When the pulp treatment is prescribed in 2 stages. Stages of pulpitis treatment with drugs

26.03.2020

In order 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 to detect caries, respectively, pulpitis will not develop;
competent home hygiene: brushing your teeth at least 2 times a day using a toothbrush and toothpaste.
Healthy lifestyle and proper nutrition - the guarantee of the health of the entire dentoalveolar system.

But if you feel pain in the tooth or discomfort when taking cold / hot food, then you should contact your dentist right away. In the clinic of the Good Dentist, you will be provided with highly qualified dental care and will effectively heal your tooth. In addition, the dentist will help you choose individual means for oral hygiene, will teach you how to brush your teeth properly, because regular hygiene is one of the factors that will help keep your teeth healthy.

The causes of pulpitis

Pulpitis develops due to infection. Untreated dental caries is the main cause of this disease. In the carious cavity there are bacteria and microorganisms that gradually destroy the tooth. And when the destruction reaches the nerve, pain occurs.

Pulpitis stages

The disease is characterized by different stages and its manifestations and intensity. pain.

Purulent pulpitis

Such acute stage manifests itself as unbearable constantly throbbing pain. It intensifies in the evening, sometimes patients wake up at night from a painful attack. The pain occurs not only in the area of \u200b\u200bthe affected tooth, but also radiates to the jaw, ear, temple. Helps reduce pain cold waterbut it is important to remember that relieving symptoms is not a cure. It is necessary to eliminate the cause - inflammation. If this is not done, then necrotic decay of the nerve will begin.

Acute pulpitis

Acute toothache that occurs when eating hot / cold food or when a stream of air enters the tooth is the main symptom of such pulpitis. The pain goes away after the irritant is removed. Sometimes the pain subsides for a long time.

But since the pain has appeared, it means that there is a serious inflammation in the tooth, which has arisen due to caries. Microorganisms invaded the nerve and pain appeared. At this point, the disease is characterized by severe pain with ripple. It occurs in the evening and at night, maybe just a couple of minutes or even last throughout the day.

Chronic pulpitis (gangrenous)

This form appears when pulpitis is already running, and no treatment has been carried out for a long time. Under the influence of external stimuli, pain appears, as soon as the stimuli are eliminated, it passes.

The most dangerous thing about gangrenous pulpitis is that pain can come on suddenly. It is characterized as strong ripple... Sometimes there is a "dull" soreness. Often, at the time of treatment of this form, there is some soreness and bleeding from the tooth.

Sometimes the disease can occur without symptoms. For example, when there is no obvious carious cavity, accordingly, irritants do not enter the tooth and do not cause pain.

Varieties of pulpitis

The tactics of the dentist's treatment will depend on which tooth this disease arose on.

Front tooth

The symptoms will be the same as on chewing teeth... It is not difficult to diagnose such pulpitis. Besides the main clinical picture the translucent pulp of the tooth will be visible through the enamel. Often there is pain of unclear localization: the patient points to a completely different tooth. In addition to the main treatment, pain relievers are prescribed, and when filling the crown part of the tooth, the aesthetics are carefully restored.

Wisdom tooth pulpitis

On this tooth, pulpitis develops for the same reasons as on other teeth and clinical manifestations the same. Often it is not possible to treat the "eights", since they are located very far away, have a complex anatomy, or even grow "in the cheek". Therefore, in such a situation, a tooth extraction is prescribed.

What happens if pulpitis is not cured?

Any disease cannot go away on its own if the cause is not eliminated. Tooth pulpitis is no exception. The infection in the tooth will only spread, the nerve will die, and microorganisms will go beyond the root of the tooth into the bone tissue - into the periodontium. If pulpitis is not cured, periodontitis will occur.

Complications can also include deterioration of the condition of the tooth, through the transition from one stage of the disease to another: a purulent form into gangrenous or into necrosis of a nerve. If you do not pay attention to the first symptoms and start the tooth, treatment will be much more expensive, and sometimes even tooth extraction is required.

Often, patients go to the doctor late because the pulpitis is asymptomatic. This is the danger of this disease: there are no worries, and the inflammatory process goes on and affects more and more tissues. Or there is a slight painful sensation, then they quickly pass, and the patient thinks that everything is in order with the tooth. It is important not to forget that if pain in the tooth has ever occurred, there is a reason to consult a dentist.

Methods and methods of pulpitis treatment (how is dental pulpitis treated?)

Many patients have the opinion that the treatment of pulpitis is very painful, but in fact, modern dentistry has done everything to make the treatment comfortable. In any case, the method of treatment, the number of visits is determined only by the dentist after examination. On the basis of objective data, an X-ray image and anamnesis data, a decision is made on the choice of treatment tactics.

Pulpitis treatment in one visit

Such treatment is possible if the tooth has a slight carious cavity, there is no extensive damage, and the infection has slightly spread. On the basis of these data, as well as if the patient agrees to conduct treatment immediately, the doctor proceeds to his manipulations.

Treatment in two visits

If the pulpitis has a complex shape, the tooth is severely destroyed by the carious process, then two or more visits are assigned. Then all non-viable tooth tissues are removed, the nerve is removed, the canal is washed and processed. The doctor will tell you more about these manipulations at the consultation and will allocate time for the next visits. Each visit the doctor monitors the tooth and, if necessary, can change the number of visits and the scheme of therapeutic manipulations.

Surgical method for the treatment of pulpitis

With it, the nerve is removed from the tooth, and, if there are conditions, the doctor preserves the root pulp. If the nerve is completely removed, the canals are cleaned and filled. If the nerve is partially removed, then a filling is placed on the tooth, its anatomical shape is restored.

Laser treatment of pulpitis

This method has appeared in dentistry relatively recently. It is characterized by its painlessness. It is required to cauterize the nerve with a special laser without removing it. This technique allows you to save the nerve. At first, a temporary filling is placed on the tooth, for a certain time the doctor observes the tooth, if there were no relapses, the end of treatment is carried out - a permanent filling.

Biological method for the treatment of pulpitis (treatment of pulpitis without removing the nerve)

This method is conservative and involves the preservation of the pulp. It is recommended when the inflammation is mild, or, for example, with a reversible form of pulpitis. Special medicines are used.

How long does the treatment take?

All cases are strictly individual and depend on the initial clinical picture. But there are two schemes: treatment in one visit and in two. In the latter case, the tooth is first covered with a temporary filling, and after a certain time the doctor completes the treatment.

What to do after pulpitis treatment?

Everything that needs to be done after treatment will be told by the doctor. Recommendations include refusal of too cold / hot food, eating after a while. Complex clinical situations may require absence physical activity, rest.

Pulpitis treatment during pregnancy

Pregnancy is a physiological condition that requires increased attention to the health of the mother and child. But when pain has arisen, endure it or self-medicate is contraindicated. This can lead to serious complications affecting not only the oral cavity, but also the body of the pregnant woman as a whole.

In no case should you postpone treatment, as this leads to serious consequences. During the consultation, the dentist will help you choose a safe method of treatment that will not harm the mother and baby. The method of pain relief is also carefully selected. In addition, an X-ray examination is not prescribed (the exception is complex clinical cases).

At the initial consultation, it is imperative to tell the doctor about the gestational age and, if any, health features (for example, the presence allergic reactions or diseases of the heart and blood vessels). After the examination, the dentist will establish a diagnosis, tell you when to start treatment.

The dentist will tell you the most complete information about the condition of the teeth, the need for their treatment. Frequently asked questions at the consultation: is it painful to remove a nerve, is it possible to do without its removal, when it is necessary to remove a tooth, is the treatment carried out in one visit, what is the cost of treatment, etc. Our experts will tell you in detail about everything related to dental treatment.

Pulpitis is one of the biggest problems that can happen to a tooth. Severe pain forces a person to seek help from a dentist, but what exactly can specialists offer in this situation?

All modern methods Treatment of pulpitis can be divided into groups depending on whether the tooth pulp is preserved, and if not, it is removed completely (extirpated) or only partially (amputated).

Regardless of which path of treatment the dentist chooses, he must achieve three goals:

Relieve the patient from excruciating pain;
Eliminate the focus of inflammation;
Restore the integrity of the tooth.

Video: pulpitis

Biological treatment method

With inflammation of any organ in human body the main task of the doctor is to relieve inflammation by using appropriate drugs. But for pulpitis, the most common approach is to remove the inflamed tissue. Why?

The answer lies in the specifics of the tooth structure. When inflammation occurs in the closed space of the tooth cavity, edema develops very quickly, which leads to squeezing of the blood capillaries and disruption of blood supply, microcirculation.

Serous inflammation quickly turns from local to diffuse, irreversible purulent changes in the structure of pulp tissues begin. Therefore, the chances of treating the disease with anti-inflammatory drugs while preserving the pulp may already be missed due to the untimely treatment of the patient.

Photo: Conservative treatment of pulpitis

In addition, there are still no reliable methods for diagnosing the real state of the pulp. The stages of acute inflammation in the clinic can be judged only indirectly (by the duration of blushes and subjective complaints), an accurate diagnosis is given only histological examination removed tooth pulp.

Indications for conservative method treatments are:

acute focal pulpitis;
accidental opening of the pulp;
chronic fibrous pulpitis without clinical and radiological manifestations of periodontitis.

Contraindications for the biological method are as follows:

a clear periodontal reaction to inflammation;
decrease in the electrical excitability of tooth tissues below 40mkA;
the patient's age is over 45-50 years;
in the presence of carious cavities in the neck or root of the tooth;
in case of damage to teeth planned under the support of bridges.

Procedure steps

After full anesthesia, isolation of the tooth with a rubber dam or sterile rollers, necrotic tissue of enamel and dentin should be removed.

The carious cavity must be prepared very carefully, taking into account the anatomical features of a particular tooth, trying to avoid overheating or other additional trauma.

After mechanical treatment, the tooth defect should be washed with a solution of a non-irritating antiseptic, for example, 0.5% solution of ethonium.

Distinguish between direct and indirect overlay drugs on the pulp of the tooth. If the pulpitis was preceded by a chronic course of caries, then the bottom part of dentin will be poorly permeable due to obliteration of the lumens of the dentinal tubules and the formation of secondary dentin.

In this case, it is recommended to make a point dissection of the pulp in the projection area of \u200b\u200bits horn. In the acute course of caries, the bottom of the cavity is soft and permeable due to active decalcification; for a sufficient drug effect on the pulp, opening is not required.

The goal of treatment at the first visit is to relieve tension in the pulp by ensuring the outflow of exudate (through perforation or dentinal tubules), as well as to eliminate the acute phase of inflammation.

For this, drugs are used containing:

corticosteroids (relieve inflammation);
sulfonamides;
antibiotics (chloramphenicol, bicillin, neomycin sulfate, etc.);
vitamins, enzymes, etc.

Antibiotics in the treatment of pulpitis are not the main drugs, since most of the microbes involved in the inflammatory process are very resistant to exposure antibacterial therapy... In addition, a high concentration of antibiotics in a medicated filling can cause pulp necrosis.

Separately, mention should be made of calcium-containing drugs (calcium hydroxide or hydroxyapatite), which help to reduce edema and stimulate the formation of secondary dentin.

During the first visit, during treatment without removal of the nerve at the bottom of the prepared cavity, leave medicinal product in the form of a solution; the moistened cotton ball is closed with a temporary filling material for a period of 1-2 days.

If pain continues, it is necessary to re-leave the medicine. If even then there is no improvement, treatment will require the use of one of the surgical methods.

In the absence of complaints on the second visit, a lining filling material of chemical or light curing is applied to the bottom of the cavity.

For direct application, use soft, slow-hardening materials such as Reogan Rapid and Biopulp, if direct contact with the pulp is not ensured, hardening pastes such as Dycal and Life.

If the dynamics of treatment is successful, after a week, the temporary filling is replaced with a glass ionomer cement gasket and a composite filling, after making sure of the viability of the pulp by means of a thermal test and EDI (electrodontodiagnostics).

Surgical methods

All surgical methods of treatment are divided into two fundamentally different groups - vital and non-vital.

The first approach is that the removal of the pulp (partial or complete) is carried out without preliminary killing, devitalization. In the second option, a devitalizing drug is first applied, and only then amputation or extirpation is performed.

Vital methods

When choosing this method, the viability of the pulp is preserved and there is no additional drug (including toxic) effects on the pulp and periodontium of the tooth.

This method is closest to the conservative one, since it aims to preserve the viability of at least the root part of the pulp.

After anesthesia and preparation of the carious defect, the pulp is fully opened with subsequent amputation of its coronal part. Further, the treatment is similar to the conservative method - a direct application of the therapeutic material to the pulp surface at the root canal orifices is carried out, followed by temporary and then permanent filling.

Indications:

acute focal pulpitis
acute diffuse pulpitis
chronic fibrous pulpitis
chronic hypertrophic pulpitis.

This method of treatment is currently the most widespread, used for all forms of dental pulp inflammation.

Treatment is carried out in a series of sequential stages, which can be carried out in one or several visits.

Stages of vital pulp extirpation:

Full (as a rule - conduction) anesthesia;
Isolation of the affected tooth with a rubber dam or sterile rollers;
Dissection of a carious cavity with subsequent antiseptic treatment;
Removal of the arch of the internal cavity of the tooth, removal of the coronal part of the pulp;
Opening of root canal orifices, removal of root pulp and further uniform expansion of root canals;
Stopping bleeding from the root canal; antiseptic treatment of the entire inner surface of the tooth;
Temporary and / or permanent root canal filling;
X-ray quality control of root canal obturation;
Restoration of the crown part of the tooth.

Treatment of pulpitis in one visit has several disadvantages. After extirpation of the pulp from the canals, there may be significant bleeding. Even if the blood is invisible, it can appear after the filling.

Most local anesthetics contain vasoconstrictor drugs, after the cessation of the action of which the lumen of the vessels returns to their previous state and often bleeds.

Therefore, it is preferable after surgical intervention make temporary filling of root canals, and then thoroughly wash out the remnants of blood and other contaminants from them when refilling. The breakdown of blood is an excellent breeding ground for microbes!

Carrying out treatment in one visit, the doctor loses the opportunity objective assessment each of the completed stages, which can negatively affect the final durability of the entire work.

Devital methods

Devital methods involve the preliminary destruction of the pulp tissue, preceding its partial or complete removal.

Indications:

allergic reactions to local anesthetics;
strong fear of injecting pain relief;
unsuccessful local anesthesia;
the presence of severe somatic diseases (oncology, etc.).

The advantages of this method include the convenience of its use, including those associated with the ease of use and exsanguination of the pulp tissues (practically no stopping of bleeding is required during mechanical processing of the orifices and other parts of the root canal).

The disadvantages include the complexity of the dosage and control of the required time spent on the devitalizing drug in the root canal. This may be due to both the patient's lack of punctuality and individual sensitivity. different people and even specific teeth for equal doses of medication.

In some cases, 1-2 days is not enough time for full devaluation, while in others, during this time, signs of periodontal intoxication may already appear.

The most commonly used drugs are arsenic. They lead to increased pulp edema (which often gives an increase in pain in the first hours after treatment), and also block enzymes that provide tissue respiration. The result is the destruction of the pulp.

The second commonly used drug, paraformaldehyde, has a milder and more lasting effect, and has a less irritating effect on periodontal tissues.

The specificity of the devital method lies in the fact that the use of most drugs and filling materials used in vital methods aimed at stimulating and restoring the pulp does not make sense. The doctor is forced to use mummifying drugs to prevent the decomposition of the remaining soft tissues of the tooth.

After the preparation of the carious cavity and antiseptic treatment, the pulp is opened in the projection area of \u200b\u200bone of the horns, where devitalizing paste is applied. It is advisable to cover the drug with a small cotton swab moistened with anesthetic solution, after which a temporary filling is placed.

Perforation and the presence of a loose substance under the filling will help to ensure that the resulting exudate does not create additional pressure on the pulp, and the anesthetic will help fight against increased pain.

The application period depends on the structure of the tooth (longer in multi-rooted teeth) and the composition of the paste. Arsenic ones are put for 1-2 days, and on the basis of paraformaldehyde - up to a week.

On the second visit, the devitalizing paste is removed, the mouths of the root canals are covered with a mummifying paste or a compound that helps transform the pulp into osteoid tissue.

Currently, the method of devital amputation in the treatment of pulpitis is used infrequently due to very narrow indications and a high probability (according to some scientists - up to 85%) of subsequent complications.

Most often, this method is forced with poor patency and even the impossibility of detecting root canals.

The technology of this method is similar to the previous ones: after the preparation of the cavity, a devitalizing preparation is applied on the first visit, and on the second, the pulp is extirpated, followed by expansion and filling of the root canals.

Combining methods

Since root canals in multi-rooted teeth can have a very different degree of patency, it is often not possible to carry out a full-fledged endodontic treatment of some of them.

Therefore, the general devitalization of the pulp is carried out according to the standard technique, and then the root pulp is extirpated from the passable canals (followed by expansion and filling), and the pulp tissue is preserved in 1-2 canals as in the amputation method.

Video: treatment

How to treat with a laser?

The laser is widely used in the treatment of this disease. Its use can be divided into two stages:

Surgical... Erbium laser can be used at the stage of cavity preparation. It allows not only to successfully remove non-viable tissues, but also to form a cavity with a "rough" wall surface, which is convenient for further work, which contributes to better adhesion of the filling material.
Therapeutic... The semiconductor laser sterilizes root canals better than many other methods, which significantly increases the stability of the quality of the entire treatment. Also, the laser stimulates blood circulation, activates metabolic processes and local tissue immunity.

Folk remedies

Since the inflammation of the pulp occurs in a closed, isolated "bone" space, and the process itself is rapid and practically irreversible, independent, folk treatment pulpitis is impossible.

Exceptionally temporary alleviation of symptoms (pain relief) using available methods is real. This is, first of all, taking analgesics, such as: Ketanov, Ketorol, Pentalgin, Baralgin, Spazmalgon, etc.

Analgin is not a worthy successor of this list, but its use is possible if it turns out to be the only available drug.

In some forms of pulpitis (usually an acute purulent one), a "bottle symptom" appears - a patient exhausted by pain and insomnia in the morning tosses around the door of the dental office with a bottle in his hand. He clearly does not hurt so much when he takes cold water into his mouth.

Sometimes soda rinses help, most often when there is already an opening of the pulp (for example, with chronic gangrenous pulpitis).

All kinds of manipulations with lard and garlic with a significant severity of pain symptoms do not lead to real relief of well-being. Also ineffective and unprofessional use of massage of reflexogenic zones.

Complications

The main complications during treatment are:

Perforation of the bottom of the tooth cavity or root wall.
Breaking off a part of an endodontic instrument, often making further high-quality processing and filling of the canal impossible.
Missing or incomplete root canal passage.
Poor root canal filling.
Pushing infected decay beyond the apical foramen with the development of periodontitis.
Removal of filling material (pins or paste) from the apex of the tooth root.

Complications include:

The appearance of post-filling pain.
Partial or complete resorption of intra-root filling material.
Development of acute or chronic periodontitis.

Pregnancy treatment

Dental treatment during pregnancy is definitely undesirable, teeth should be sanitized before the planned conception.

However, if the inflammation of the pulp has already begun, then treatment becomes necessary, since the suffering of the expectant mother from the pulpitis itself and its possible complications much more dangerous for the health of the child than the alleged troubles from competently conducted treatment.

The doctor should take into account the peculiarities of the psychological state of the woman, use anesthetics and other drugs and materials that are acceptable during pregnancy.

Pulpitis is an inflammation of the dental pulp. This disease must be treated, if ignored, the inflammation leads to pulp necrosis and periodontitis. Pulpitis is treated with several methods, it all depends on the form of the disease. It is possible to independently determine the shape of the pulpitis only by the characteristic symptoms. To diagnose the disease at the initial stage, it is necessary to visit the dentist in a timely manner. Pulpitis occurs after deep caries.

Stages

Pulpitis can be treated with several methods:

Surgical. This procedure removes the tooth nerve from the crown and root parts.
Conservative. Helps to keep the pulp alive, therapy takes place without removing the nerve. The conservative method is used with timely access to the dental office.

The surgical method of treatment is carried out in several visits, depends on the number of canals, and includes the following stages:

First visit

Anesthesia.
Removal of carious lesions with a drill.
Isolation of a sick tooth from saliva ingress. A rubber dam is used.
Removal of pulp from coronal and root canals.
Correction of the length of root canals.
Channel processing with manual files.
Treatment of canals with antiseptics.
Antiseptic filling and temporary filling.

Second visit

Removal of temporary filling.
Rinsing the canals with antiseptics.
Drying of channels.
Canal filling with gutta-percha and sealer.
Mandatory quality control of the performed root canal filling using X-ray.
Installation of a temporary seal.

Third visit

As for the conservative method, it is of two types:

Biological method - complete preservation of the living pulp in the coronal and root canals.
Amputation method (vital amputation method) - preservation of the pulp in the root canal.

Stages in the treatment of the conservative method:

Anesthesia.
Removal of carious lesions.
Applying a healing paste to the bottom of the cavity.
Dental crown restoration.

If the treatment is carried out in one visit, then the filling is installed immediately, if in two, then a temporary filling is first installed, and then replaced with a permanent one.

Very often the patient has a aching tooth after treatment. This can be for several reasons:

Poor therapy.
Injury to the mucous surface around the tooth.
Conservative treatment did not give positive results.
Poor canal filling.
Poor quality filling of the tooth.
Overload of the periodontal during filling.

Modern methods

How is pulpitis treated now? Several methods are used in modern dentistry:

1. Biological method.

2. Surgical method:

Without pulp devitalization: vital amputation or vital extirpation of the pulp.
With preliminary devitalization of the pulp: devital amputation and devital extirpation of the pulp.
The use of a mixed surgical method.

3. Laser therapy. Its use is carried out in two stages:

Surgical. Used at the preparation stage.
Therapeutic. Used for sterilizing tooth root canals.

During the treatment of pulpitis, various pastes, ointments and preparations are necessarily used.

Medication

When treating pulpitis, drugs must be used. If it happened that the patient did not seek timely help, and serious complications began, up to the entry of pus into the blood, then antibiotics should also be used.

In order to expand root canals, dentists use:

ENDOZHI # 2.
Belodez 3% and 5.2%.
ENDOZHI # 3.
Pulpevit.
Endosept.
Calsept.

Pastes are also used in the treatment process:

Greenazol.
Calcipulp.
Calcipulpin.
Metrozol.
Non Arsenik.
Pulposeptin.
Dewit-ARS. Arsenic based paste.
Dewit-P.
Dewit-S.

Additionally, the dentist may use ointments, dressings for sore gums and solutions.

At home

As for the treatment of pulpitis folk remedies at home, this is impossible. This is due to the fact that the inflammatory process of the pulp occurs in a confined space, is fast and irreversible.

The only thing you can do at home before visiting the dentist is to relieve pain with an appointment. medicines or by rinsing oral cavity to relieve inflammation. It is recommended to take the following analgesic medications:

Ketanov,
Ketorol,
Pentalgin,
Baralgin,
Spazmalgon.

If the listed drugs are not at hand, then you can use Analgin.

You can also drink and rinse your mouth with cool water, which can also soothe pain. You can also rinse your mouth with baking soda, especially for chronic gangrenous pulpitis.

During pregnancy

It often happens that pulpitis occurs during pregnancy. Then the woman asks the question, is it possible to treat pulpitis during pregnancy and how does it happen? Pulpitis can be treated during pregnancy, but the process itself has its own nuances and takes place under the more careful and close supervision of a doctor.

Currently, there are rumors that pulpitis during pregnancy cannot be treated. It can and even needs to be treated. At best, it can be prevented, since pulpitis is a complication of deep caries. If pulpitis is not treated, fetal infection may occur. Also, during pregnancy, you cannot use the drug arsenic, but modern dentistry rarely resorts to it.

Due to the interesting position of the woman, during this period, therapy is carried out to a minimum. The dentist tries to completely eliminate pain during the procedure. The second trimester of pregnancy is considered the best option for treating pulp inflammation.

This is due to the complete formation of the placenta and the prevention of microorganisms entering the fetus. It is recommended to exclude the procedure in the first trimester, since the fetus is just beginning to form internal organs... It is not advisable to carry out the procedure in the third semester, as this can provoke childbirth.

In any situation, it is necessary to treat pulpitis, as well as its prevention, since the inflammatory process can negatively affect the condition of the fetus. during pregnancy, temporary treatment is carried out. Canal filling is carried out using safe materials and medicines. The installation of a permanent filling is carried out after childbirth. The therapy is recommended to be carried out without the use of anesthesia, if this is not possible, then modern anesthetics without adrenaline are used.

X-rays are not prescribed for pregnant women, only modern equipment is used. On a mandatory basis, at a doctor's appointment, a pregnant woman must report her time, tell about her health and report about allergies to components and drugs.

As a rule, we do not think about the fact that nerve endings pass inside each tooth and blood vessels... However acute inflammation able to remind you of this at any time. Pulpitis is a pathology that everyone encounters at least once in their life. The good news is that modern dentistry has proven therapies that can solve the problem quickly and effectively.

But maybe everything is not so scary and you can just endure the pain? After all, sometimes you don't want to go to the dentist's office! Let's see what processes occur inside the tooth with pulpitis and why a visit to the doctor should not be postponed.

General characteristics of the disease

Pulpitis is an inflammation of the dental nerve (pulp) that is found in the dental cavity and root canals. The pulp is extremely sensitive, and if the tooth is deeply damaged by caries, there is a crack in it, or a filling has fallen out of it, then the likelihood of pulpitis development is quite high. Inflammation can also occur during treatment or preparation for dental surgery if the doctor is not careful. In rare cases, a past infectious disease becomes a provoking factor.

Pain can occur when the tooth is exposed to cold or heat, acidic foods, alcohol, sugar. If you see a doctor right away, inflammation can be suppressed. However, patients often try to bring down pain with analgesics, wasting precious time. As a result, the damage to the nerve becomes irreversible and the pulp must be removed. The danger of pulpitis is that, without treatment, the inflammation can spread to the tooth root, which increases the risk of tooth loss. Sometimes the pain goes away on its own, but this is not an indicator of recovery. This situation may indicate that the nerve is irreversibly damaged by harmful bacteria and a purulent mass begins to form in the tooth cavity. The latter, when it enters the base of the tooth root, can cause a flux - a purulent lesion of the jaw.

If the inflammatory process has been giving you unpleasant sensations for a long time, you should not delay going to the doctor: a nerve removed in time will help to avoid complications. Of course, there is a psychological factor: many patients do not like going to the dentist, they are afraid of pain, they do not want to waste time and money. It is important to make a sensible decision here so as not to aggravate the situation, especially since modern dentistry is affordable and practically painless.

How pulpitis is treated: modern approaches and methods

Pulpitis treatment is to eliminate inflammation. This can be done in two ways: either by performing healing and restorative procedures in relation to the pulp, or by completely removing it. The choice of a doctor will depend on the condition of the pulp and the stage of inflammation.

Conservative treatment of pulpitis (biological method)

If, immediately after the onset of acute pain, the patient seeks a doctor, it is possible to stop the inflammation while preserving the nerve. The pulp is exposed, treated with an antibacterial drug, a micro-bandage with calcium hydroxide is applied on top and the hole is closed with a temporary filling. After a few days, an X-ray is taken, the condition of the pulp is assessed and, if the inflammation has stopped, a permanent filling is placed. It must be borne in mind that this method is not always applicable and requires high qualifications of a doctor, therefore conservative treatment not every dental clinic will offer you.

Surgical treatment of pulpitis

The traditional method having different variants implementation depending on the specific case and the age of the patient. Consists of complete or partial extraction of the pulp from the tooth cavity.

Extirpation. It is used in the vast majority of cases. It is a complete removal of the pulp.

Vital... Living pulp tissue is removed under anesthesia. First, the dental tissue affected by caries is removed, treated with an antiseptic, then the infected nerve is removed and the cavity is filled. One visit to the dentist is enough for the procedure, it is universal for all forms of pulpitis, but is not applicable for patients with allergies to anesthetics.
Devital. If it is impossible to carry out vital extirpation, the pulp is exposed to pasty toxic substances (for example, arsenic) so that later it can be painlessly removed. The paste is laid for 24-48 hours if the patient can come for a second appointment quickly enough, or for up to 14 days - in this case, it is used gently active formulations... The cavity is closed with a temporary filling until the next procedure. At the second visit, the doctor removes the dead pulp, unclogs the canals and places a permanent filling. With purulent pulpitis or tissue necrosis, the method is not used.

Amputation. In this case, only the coronal part of the pulp is removed, the root remains in place. For teeth with one root, amputation is not suitable, since in this case it is almost impossible to isolate individual pulp elements. Amputation is usually indicated for acute pulpitis or accidental mechanical damage tooth.

Vital. The necessary part of the nerve is amputated under anesthesia in a single session. The method is indicated for patients under the age of 45 with a healthy periodontium.
Devital. After exposure to the pulp with a toxic paste, the dead area is removed, and the healthy one is deliberately mummified, for example, with an antiseptic paste based on zinc oxide-eugenol, so that the infection cannot develop again. Devital amputation is used in difficult cases when it is impossible to reach the desired site of the pulp. The modern dentist arsenal includes flexible nickel and titanium instruments. With their help, even the most curved canals can be processed, which makes it possible to abandon complex techniques.

The use of arsenic for the treatment of pulpitis was proposed only at the end of the 19th century. Prior to that, the inflamed pulp was destroyed with hot oil or burned out with a hot iron. These methods were used by the ancient Greek and ancient Egyptian dentists.

Stages of pulpitis treatment

Let us dwell in more detail on the method of extirpation - as the most common and long-term. The procedure requires two or three visits to the doctor, depending on the number of roots of the diseased tooth.

Removal of tissue affected by caries. The tooth is cleaned, opened and the pulp chamber is exposed. With a non-vital treatment option, arsenic is placed in the tooth cavity, a temporary filling is placed and a date is set next appointment... If the pulp can be removed immediately, treatment starts from the next stage.
Pulp removal. A special pulpextractor is used.
X-ray. The snapshot is necessary to determine the length and shape of the canals.
Cleaning of canals and the tooth as a whole. This step is necessary to rule out new inflammation.
Installation of a seal. First, the canals are filled, then the coronal part.

The last stage can be completed in two visits. In some cases, anti-inflammatory drug therapy is prescribed.

After placing the filling, the so-called post-filling pain when biting is possible. It is considered a variant of the norm, unless it lasts more than a week. Some dentists consider it unacceptable. In any case, it doesn't have to be strong. If you are experiencing severe discomfort, it is worthwhile to additionally consult with your doctor.

Features of the treatment of various forms of damage to the dental nerve

In the modern classification, pulpitis is divided into acute and chronic. In each of the two forms, it is easy to distinguish characteristic stages.

Acute pulpitis... One of the most common complications of deep caries. It manifests itself as severe pain, which can be aggravated by pressure on the tooth, exposure to heat or cold, acidic or spicy foods. Pain attacks are more likely to occur at night. In children, due to the peculiarities of the structure of the jaw, acute pulpitis practically does not occur; in adulthood, men and women are equally susceptible to it. The disease passes in two stages, after which, in the absence of treatment, flows into a chronic form.

Focal. initial stage, lasts up to 2 days. The inflammatory focus is close to the carious cavity. The pain is sharp, "shooting" character, the attacks last for 10-30 minutes with breaks for several hours. At this stage, it is easy to identify a sick tooth, since the pain is point.
Diffuse. The second stage, which occurs when the coronal and root parts of the pulp are affected. Dispersed pain, radiating to different parts of the jaw, temporal and occipital part of the head, cheekbones. The attacks are longer, and the pauses between them are only 30-40 minutes. Acute diffuse pulpitis lasts no more than 2 weeks. If during this time the patient has not consulted a doctor, the disease becomes chronic.

Chronic pulpitis. It can last, without disturbing the patient too much, up to several years. Toothache significantly dulls, you can get used to it, although chewing is difficult, and with external influences the pain sensations increase. Exacerbations are periodically possible. The method of treatment depends on the type of chronic pulpitis.

Fibrous. It is characterized by the presence of a deep carious cavity, which does not always reach the pulp chamber. The pain is weak, increases only when pressing on the tooth, blood appears from time to time.
Gangrenous. If an infection joins the fibrous pulpitis, the pulp atrophies, becomes dirty gray, the pain intensifies, the carious cavity expands. Odor from the mouth appears.
Hypertrophic.It is characterized by the fusion of the carious cavity with the cavity of the tooth and the formation of a polyp of granulation tissue, which bleeds and hurts when pressed. But there is usually no pain.
Exacerbation of chronic pulpitis. Simultaneous manifestation of signs of acute and chronic pulpitis. The patient experiences bouts of sharp pain, aggravated by pressure on the tooth. Destruction possible bone tissue, periodontal infection.

Most often, patients with fibrous chronic pulpitis turn to dentists. Less common is gangrenous, in last place - hypertrophic. If pulpitis has managed to become chronic, in 90% of cases it is required surgery... Acute forms are amenable to conservative therapy. In any case, you will need a reliable clinic, where they will not only carry out the procedure for the restoration or removal of the pulp in a qualified manner, but also provide a high-quality permanent filling. Failure of the filling can cause damage and pulpitis of adjacent teeth.

How to choose a reliable dental clinic?

Many patients, under the influence of acute pain, choose the clinic spontaneously, and then continue to go there for years, without thinking about the quality of the services provided. Of course, there is no time to search and compare data in such a situation. We asked a representative of the Dental Association to comment on this issue:

“Of course, if you have sharp pain, you can go to the nearest dentistry, this is a natural solution. However, try to pay attention to the following details:

Dialogue with a doctor - the dentist should ask you in detail about your feelings, check the tooth's reaction to various influences. The patient is then informed about possible treatments.
A clear treatment plan - after talking with your doctor, you should understand how many procedures will be required, at what intervals and why.
Possibility of an unscheduled appointment - in case of a sudden complication, you should be received at a convenient time for you.

If you do not like something, you can go through the next stages of treatment in another clinic, which you choose in a calm state, when the pain passes.

Our Association has opened hotline on dental treatment. Around the clock, seven days a week, specialists from different areas of dentistry will consult you by phone for free, tell you about a possible treatment plan, and suggest a particular clinic. In case of treatment on a referral from the Association, guarantees are given for materials and services rendered, competitive prices are offered. Our dentists have vast experience in therapy and surgery different forms and stages of pulpitis, and you can be sure that after the treatment the tooth will not cause you anxiety. "

P.S. The website presents prices for treatment on an all-inclusive basis, which will allow you to avoid unexpected expenses during treatment.

Pulpitis is an inflammation of the soft connective tissues of the tooth or pulp. It consists of blood vessels, nerve endings and promotes tissue trophism. Pathology occurs against the background of carious lesions, tooth injuries and incorrect treatment.

Methods and depend on the type of pathology. There are two main forms of the disease: chronic and acute. Acute pulpitis develops rapidly. It is characterized by pronounced symptoms:

Intense pain on exposure to pungent, cold, hot, sour and sweet.
Painful sensations do not go away after the elimination of the provoking factor, intensifies in the evening and at night.
The pain can occur on its own, without irritants.
The tooth responds to touch and chewing.
The pain can be given to the temple or head from the side where the affected tooth is located.

In some cases, with acute pulpitis, conservative treatment or only partial removal of the pulp is possible.

Chronic pulpitis flows from acute form or appears against the background of a deep carious lesion of the tooth. For a long time, he may not let him know about himself and develop for several months or a couple of years. Symptoms of chronic pulpitis are mild:

Important! Can often be easily distinguished from chronic appearance tooth. In the first case, a small white speck appears on the enamel.

Treatment of chronic pulpitis always consists in complete depulpation, or, in a simple way, removal of the nerve. Failed to save pulp.

Treatment methods

The types of treatment for the disease differ depending on the possibility of preserving the pulp (partial or complete) or removing it.

There are three ways to treat pulpitis:

Conservative. It is carried out at the initial stage of acute pulpitis, when the tissues are almost not affected. It is often prescribed for children with milk teeth.
Devital. Therapy consists in the use of special pastes to kill the nerve. It is divided into:
- devital amputation;
- devital extirpation.
Vital. Pulp extraction is performed at the first visit under anesthesia. It is also subdivided into:
- vital amputation;
- vital extirpation.

The photo shows the canals of the tooth.

Devital amputation

Devital amputation is a partial removal of the pulp (its coronal part) with the preliminary imposition of necrotizing pastes. This method was popular at the end of the last century. It is hardly used today. An exception is also cases when it is impossible to remove the nerve bundle in an operative way.

After opening the cavity, a toxic drug is applied to the pulp. After the upper, dead, part is removed, and an antiseptic paste based on zinc oxide is applied to the healthy one. This "mummifies" the remaining pulp.

Important! With devital amputation, there is a high risk of repeated sluggish inflammatory process... The remaining "mummified" section of the pulp cannot feed the tooth. But it promotes the reproduction of microorganisms.

Devital extirpation

Stages of pulpitis treatment.

Devital extirpation by the technique is similar to amputation. The difference lies in the complete, rather than partial, killing of the pulp.Devital extirpation is not used for tissue necrosis or purulent pulpitis.

Removal is carried out in 3 visits:

Removal of caries-affected tissues with a drill.
The imposition of devitalizing pastes: arsenic or arsenic-free. Arsenic preparations are applied from 24 (for single-canal teeth) to 48 (for multi-canal teeth) hours. Arsenic-free products - up to 14 days.
Closing the cavity with a temporary filling.
Removal of temporary filling material and extraction of a dead nerve bundle.
Mechanical cleaning of root canals and their treatment with antiseptics.
Restoration of the crown part of the tooth with photopolymer materials.

In some dentistry, the method of devital extirpation using resorcinol-formalin paste is still practiced. However, this drug is toxic, stains the enamel in a pinkish-gray shade and there is a high risk of complications with subsequent retreatment or tooth extraction.

Vital amputation

Vital extirpation consists in complete removal pulp in an operational (surgical) way.

Vital amputation is somewhat similar to devital amputation. The upper, coronal, part of the pulp is removed in the same way. However, this is done surgically, and the nerve bundle in the apical part of the canal remains intact. Due to this, nutrition and protection of the tooth from pathogenic microorganisms continues.

Important! Vital amputation is performed only when treating multi-canal teeth. In single-root units, there are no clear boundaries between the outer and inner parts of the pulp.

The method involves a number of procedures:

Opening the cavity and cleaning the tissues affected by caries.
Removal of the coronal part of the pulp.
Application of rubber dam and antiseptic treatment of the tooth.
Installation of medicinal, and on top of it - an insulating pad.
Closing the cavity with temporary filling materials.

Further treatment is similar to devital amputation. The patient is prescribed physiotherapy and taking non-steroidal anti-inflammatory drugs.

Vital extirpation

Vital extirpation is the most common treatment for pulpitis. With its help, any stage of pathology is treated. The method consists in the complete removal of the pulp by an operative (surgical) method.

Important! Pulpitis therapy with vital extirpation is carried out in at least 3 visits. Immediately after removing the pulp, it is impossible to fill the canals and restore the coronal part of the tooth. It takes time for the root canals to heal and the material to shrink.

Vital extirpation is carried out in several stages:

First visit:

Second visit:

a temporary filling is removed;
drugs are removed from the canals, they are re-cleaned and treated with antiseptics - sodium hypochlorite or chlorhexidine;
root canals are filled with gutta-percha or cement pastes;
the cavity is closed with temporary filling materials.

Third visit:

the seal is removed;
the crown part of the tooth is restored with photocurable materials;
the filling is adjusted to the bite - excess layers are removed;
grinding;
polishing.

At the first two stages of vital extirpation, X-ray control of the treatment is mandatory. It is necessary to determine the length of the channels, their anatomical structure and whether the pulp has been completely removed.

Modern methods of treatment are aimed at preserving the vitality of the tooth.
The most important part of the therapy is the passage and cleaning of the root canals. Before the procedure, the tooth cavity must be isolated with a rubber dam. The dentist must accurately determine the length of the canals: incomplete filling or removal of materials outside the apex - the maximum physiological narrowing - will lead to complications, and the tooth will have to be re-treated.

Important! The length of each channel is measured separately: the size of each channel can vary greatly.

Combined method

In some cases, it is impossible to cure pulpitis using one method - you have to resort to a combined method. It is used when:

One or more channels are severely curved.
It is impossible to completely pass and disinfect the channels mechanically.
The instrument broke and remained in the root canal.

With the combined method, two types of pulpitis treatment are used simultaneously, most often vital and devital. The accessible sections of the canals are passed, the pulp is removed, and the rest are processed with necrotizing pastes.

Complications in the treatment of pulpitis, in most cases, arise from medical errors.

Possible complications

Complications in the treatment of pulpitis, in most cases, arise from medical errors. Most often, periodontitis develops - inflammation of the root apex. The following negative consequences are possible:

1. Unfilled canals or incompletely removed pulp. The complication is associated with insufficient qualifications of the doctor, lack of necessary equipment in the clinic or hasty - in one visit.
2. Removal of filling material beyond the root apex. Occurs when the instrument is pushed beyond the apex. Occasionally, there are cases of material removal into maxillary sinus or the mandibular canal.
3. Broken tool. This is the only case where the complication is not directly related to medical error... Most often, reamers and files break in channels. However, the doctor must immediately report the problem and correct it.
4. Violation of the integrity of the root canal. It is characterized by perforation or false hole creation when the instrument is outside the root.

Methods for treating pulpitis are similar to each other. All of them, with the exception of the biological one, are aimed at removing the pulp, treating the canals and restoring the supragingival part of the tooth. The most commonly used method is vital extirpation. However, in some cases, devital or conservative therapy is possible.