Exacerbation of chronic pulpitis. Causes, differential diagnosis, treatment of chronic pulpitis

Probably, there is no such person, who neverDo not hurt your teeth. And when, as they say, the process has gone, all the sensations center around one single aching tooth. If you postpone the visit to the dentist for later, the patient has every chance to know all the "delights" of chronic pulpitis.

What is the essence of the process?

Pulpit, if available, isan inflammatory process that develops in the vascular-neural bundle inside the channels of the root of the teeth and their crown part. If the patient turned to the doctor with complaints of severe pain (ie, there is an acute pulpitis), in some cases the inflammatory process can be stopped and the tooth can be saved.

chronic pulpitis

In a state of chronic pulpitis of pulpgradually degenerates, fibrotic tissue is formed, necrosis or transformation of the vascular-neural bundle is observed up to such a state, when its entire tissues are filled with the carious cavity, which led to pathology.

Most often with chronic pulpitis of acute painthere is no, and patients come to the doctor in order to save the tooth from removal. However, the chronic form of pulpitis is almost always an irreversible disease.

Causes of development

Any pathology has prerequisites andThe circumstances that gave impetus to the development of the pathogenic process. The pulpitis is not an exception. Chronic forms of this disease are provoked by pathogenic microorganisms and products of their vital activity. As a rule, the beginning of all the beginnings is the presence in the patient of deep caries or poor-quality treatment of this widespread ailment. The latter term means non-observance of the technique for treating a diseased tooth, insufficient cleaning of the carious cavity, an inadequately placed seal, and so on.

Less common causes of chronic pulpitis,provoking the development of the pathological process, may consist of trauma to the tooth, blockage of the channels of the neurovascular bundle with salt stoppers ("concrements"). Also, chronic pulpitis can appear as a complication in maxillofacial and general diseases (sinusitis, influenza, periodontitis, osteomyelitis, periostitis, etc.). During the course of such diseases, pathogenic microorganisms can penetrate through the apex of the root of the tooth.

exacerbation of chronic pulpitis

Types of chronic process

Dentists distinguish 3 varieties of chronic pulpitis: hypertrophic, fibrous, gangrenous.

In the hypertrophic process in cariousplane, there is a proliferation of pulp tissues in the form of a polyp. As a rule, the patient sees a bleeding build-up, which is traumatized when chewing food. The pains can be moderate and are caused in most cases by external irritating factors.

Fibrous form occurs most often andcharacterized by recurrent painful aching sensations, which within 1-2 days cease by themselves, but the carious cavity almost constantly bleeds.

Gangrenous form is characterized by completedecomposition of the nerve tissue of the tooth and large destruction of the crown part of the tooth. This form of pulpitis is always accompanied by an unpleasant odor from the mouth. Painful sensations, as a rule, are mild, arising periodically. Typical complaints of the patient in this case look like this: "the tooth was very sick, and then stopped itself".

It is worth noting that more often (≈ 70% of cases)doctors diagnosed with chronic fibrotic pulpitis, much less often - gangrenous. The hypertrophic form in adult patients practically does not occur. This diagnosis is sometimes put children's dentists.

forms of chronic pulpitis in children

Diagnosis of chronic pulpitis

In order to diagnose, the doctor, in addition tolistening to the patient's complaints, it will be necessary to carry out a certain set of measures, consisting of a visual examination of the aching tooth, thermometry, EOD, and radiography.

At visual inspection the doctor receives about 50%information on the condition of the causative tooth. Thermometric studies on the response to cold and hot stimuli provide an opportunity to understand what kind of disease and what kind of disease the patient turned to the doctor. For example, the reaction to the cold says that the "nerve" is not dead.

Electroodontodiagnosis (EOD) is one of thethe most reliable ways to diagnose pulpitis. The technique is based on the fact that diseased and healthy pulp tissues have different electrical excitability. A healthy nerve will respond with minor pain sensations to the effect of current intensity of 2-6 μA, fibrous pulpitis with pain of the same intensity will respond to 35-50 μA, gangrenous will require exposure in 60-90 μA.

Radiography involves evaluating the state of the tooth using X-rays.

treatment of chronic pulpitis in stages

Differential diagnosis of chronic pulpitis involves a comprehensive assessment of all the above described methods and a comparative analysis of the information obtained in the diagnosis process.

Symptomatic of chronic pulpitis

In general, the ailment at this stage occursis asymptomatic. How can you understand that a person has chronic pulpitis? Complaints basically boil down to the presence of aching pains with different intervals of silence between them.

With fibrous form, as a rule, there arepainful sensations as a result of influence of irritating factors (hot, cold, sweet). Pains do not last long even after the influence of stimuli is eliminated. A characteristic symptom is the development of prolonged painful sensations when the external temperature changes from cold to warm (for example, moving from street to room). Although in some cases the course of fibrous pulpitis is possible without obvious signs. This happens if the stimuli do not have direct access to the carious cavity (for example, it is located under the gum or has a through communication with the pulp chamber). In the latter case, there is no puffiness, the pulp "does not burst out," and as a consequence, there are no pains.

With gangrenous pulpitis is always presentan unpleasant smell from a sick tooth and from a mouth. Characterized by pain from the effects of hot, which do not stop long enough even after the stimulus is eliminated. Often there are feelings of raspiraniya in the tooth. In addition, the tooth color changes almost always: it becomes grayish.

exacerbation of chronic pulpitis symptoms

Hypertrophic pulpitis accompanied by aching painswhen chewing food and bleeding. This is due to the germination of the pulp into a carious cavity like "wild meat". It is this factor that most often frightens the patient and makes him turn to a doctor.

Stages of treatment of a chronic process

Since with this disease soft tissue in the toothTo save it is not possible any more, the main kind of therapy is removal of a pulp from all channels of a tooth. Modern dentistry in the overwhelming majority of cases prefers the technique of vital extirpation (live extraction) of the nerve, when only anesthetic agents are used without medication to kill the pulp.

However, sometimes individual characteristicsthe patient's jaw, lack of time and lack of good anesthetics do not allow you to remove the nerve immediately on the first visit. Then the treatment of chronic pulpitis is applied step by step, when a special paste is put in the carious cavity, which is aimed at preparing the pulp to be removed, which is what happens during the second visit.

exacerbation of chronic pulpitis treatment

After treatment

Quite often after treatmentchronic pulpitis is over, people complain of pain. These sensations are called post-pilling (as they are called dentists). As a rule, discomfort appears for several reasons and fits into the conventionally permissible norm. The emergence of pain after pulpitis treatment is possible due to the fact that the tissues around the diseased tooth can be slightly traumatized, or with a rough, sharp detachment of the "nerve" in the process of its removal. Also, pain may appear if during the treatment the canal channels were treated with powerful antiseptic agents, which in small volumes could go beyond the root.

Another reason for post-reflex pain is the emergence of a thin instrument that dentists use during the treatment to work inside the canals, beyond the apical foramen of the root.

Causes of complications after therapy

Sometimes after a seemingly successful "communication" withthe dentist begins severe pain, and the initially treated exacerbation of chronic pulpitis is complicated. The reasons for this phenomenon can be several. These are poorly performed work on filling the tooth canals, breaking off the dental instrument when it is in the dental canal or perforating (creating a hole) in the root wall.

differential diagnosis of chronic pulpitis

If the channels are poorly filledor the penetration of the filling material beyond the apex of the root was allowed, for some time period (from several days to a year) the symptoms of periodontitis appear in the stage of exacerbation. Fracture of the instrument may not immediately manifest itself, but the infection in the unwashed and unsealed channel will still declare itself by flux, the periodic appearance on the gingiva of fistula (at best) or the formation of cysts with purulent contents.

Exacerbation of the chronic process: signs

If a sick tooth with manifestations of acute pulpitisin time can not be cured, the disease will pass into a chronic form and will remind you of itself with enviable constancy throughout life. How does exacerbation of chronic pulpitis manifest? Symptoms are unpleasant: pain from the effects of various stimuli (warm, cold, sweet, transition from cold to heat), quite a negative sensation during palpation and percussion (mild tapping of the dental instrument on the causative tooth). Most often, patients describe pain as paroxysmal. At the stage of exacerbation of the chronic process, the spread of pain sensations along the routes of the trigeminal nerve is characteristic. It is for this reason that patients say that pain is given in the area of ​​the temple or under the eye, nose or chin.

The aggravation and reasons for its development

Exacerbation of chronic pulpitis can give aboutto know for several months. Pain sensations are not as intense as in acute form. The most frequent causes of exacerbation may be such phenomena as worsening of outflow of exudate, trauma to the tooth, intensification of activity of pathogenic bacteria. In addition, the weakening of general immunity, the inflammatory process in the lymph nodes and the general intoxication of the body may contribute to relapse.

Exacerbation of the chronic form of pulpitis canaccompanied by the phenomena of focal periodontitis. In such cases, patients come to the dentist with complaints of persistent pain. Pathological changes are recorded on the X-ray.

Temporary teeth in small patients

Not only in adult patients is diagnosedchronic pulpitis. In children, not only with permanent, but also with temporary teeth, this disease is also possible. All forms of chronic inflammation are characterized by pronounced symptoms.

chronic pulpitis in children

A child can not chew food properly.The causative tooth reacts to temperature stimuli. With gangrenous form of pain appear in response to irritation warm, hot or when going from a cold to a warm room. Proliferative pulpitis (and its hypertrophic form in particular) is characterized by the appearance of pain when food particles enter the carious cavity. In addition, the polyp of the pulp bleeds under mechanical action.

The peculiarity of the course of the disease at this age -low pain intensity, which can be explained by the structural change of the pulp and its dense communication with the periodontium. In this case, optimal conditions are created for the free drainage of exudate, as a result, there are no severe pains.

Permanent teeth in children

Constant teeth in children are also susceptiblediseases of pulp. Forms of chronic pulpitis in children are exactly the same as in adult patients. The chronic process in the acute stage in small patients is usually characterized by a prolonged sluggish course with periods of acute pain. Often, the growing discomfort suddenly goes away, and the child does not bother with a sufficiently long period of time. But in most cases, patients complain of paroxysmal or tearing acute pain, giving off in the direction of the branches of the trigeminal nerve. Low electrical excitability (120-160 μA) indicates changes in the nerve elements of the pulp, which are of a dystrophic and destructive character.

 chronic complaints pulpitis

Let's summarize all of the above

To the great regret of patients, by itself is notthere will be no acute phase of the disease, nor a subsequent exacerbation of chronic pulpitis. Treatment with a dentist will sooner or later. And it is better that this happens as soon as possible in order to save the patient from unnecessary suffering and costly and painful interventions, and the doctor from a long and tedious work that requires considerable experience and patience.

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