Pulpitis
Description:
Pulpitis — an inflammation of a neurovascular bunch of tooth (pulp).
Classification:
Acute pulpitis
* pulp hyperemia
* serous limited
* serous diffusion
* purulent
* traumatic
Chronic pulpitis
* fibrous
* gangrenous
* hypertrophic (proliferative)
Aggravation of a chronic pulpitis
Konkrementozny pulpitis
The pulpitis complicated by focal periodontitis
Pulpitis symptoms:
Acute focal and diffusion pulpitis.
The main signs of an acute pulpitis it is very strong, irradiruyushchy (extending) on trifacial branches (at an acute focal pulpitis there is no irradiation, the patient can accurately specify painful tooth) pains which amplify at night. Pains have periodic character. Causal tooth is very sensitive to thermal irritants, and pain amplifies and proceeds after removal of an irritant (unlike caries). Percussion (percussion) of tooth is insensitive or insensitive (unlike periodontitis).
Chronic fibrous pulpitis.
These are the most often meeting a pulpitis form which is an outcome of an acute pulpitis.
The complaint to pains from temperature and chemical irritants which do not pass right after elimination of the reason, but the patient of complaints does not show to a thicket, spontaneous pains is absent, and arise only at an aggravation of chronic process. At survey the deep carious cavity, a pulp cavity is opened in one point, sounding is sharply painful. If the painful tooth is under a seal, then after removal of a seal the message with a pulp cavity is found painfully. Tooth percussion painless, but sometimes comparative percussion helps to define a painful tooth.
Transitional fold without change. EOD-35mka. The chronic fibrous pulpitis needs to be differentiated with deep caries, an acute focal pulpitis and a chronic gangrenous pulpitis.
Chronic hypertrophic (proliferative) pulpitis.
At a hypertrophic pulpitis in a carious cavity the hypertrophied fibrous polyp is found.
Chronic gangrenous pulpitis.
The gangrenous pulpitis can proceed with considerable pain, at the same time tooth is sensitive to hot, and cold calms pain.
Pulpitis reasons:
Most often the pulpitis is a consequence of the wrong actions of the doctor (preparation of tooth under orthopedic designs, low-quality seals, operative measures on a parodonta, influence of chemicals), and also to be caries complication, cases of a retrograde pulpitis are also described (that is infection through an apical opening).
Treatment of the Pulpitis:
Serous pulpitises are considered reversible at appropriate treatment (the Ca-containing medical laying under seals, anti-bioteak bandages and so forth) which is directed to alkalization of a pulp cavity, with the subsequent formation of secondary dentine. Indications to this (biological) method of treatment are young age (up to 30 years), absence of chronic diseases and sufficient caries resistance (resistance of tissues of tooth to carious process). Perhaps also partial removal of a pulp (amputation of a pulp), however, is used now seldom, generally in milk teeth and in teeth with not created top (up to two years after eruption).
At treatment of acute purulent and chronic pulpitises mechanical and medicamentous processing of system of root channels (a depulpirovaniye — "removal of a nerve") and sealing (tight obturation) of the channel is made. Removal of a nerve can be carried out both to one visit, and to two. After anesthesia the message with a nerve is created, and on it impose the devitalizing paste (in the people called "arsenic"; actually, it already is practically not used, being the replaced new means — paste on the basis of paraformaldehyde and anesthetic; it it is possible for a week, at the same time, toxicity to leave much lower than it). Or under anesthesia the nerve is removed, in the canal leave medical substance (for antiseptics and removal of an inflammation) in 3 days tooth can be sealed up. During treatment it is necessary to make at least 2 pictures: the first — prior to treatment, for assessment of length and structure of channels, the second — later, for assessment of quality of sealing of channels. Pulpless tooth needs afterwards reinforcing (fixing of a pin from fiber glass, titanium, silver, the ave.) and/or a covering a crown, according to indications.
