Pulpitis
Pulpitis is an inflammation of the
neurovascular bundle of the tooth.
⚫ Most often, pulpitis is
a complication of
caries, and can also
be a consequence of
incorrect actions by
the doctor; cases of
retrograde pulpitis
have also been
described.
Causes (physical)
⚫ pulp overheating;
⚫ opening the tooth cavity during
preparation of a carious cavity;
⚫ traumatic fracture of the tooth crown with
opening of the pulp chamber;
⚫ denticlesAndpetrifications;
⚫ pronounced pathologicalwashabilityteeth.
Causes (chemical)
⚫ failure to maintain the exposure of the
etching gel required for adhesion of most
composite materials and someglass
ionomercements;
⚫ poor quality (incomplete) rinsing of the
etching gel;
⚫ the use of strong antiseptics in the medicinal
treatment of the formed cavity in the
treatment of caries;
⚫ toxic effect of filling material.
Causes (biological)
⚫ as a complication of the carious process;
⚫ penetration of microbes from the carious
cavity through the dentinal tubules after
preparation, when taking an impression
under pressure (a very rare way);
⚫ retrograde pulpitis.
Sources and routes of infection
⚫ Intradentally
⚫ Retrograde
⚫ Tooth injury;
⚫ Trauma to the anterior teeth in children;
⚫ Careless or rough mechanical treatment of a carious
cavity;
⚫ Hematogenous route.
Classic variant of the development of
pulpitis after deep caries
Clinical classification:
[Link] pulpitis
⚫ Partial pulpitis
⚫ Diffuse pulpitis
[Link] pulpitis
⚫ Fibrous pulpitis
⚫ Gangrenous pulpitis
⚫ Hypertrophic pulpitis
Acute pulpitis
Chronic fibrous pulpitis
Chronic gangrenous
pulpitis
Chronic hypertrophic
pulpitis
Acute focal pulpitis
This is the initial stage of the disease. The source of
inflammation is located near the carious cavity.
Symptoms of focal pulpitis: sharp spontaneous pain that
lasts from several minutes to half an hour. It may
subside for 3-5 hours and sharply intensify at night.
Unpleasant sensations in a diseased tooth that occur in
response to exposure to irritants do not go away for a
long time.
The patient can clearly indicate which tooth hurts.
When probing, a sharp pain is noted at one point, often
in the area of the horn of the tooth pulp. In this case, the
tooth cavity remains unopened.
Acute diffuse pulpitis
at this stage the inflammatory process covers the entire
pulp. Prolonged attacks of severe pain occur. Periods
of decreased discomfort become short-lived. When the
process turns from serous to purulent, the pain
intensifies and becomes constant. A person begins to
feel pain in the temple, ear and the entire half of the
jaw on which the tooth with pulpitis is located. Hot
heat makes the pain stronger, but cold may ease it
somewhat. This indicates that the inflammation has
entered the purulent stage.
Acute diffuse pulpitiscan last from 2 to 14 days. Then
the process enters the chronic stage.
Treatment
⚫ Conservative method- with this method of treating pulpitis, the
viability of the pulp is preserved. This method is effective for young
people and is used if pulp diseases are reversible - for example,
traumatic pulpitis. The treatment is exactly the same as the treatment
of caries. Particular attention is paid to medicinal treatment of the
affected cavity. For this, antiseptic drugs, antibiotics and proteolytic
enzymes are used, with the exception of potent drugs, alcohol and
ether.
⚫ Surgical method -With this treatment method, the inflamed pulp is
removed and the root canal of the tooth is filled with filling material.
With this method, pulp removal can be done in two ways:
Vital- indications for its use are all forms of pulpitis. Pulp removal
occurs under general or local anesthesia.
Devital – when using this method, pulp removal occurs
afternecrotization, that is, killing the nerve.
Complications
Periodontitis
Pulp necrosis
Periapicalabscess
If the infection spreads through the bloodstream:
•Purulent sinusitis
•Meningitis
•Brain abscess
•Periopharyngeal abscess