Surprisingly, a fact - a disease such as pulpitis, has more than 20 classification approaches. Dentists themselves use various methods of assessing the type of disease during their work, but note that none of them is able to 100% accurately describe all the features of this insidious disease. Dentists note that they need a more convenient and capacious classification of pulpitis, which would allow to characterize the disease from all necessary positions.
Why is pulpitis classified?
The presence of such an extensive systematization of this dental disease is associated with various approaches to attempts to describe the picture of the disease. Different types of pulpitis classifications offer to consider them from different perspectives: the causes of occurrence and development, the clinical picture, progression, the circumstances of the underlying processes in the tooth canals, and others.
The classification from all angles of pulpitis classification has not yet been developed. Therefore, dentists have to embed the existing clinical picture of an individual patient in the framework of existing methods for its evaluation. Some classification schemes were developed decades ago, but are still used in the practice of diagnosis and treatment of pulpitis.
The first attempts to systematize this dental disease were made in the 20s of the last century and were designed to describe pulpitis as accurately as possible. These classifications were quite complex and cumbersome. That is why the specialists conducted continuous work to improve the methods for describing the disease. With a frequency of 5-10 years, a new classification was proposed, which was based on earlier schemes, but had a certain new position in describing the picture of pulpites.
WHO classification
The end of the 20th century, namely 1997, for dentistry was marked by the introduction of the international classification of diseases of the 10th revision, which is known by the abbreviation ICD-10. It was approved by the World Health Organization, and already in 1999 it became widely used in dental practice for the diagnosis and treatment of pulpitis. This system is the name of the codes and their decoding to describe the clinical picture of the disease. The classification of pulpitis according to the ICD includes the following positions:
- It is proposed to designate diseases of the pulp and tissues of the periapical type using code K04.
- The pulpit itself is encrypted K04.0.
- The initial stage of the disease, characterized by hyperemia, is indicated by K04.00.
- Acute pulpitis is proposed to encrypt K04.01.
- If an abscess is detected, then the code K04.02 is affixed.
- The chronic form of pulpitis is indicated by K04.03, and if ulcers are diagnosed, it is proposed to encrypt the diagnosis in the form of K04.04.
- If the patient has a pulp polyp in chronic form, then it is designated K04.05.
- In case of a disease of the neurovascular tissue of a tooth of another specified nature, mark K04.08.
- If the cause of pulpitis is unclear, this is indicated by code K04.09.
- Necrotic or gangrenous phenomena in the pulp are indicated by the code K04.1.
- If the dentist observes degenerative processes, such as denticles, pulp stones or calcifications, then he designates them with code K04.2.
- If there is an abnormal formation of hard tissue in the pulp area, the mark K04.3 is made. Moreover, if it is an irregular (secondary) dentin, then it is indicated by the code K4.3X. It is worth noting that in this situation calcifications and stones in the pulp are excluded.
- With acute apical periodontitis , the cause of which is a change in the neurovascular tissue of the tooth, the code is K04.4.
- If the dentist believes that this is a disease of the pulp and periapical tissues that do not fit into the above items, then he puts the mark K04.9.
This classification of pulpitis according to WHO, according to dentists, is not entirely convenient. However, to this day it is used as an official scheme for compiling statistical reports of specialists on the work done for a certain time period.
The codes and codes for this classification, the doctor is obliged to affix in the card and the patient's coupon. Many dentists admit that often they have to fit the diseases they treat into the framework of the scheme proposed by WHO, although they use completely different convenient ways to characterize dental pathology in their work.
Pulpitis characteristic by its origin
This classification of pulpitis and periodontitis takes into account the causes of this disease. According to this criterion, dentists distinguish 4 types of disease:
- Infectious.
- Traumatic.
- Calculus.
- Drug or chemical.
Let us consider in more detail each pulpitis, the classification of which describes the causes of its occurrence.
Infectious pulpitis
This type of disease is caused by the activity of bacteria that secrete toxins and provoke inflammation of the vascular and nerve bundles of the tooth. In 9 cases out of 10 microorganisms enter the carious cavity inside through the dentinal canals or act on the open surface of the nerve. Retrograde pulpitis is less common when microbes penetrate the tooth through a hole in the apex of the root. This occurs with infectious diseases such as acute respiratory infections, rubella, osteomyelitis, sinusitis, or periodontitis. In isolated cases, infection can be hematogenous. The surest aspect to recognize pulpitis is etiology. Classification by this principle is often used by doctors.
Traumatic pulpitis
It is worth noting that trauma causes a pathological process that can lead to pulpitis. In this case, the sterility of the tooth cavities is violated and their infection occurs with the further development of inflammation of the nerve bundle. Sometimes not the integrity of the tooth is violated, but its correct location (dislocation or subluxation). In this case, pulpitis is closed and progresses without the involvement of microorganisms.
Injuries can be of a domestic nature, can be obtained as a result of an accident or injury, and can be the result of inept medical intervention.
For example, when grinding a tooth “under the crown” pulpitis often occurs as a result of tissue perforation. This phenomenon needs immediate correction. It is very important for the doctor to observe the scheme: pulpitis - classification - clinic - treatment. With the consistent work of a specialist, almost any, even the most difficult case, can be corrected, avoiding a lot of unpleasant complications.
Calculus pulpitis
This type of pulpitis occurs due to some formations in the channels of the tooth - denticles or petrificates. They grow in the cavities of the canals and squeeze the blood vessels. As a result, microcirculation is disturbed, swelling is formed. The consequence is pulpitis.
Drug or chemical pulpitis
This pulpitis classification is usually not described, but in fact it is quite common and is due to medical error. This happens if the dentist uses substances of a potent nature (alcohols or ethers) when preparing the cavity of the caries or periodontal pocket , or a technical error was made when filling.
Platonov classification
Despite the fact that this type of disease assessment was proposed by Professor Platonov back in 1968, it is still used by dentists in practice. This classification of pulpitis and periodontitis has its drawbacks, but is good for its simplicity and convenience. The professor in his methodology combined three approaches: assessment of pathological processes in the pulp, the nature of the course of the disease, and also the localization of unpleasant sensations. This rather simple, but capacious system for assessing the disease was liked by many specialists, which explains its current relevance.
In this systematization, the main aspects of such a phenomenon as pulpitis are considered - etiology, pathogenesis. The classification of the disease according to Platonov is as follows:
- Pulpitis of the acute type: focal form (acute pain, the localization of which is clear to the patient) and diffuse form (indefinite localization, giving along the trigeminal nerve on the face).
- Chronic pulpitis : hypertrophic (proliferation of pulp with filling the cavity of caries), gangrenous (necrosis of the nerve bundle and blood vessels) and fibrous (degeneration of tooth tissue).
- Exacerbation of chronic pulpitis.
This classification and pulpitis clinic greatly simplify the work of dentists, especially in budget clinics. As a rule, in such circumstances, the doctor does not have enough time to find out the causes of a dental ailment. To establish the type of disease, it is enough to ask the patient a couple of questions.
Hofung classification
This method is quite popular among dentists, as it describes the most important aspects of such a pathology as pulpitis - classification, clinic, treatment. It gives an idea of the stages of the disease, takes into account various clinical indicators and the morphology of pulp changes during the inflammatory process. According to this system, the following forms of the disease are distinguished:
- The acute form of pulpitis: partial (reversible, can be cured biologically with preservation of the nerve), general (diffuse, covers the entire pulp and is treated by extirpation), general purulent (extensive and irreversible pulp disorders, treated with vital extirpation with prevention of periodontitis).
- The chronic form of pulpitis: simple, hypertrophic (these two types are very treatable with the ability to preserve the root), gangrenous (destructive type, can be treated by extirpation in several visits to the doctor).
Classification according to MMDS
This method of morphology of the disease of the neurovascular bundle is a direct continuation of the Hofung technique.
Classification of pulpitis MMSI includes an exacerbation of the chronic form of pulpitis and takes into account the peculiarity of inflammation in the tooth previously treated. According to this morphology, the disease is divided into:
- Acute forms of pulpitis: focal or diffuse purulent, serous.
- Chronic types of pulpitis: gangrenous, fibrous or hypertrophic.
- Exacerbation of the chronic form of pulpitis: fibrous or gangrenous.
An exacerbation of the gangrenous type of pulpitis can cause periodontal complications, since anaerobic microflora actively develops in it. If partial removal of the nerve does not solve the problem of inflammation, complete extirpation or repeated mummification of the channels usually completely solves the problem.
Grape classification
Pulpitis in children is classified according to the system of Professor Vinogradova, which offers a clear separation of diseases of temporary teeth from permanent ones. The doctor explains that inflammation in milk and molars proceeds differently. The professor recommends taking into account the specifics of the location of the tips of the temporary teeth and insists on refusing to completely pass the canal with the treatment method. This can damage the rudiment of a child’s permanent tooth.
The classification of pulpitis in children includes the following items:
- Pulpitis of milk teeth of an acute nature: serous (proceeds quickly, the focal form becomes diffuse), purulent (quickly covers the entire pulp and can become chronic).
- Pulpitis of a permanent row of teeth of an acute nature: acute serous general or partial, acute purulent general or partial.
- Chronic pulpitis of a temporary and permanent row of teeth: simple, proliferative or hypertrophic, gangrenous.
- Exacerbation of the chronic form of pulpitis of temporary and permanent teeth: most often occurs against the background of simple chronic pulpitis.
The peculiarity of the inflammatory process in the temporary tooth is that with a high probability the process will spread to the interroot space.
This is because dentin in this zone has a high degree of permeability. This phenomenon is dangerous, as it can provoke disturbances in the formation of the anlage of the molar, change the period of its eruption, and reduce its resistance.
Chronic pulpitis of temporary teeth is characterized by the fact that they can occur as primary forms, bypassing the acute phases. They can be asymptomatic, but insidious in that they quickly spread to periodontal tissues. Therefore, you should carefully monitor the condition of the oral cavity of children and do not neglect the treatment of milk teeth.
Features of the treatment of pulpitis
The classification of pulpitis treatment methods is directly related to the diagnosis. It is on the skillful identification of the degree of complexity of the disease that the success of therapy will depend on.
If a call to the dentist was made at the beginning of the development of pulpitis, then the doctor produces a biological method for its treatment. It consists in the following: the nerve is not removed from the tooth, a special calcium-containing and antihistamine preparation is used. As a result of such treatment, inflammation in the pulp goes away, and replacement dentin is formed. A seal is applied to the cleaned carious cavity.
If timely treatment to the doctor did not occur, then the possibility of biological treatment was missed. At this stage, the dentist will have to figure out which patient has pulpitis. The concept, classification and diagnostic methods will help to do this as accurately as possible.
Quite often, a method of partial pulp removal is used. Under the influence of anesthesia, part of the nerve is removed at the crown level, while the root zone remains viable. After this, a preparation with calcium is laid, and the tooth is filled. If necessary, physiotherapy is carried out, anti-inflammatory therapy is prescribed. This method is recommended for children whose tooth tips are not yet formed enough.
As dental practice shows, in most cases, complete removal of the nerve is used. This can be done under anesthesia or by applying a devitalizing paste containing arsenic. This substance is very toxic, and the bandage should be removed at the exact time prescribed by the doctor. After this,
endodontic treatment is performed
, during which the gutta-percha
tooth canals are filled .
After such treatment, an x-ray is taken to control the quality factor of the manipulation performed in the channels. If they are filled to the top, a seal is applied.
In the case of almost complete destruction of the tooth, the doctor uses a pin stump tab on which the tooth is restored. Each specialist will say that it is guaranteed to help determine pulpitis classification. Treatment is a logical continuation of a thorough diagnosis of the patient’s teeth.
A visit to the dentist in the early stages of pulpitis is beneficial to the patient himself. Treatment at this phase is almost painless and inexpensive. If you start the disease, then periodontitis may develop, which is much more difficult and longer to treat.