutes to several hours.
• K04.02 - purulent( pulp abscess) - a severe form of acute inflammation of the pulp, is accompanied by a very strong, unbearable pain, which gives off in the entire jaw, so that the patient can not determine which tooth it hurts. A large carious cavity is visible, a tapping on the tooth( percussion) causes pain.
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• K04.03 - chronic - painful sensations arise in response to the stimulus, and when it is eliminated pass.
• K04.04 - chronic ulcerative - on the tooth there is a carious defect, if it is opened, a pulp with ulcers becomes visible, this species can be asymptomatic.
• K04.05 - chronic hyperplastic( pulpal polyp) - accompanied by tissue proliferation and protrusion through the cavity of the destroyed crown( so-called "wild meat").
• K04.08 - other specified.
• K04.09 - unspecified.

Other diseases of the internal tissues of the tooth are also classified in the ICD-10 classification:

• pulp necrosis - complete death in which the tooth loses sensitivity,
• pulp gangrene - putrefaction, one of the symptoms - bad breath.
• degeneration( degeneration) of pulp, including solid formations in the pulp - denticles, calcifications and stones.
• broken formation of solid pulp tissues,
• acute apical periodontitis of pulp origin, that is, developed as a complication of pulpitis,
• other diseases of pulp.

This is the classification used by dentists when they make notes in patient records. In practice, it is important not so much to distinguish between the types of inflammation of the pulp, how to distinguish pulpitis from a similar form of periodontitis - periodontal inflammation. Some doctors consider this systematization to be inconvenient, since it is complex and does not reflect the full picture of the disease. It is especially difficult for a dentist to distinguish the stage of the initial pulpitis or deep caries, as the pulp flushing can not be seen during examination. Sometimes doctors put the code K04.0 in the map - just pulpitis without specifying the type. For a more complete description of the clinical picture in Russia, for example, use Classification according to Gofung or Platonov, although records in medical charts, like everywhere else in the world, are made in the ICD.On the other hand, this list includes such forms of pulpitis that are not reflected in others:

• ulcerative,
• other specified,
• , unspecified.

When training dentists, it is also the systematization of the ICD.

2 According to Vinogradova

Classification of pulpitis by Vinogradova was developed in 1987 and affects pulpal lesions of dairy and molar teeth in children. T.F.Vinogradova determined that the course of the disease of dairy and replaced teeth has significant differences. Vinogradova distinguishes such types of pulpitis:

• Acute temporary teeth - this species is divided into serous, purulent, periodontal and nearby lymph nodes may also be involved;
• Acute permanent teeth - secrete acute serous partial or general, acute purulent partial or general. Partial acute serous form can occur in teeth with formed roots;
• Chronic pulpitis of milk and permanent teeth can be simple, proliferative, proliferative hypertrophic, gangrenous;
• Exacerbated chronic pulpitis of dairy or permanent teeth.

Acute serous form on the milk teeth quickly turns into purulent. At the same time, painful sensations are not very pronounced, but are( often) strong. In this case, the child can not accurately show the tooth on the patient, the pain irradiates in the entire jaw, in the ear. Pulpitis in children can occur with fever, severe soreness in chewing, that is, with signs of periodontitis - this is the course of the disease in childhood differs. When the inflammation in the pulp is involved and periodontitis, there is a flux, inflammation is accompanied by symptoms of general intoxication and can be dangerous for the life of the child.

Acute pulpitis of permanent teeth can be partial or total. Partial( limited) stage usually lasts no more than 2 days and goes into the general form. With a general( diffuse) inflammation, periods of pain become longer, the intervals between them are less. If the tooth roots are not formed, the pain is local, does not give anywhere.

In chronic course of pain, pulling, but not very pronounced, increases with chewing. In the proliferative form, a bursting is felt, as the pulp grows. Exacerbated pulpitis is characterized by aching, not acute pain. Vinogradova's classification does not lose its relevance, and children's dentists actively use it.

3 According to Lukomsky

Classification of pulpits by Lukomsky appeared in 1936.The author set the task to establish a link between the clinical manifestations of the disease and changes at the tissue level. Lukomsky subdivides pulpal inflammations on

• coronal( partial);
• root( common).

At the same time, he divides the forms and by the type of exudate - the fluid accumulating in the tooth during inflammation - which can be: purulent

• ;
• serous.

At present Lukomsky's classification is considered obsolete and is criticized, as the phase of inflammation with serous exudate is very brief and quickly passes into purulent inflammation. In practice, it is not possible to isolate these phases. However, the division into the crown and root allows us to assess how much of the tooth is affected by inflammation, and this is an important advantage of Lukomsky's classification.

Despite the fact that the classification of Lukomsky is now obsolete, it was an important contribution to the study of dental diseases. Also Lukomsky singled out the areas of pain radiology in pulpitis, that is, where she gives.

4 Conclusion

Unified systematization of pulpitis, reflecting all aspects of this disease, at the moment there. Each of the existing classifications has advantages and disadvantages and more fully covers some aspect of the issue. The world has adopted the systematization of pulpitis in the ICD 10( WHO).In Russia, also using the classification of Gofungu or Platonov, as many doctors find them more convenient and accurate, and according to Vinogradova for pulpitis in children.