Inflammation of the dental nerve, i.e. pulp, is called pulpitis. A similar disease appears due to mechanical damage to the crown of the tooth or medical errors when filling. However, the most common cause of pathology is an advanced state of caries.
What a dental nerve looks like is interesting to many. The development of pulpitis is caused by infection in the pulp cavity (chamber). Malicious microbes (staphylococci, streptococci and lactobacilli) inhabit the pulp, moving there from a deep focus of caries.
Bacteria penetrate in various ways: enamel cracks, dentinal tubules, etc.
Why is pulp inflamed?
The pathogenesis of inflammation of the dental nerve is often caused by a bruise or fracture of the tooth crown, inaccurate opening of the tooth cavity by the dentist during treatment. In this case, a traumatic pulpitis occurs.
Another cause of the pathology is a retrograde infection that enters the root canals through the apical foramen. Retrograde pulpitis, as a rule, appears on the background of otitis media, periodontitis and other chronic diseases of the oral cavity.
Often, inflammation of the dental nerve (pulpitis) occurs due to medical errors:
- the toxic effect of therapeutic agents used for filling;
- the use of excessively concentrated antiseptics during the treatment of the tooth cavity;
- overheating of the pulp, for example, with a dental preparation under a prosthesis or photobleaching of enamel.
The essence and etiology of pulpitis
Inflammation of the dental nerve, or pulpitis, appears under the influence of various stimuli: temperature, chemical, mechanical and infectious.
- Infectious. It occurs when the infection penetrates the dental pulp. This can happen for various reasons. Bacteria most often enter the pulp through dentin, thinned by severe caries. This can be avoided if you go to a specialist in a timely manner and cure tooth decay. Another retrograde method of infection through the root apex during periodontal disease or periodontitis, when the pockets of the gums are greatly enlarged or the inflammation proceeds near the tooth (periodontitis, osteomyelitis, sinusitis, etc.). Through the lymphatic and blood channels, the infection can also enter the pulp from other organs.
- Iatrogenic. This is a consequence of a mistake made by the dentist in the treatment of caries or its complications. Prolonged treatment of the cavity of the caries with a drill with insufficient cooling with the help of water provokes overheating of the pulp with its further inflammation. The same mistake can be made with rough dental preparation under the crown. In addition to the influence of high temperatures, the process of inflammation can develop due to the treatment of root canals with potent antiseptics, the use of pads containing a lot of alkali, filling allergenic materials and agents without taking into account the allergic reactions of a person.
- Traumatic. Sports, work-related, and domestic injuries can cause pulpitis to progress and, worse, pulp necrosis. Small cracks and chips without opening the pulp are able to pass bacteria into the tooth. In this situation, manifested pulpitis appears.
Dissection of the pulp
An even more serious case is when opening the pulp. Dislocation of the tooth, fracture of the root or crown, opening of the pulp accidentally when grinding the tooth before installing the crown or in the treatment of caries often causes post-traumatic pulp necrosis or acute inflammation. In the most difficult situations, the patient is already diagnosed with complete necrosis after a week.
What the dental nerve looks like can be seen in the figure.
Excessive tooth abrasion due to malocclusion or bruxism is fraught with subsequent exposure of the pulp horn. In some cases, pulpitis is the result of the installation of a very large filling, as well as the pressure of petrifikates or denticles (dentinal-like formations in the tooth root or crown). They contribute to the violation of microcirculation and compress blood vessels and nerve endings.
Symptoms of pulpitis
The main symptom of inflammation of the dental nerve is aching spontaneous pain, worse at night.
Initially, the pain syndrome appears several times a day and lasts a maximum of twenty seconds. However, over time, unpleasant sensations become more frequent, become continuous, their character is radiant, that is, pain can be given to the chin, temple or ear. In some cases, it seems to a person that half his jaw hurts. Symptoms of inflammation of the dental nerve should not be ignored.
It is very easy to see the difference between caries and pulpitis. If there is a carious focus, unpleasant sensations appear only when external factors influence (when chewing food or when brushing your teeth). With pulpitis, the pain most often does not depend on various kinds of mechanical stimuli, it occurs unexpectedly.
Pulpitis Forms
Pulpitis by the nature of the inflammation process can be as follows:
- Acute is the first inflammatory stage, lasting from three to five days. Inflammation at this stage only affects the coronal portion of the pulp.
- Chronic - with untreated acute pulpitis, it develops into a chronic form. The nerve of the tooth begins to die off gradually, dead tissues accumulate in the tooth cavity, while the pain is either absent or mild. May periodically worsen.
By location of inflammation:
- pulpitis under a filling is a secondary caries that forms under a filling;
- deep root pulpitis - the spread of infection occurs along the entire length of the root canal and is able to leave the limits through the apical opening (apex);
- two-channel and three-channel pulpitis - the process of inflammation develops in premolars and molars, capturing the root canals, as a result of which the dental task is complicated.
Pulpitis of temporary teeth is also a frequent occurrence. Children's milk teeth have an extensive pulp chamber and weak enamel, therefore, the inflammatory process of the dental nerve is characterized by rapid development. The danger lies in the fact that the infection can penetrate into the tissues near the tooth, and also harm the rudiments of permanent teeth.
Types of Acute Pulpitis
- Diffuse - affects the entire root and crown part of the pulp. Unpleasant sensations last 10-15 minutes, appear once every few hours. Unpleasant symptoms intensify when the patient lies.
- Focal. Inflammation affects only the upper part of the tooth. A similar form is characterized by severe paroxysmal pain that spreads along the branches of the trigeminal nerve. In some cases, gum edema and inflammation of the submandibular local lymph nodes appear.
- Serous. Acute pulpitis in advanced form, develops by 3-4 days. Throbbing spontaneous pain lasts almost all the time.
- Purulent. A purulent lesion appears in the tooth cavity. When heat is applied, unpleasant sensations intensify, uncomfortable sensations are removed from the cold. Body temperature can rise to 38 degrees, overall health worsens.
Varieties of chronic pulpitis
- Hypertrophic, which is accompanied by the expansion of the polyp (granulation tissue), sometimes beyond the carious cavity. There is bleeding from the tooth when eating. In this case, the crown is destroyed, when tapped, it does not hurt, does not respond to cold.
- Fibrous. The most common type of pathology. The pain syndrome most often does not bother the person, however, a reaction to the hot or cold may appear. Pulp on palpation bleeds. This stage lasts about 2-3 months.
- Gangrenous. Pulpitis in severe form, characterized by decay (necrotization) of the pulp. The enamel of the inflamed tooth becomes darker, a putrid bad breath appears, the person's reaction to the hot intensifies. It can develop both in the closed and in the open cavity of the tooth.
It happens that the nerve in the wisdom tooth hurts.
Pathology of the wisdom tooth
Like the rest of the teeth, the eights are also exposed to negative factors, only more often. Since it is difficult to get to the third molars, it is impossible to do a good cleaning. Bacterial plaque quickly appears on them, caries and its consequence develop, that is, pulpitis.
The clinical picture is standard - unbearable pain, fever, etc. The treatment of wisdom teeth is carried out with arsenic, which kills the inflamed pulp. However, such therapy is rarely prescribed, the "eight" is most often simply deleted.
Complications
For pulpitis, immediate treatment is needed. If it is absent, significant complications may appear. Bacteria eventually go beyond the root canal, deep periodontal tissues become inflamed.
The likelihood of the appearance of such pathologies increases:
- inflammation of the periosteum (flux);
- purulent type of inflammatory disease of the jaw bone - osteomyelitis;
- purulent abscess in the oral cavity - an abscess;
- a dangerous pathology in which purulent exudate affects soft facial tissues - phlegmon.
How to kill a tooth nerve? Let's figure it out.
Pulpitis Treatment
In the past, pulpitis was treated only by removing the affected tooth, but nowadays, the latest technology often allows you to save it even with this disease. In some situations, when the patient comes to the doctor with a slight inflammation, it turns out to save the pulp whole or at least part of it without loss of functionality.
As a result of the treatment of inflammation of the dental nerve, the pulp either remains or is partially or completely removed. Depending on the stage of the disease, the dentist uses surgical or biological methods of therapy.
- Surgical method. Used when pulp storage is simply not possible. Nerve removal and filling is performed.
The pulp in this situation is removed partially or completely. However, the preferred option is to preserve at least a small portion of the nerve, since the "dead" tooth is most often more fragile and undergoes destruction faster.
Fully or partially pulp is removed using devital and vital methods. In the first case, it is eliminated without prior treatment with drugs or toxic drugs. For devitalization, a special medication is put inside to kill the pulp, and only after that it is removed.
How to kill a tooth nerve? Stage of partial or complete removal:
- local anesthetic injection;
- dental preparation with removal of affected tissue;
- complete or partial removal of pulp;
- treatment with an anti-inflammatory agent and application of medication to the mouth of the canals and pulp, installation of a temporary filling;
- root canals are sealed;
- a photopolymer permanent seal is installed.
Preventive measures
With pulpitis, prevention consists of high-quality hygienic care of the oral cavity and timely treatment of caries.
To determine the carious lesion on time, you need to contact the dentist twice a year and conduct preventive examinations. In addition to home brushing, it is advisable to carry out professional removal of deposits at least once every six months.