DISEASES OF THE TEETH AND ALVEOLAR PROCESS : TOOTH PULP (PULPITIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Pathogen infection of the pulp are usually microbes that have penetrated through carious dentin in the pulp cavity, mainly streptococci. Hematogenous infection of the pulp is not excluded, although it is a rare phenomena. It is also possible ascending infection of the pulp from the alveoli to stretch.
The pathogenesis. The development of inflammation in the pulp is accompanied in the acute period mainly exudative phenomena - serous and purulent pulpitis. Chronic pulpitis, along with symptoms of purulent inflammation, characterized by phenomena of proliferation. The outcome of the majority of acute pulpitis - necrosis, rarely becomes chronic inflammation, which, in the end, also ends with the death of the pulp. Thus, the pulp inflammation ends sooner or later necrosis. The reasons for this lie in adverse conditions of evacuation of the products of inflammation, due to the topographic location of the pulp in the tooth cavity. Distinguish partial, or coronary pulpitis, as well as the total, or root pulpitis. In the latter case are affected by inflammation and coronary, and root pulp.
Symptoms. Characteristic of the so-called spontaneous pain (pain that appear without apparent external stimulus, pain or a seizure occurs in which an external stimulus is played only the role of short-acting agent-provocateur). For total pulpitis the following features typical pain symptom: acute spontaneous pain; paroxysmal pain; pain radiating to the tract of the trigeminal nerve, not localized to a particular tooth. Partial or coronary pulpitis pain accompanied by the same symptoms, but without irradiate. For inflamed pulp very characteristic reaction to cold, and unlike caries removal agent that causes the pain, not the pain stops seizures. Only in advanced stages of development of purulent pulpitis replaced pulp sensitivity to cold appears acute sensitivity to hot. Objective symptoms of pulpitis include the presence of carious cavity, which, however, may not always be detected, particularly when located in aproximaly surfaces of the tooth. In such cases, when suspected pulpitis valuable diagnostic tool is the x-ray crowns suspicious teeth.
Course and complications. In the early stages of pulpitis is accompanied by a short attack of pain, appearing once or twice in a few days, weeks. Then pain attacks become more frequent, it also increases the duration of the seizure. Thus, if total pulpitis lucid intervals of a few minutes (hours) often share a long period of acute attacks of pain. With the outcome in gangrene of the pulp pain disappear and pain appear only as the symptoms are complicated with gangrene, right, acute or subacute periodontitis (pain with pressure on the tooth).
For pulpitis is characterized by the presence of spontaneous acute paroxysmal pain. From decay pain differ in spontaneous character from periodontitis - acute, paroxysmal in nature and irradiation without accurate globalizovannosti forms in total. Perhaps mixing the pulp with trigeminal neuralgia. In addition to the presence of caries with pulpitis, differential sign may be the lack of consistency zones radiating pain that occurs in pulpitis contrast to neuralgic pain radiating predominantly in certain branches.
To preserve pulp prediction adversely. In most cases the death of the pulp does not interfere with the preservation of the tooth, if not fatal complications from periodontal. Less favourable prediction in immature teeth, because with the death of the pulp stops further development of the tooth.
The purpose of sedation used cocainizing pulp, searing her with phenol, the imposition of arsenious acid. Technique pain relief: eliminate from the cavity by washing with tepid water and food residues by excavation remove the softened dentin. The thicker the layer of dentin covering the pulp, the more effective will be the analgesic effect of used drugs. After mechanical treatment of carious cavity of the latter is dried and at the bottom of the cavity put the tampon with phenol or cocaine (or stainaway) PAP. Arsenious acid may be applied only in cases, when there is an option not later than 48 hours to open the pulp chamber and remove the pulp. After leaving the cavity in the tooth or other analgesic substances cavity closed bandage impregnated with collodion cotton swab or artificial dentin. If applied it is necessary to eliminate pressure on the pulp, as it intensifies the pain. When properly imposition of cocaine or phenol analgesic effect occurs very quickly - often in the first few minutes. Infection of the inflamed pulp in zaverhseniyu region of the root is suspended by the partial or relatively complete removal of the pulp. The removal of the pulp within the tooth, called the pulp amputation, shown mainly in the coronal pulpitis. Extirpation of the pulp, i.e. the removal to the extent practicable, and also the root pulp, shown in total purulent pulpitis. After amputation or extirpation of pulp remaining stump is treated with antiseptic substances: 3 - -5% formalin solution or camporotondo (equal parts of both ingredients), or liquid Albrecht (2 parts of resorcinol + 2 parts formalin + 1 part of sodium hydroxide). Liquid filling channel, vitreous turns into a dense mass, and serves as a root filling. For sealing of the pulp used soft paste: iodoform, zinc oxide or from a mixture of zinc oxide with iodoform. These powdery substances ex tempore kneaded with camporovere or clove oil, or formalin to the consistency of paste. Preservative and non-irritating action has a fluoride toothpaste. The paste is pumped into the channel through the root of a needle or a filling tool. Then the tooth is filled with a filling material. Thus, treatment of pulpitis in the absence of complications takes 2 - 3 sessions. Proposed method odnorangovogo of pulpitis treatment: under local anesthesia open pulp cavity, remove the pulp and the tooth sealed. Without much evidence to apply this method is not recommended.