The development of caries requires timely treatment and does not tolerate ignoring the problem. The result of inaction and postponing a visit to the dentist in a long box, ultimately, leads to inflammation of the pulp of the tooth. As a result, pain appears, and so severe that the patient is simply forced to consult a specialist. And if the disease cannot be cured by medication, then in this case devital amputation can be prescribed. But what is this procedure?
Pulpitis classification
Before considering the features of the operation in relation to the dental nerve, it is worth getting acquainted with the varieties of the disease.
Depending on the cause, pulpitis can be:
- Infectious. The main reason for almost any inflammatory process lies in the activity of bacteria. Typically, the infection can penetrate from the internal cavity through the dentinal tubules.
- Retrograde. In fact, this is a type of infectious pulpitis. Its difference is that microorganisms penetrate the tooth through a hole in the apex of the root.
- Traumatic. This can lead to any damage to the tooth of a mechanical nature. Moreover, as a result of an impact (chips, cracks, fractures), and as a result of caries treatment (accidental opening with boron).
- Calculus. In this case, the cause of the inflammatory process is a solid formation (denticle) in the internal cavity of the tooth. In another way, it is called a "dental pearl." It can be located near the wall or located in the thickness of the pulp. Denticles are based on an amorphous dentin-like substance. This explains their name. Moreover, the process of their formation is invisible to humans. A “dental pearl” can be detected during therapy or during an x-ray.
In addition, there are acute and chronic stages of the disease. In addition, there may be cases of exacerbation of pulpitis. As for the pulpitis code according to ICD 10, according to the classification of the World Health Organization (WHO) it is K04.
Pulp Amputation Overview
The internal cavity of the tooth is filled with pulp - in fact, it is an organ that is rather complicated in structure. Its purpose is to provide nutrition for dental tissues and, consequently, their growth. This is a whole cluster consisting of nerve fibers, blood vessels, receptors. In fact, the pulp is the dental nerve itself, and while it is safe, the tooth lives.
In the event of a disease of such an important and necessary organ, it is often necessary to remove it. The procedure for completely cleansing the internal cavity of the crown, including the root canals, is called extirpation. However, there is a more gentle operation. Here it is just called amputation (pulpotomy). And in this case, partial pulp removal occurs. That is, it is removed only from the cavity of the crown, and is preserved in the root of the tooth.
Amputation is relevant in case of minor damage to the pulp and severe curvature of the root canals. As a rule, it is performed for pediatric patients, when the roots of the teeth are not yet fully formed. Up to the age of 25 years, the chance of successful treatment with amputation is significantly increased.
There are two types of procedures - vital and devital amputation. Each of them has its own characteristics.
Vital amputation
Currently, in many dental clinics, it is the vital technique that is widely used. In this case, treatment is carried out, as a rule, during one visit to the dentist. A local method of analgesia is applied to patients - conduction, infiltration, intraosseous anesthesia. In most cases, anesthetics with articaine, mepivacaine, lidocaine are used.
An application type of anesthesia can serve as additional anesthesia of the mucosa before injecting. For this purpose, anesthetics based on lidocaine or prilocaine in liquid or gel form are used. And in case of loss of sensitivity under the influence of anesthetic, the dentist needs to remove the tooth nerve at the level of the root canals.
Devital procedure
In the treatment of pulpitis by the method of devital amputation, a special paste is placed in the cavity of the nerve chamber, which leads to a complete violation of its functions, including loss of pain sensitivity. In other words, the tooth nerve is killed. Such drugs are usually made on the basis of arsenic, and it itself is a poison. When it enters the nerve tissue, their hypoxia sets in and the pulp fibers decay.
At the same time, as a result of prolonged exposure to paste with arsenic, necrosis of nearby tissues develops and an inflammatory process of periodontium occurs. For this reason, such a technique has not found wide application in relation to teeth with a permanent bite due to its low efficiency.
As already noted above, the devital procedure is carried out only when the roots of the tooth are at the formation stage. And at the end of their growth, pulp is removed from the root canal. In addition, the technique is applicable to elderly patients.
Arsenic Based Components
Depending on the manufacturer, the composition of arsenic paste for pulp devitalization may vary slightly. However, the components remain the same. The difference lies in their concentration. The main part of the paste:
- Arsenic trioxide or anhydride - the composition of the drug contains about a third of the total volume.
- Local anesthetic - with its help, the pain of an inflamed pulp is relieved. For this purpose, novocaine, lidocaine hydrochloride or dicaine is usually used. The anesthetic itself in the paste is 27-30%.
- Antiseptic. Its presence is due to the need for disinfection of dead tissue and the destruction of pathogenic microflora. Often, thymol, carbolic acid or camphor is used for this purpose. In paste it is added no more than 5%.
- Tannin. It is an astringent component that helps slow the spread of arsenic in the pulp. Due to this, the duration of exposure to the paste can be increased. It contains no more than 1%.
- Special filler. Thanks to him, it is possible to form metered portions in the form of small balls.
In cases where arsenic-based preparation cannot be used to remove pulp (for various reasons), it is replaced by an analog.
As a vivid example, paraformaldehyde composition.
Indications for devital amputation of pulp
The list of medical indications for devital surgery includes the following cases:
- acute and partially serous form;
- acute general serous stage;
- fibrous chronic variety;
- hypertrophically chronic form of the disease;
- exacerbation of the chronic stage of pulpitis, but so far in the absence of acute periodontitis;
- abnormal location of the element in the dentition;
- the size of the inner pulp chamber is too large;
- the presence of a large cleavage that exposes the dental nerve.
Everything else, a similar procedure is resorted to in case of tooth decay or its severe damage.
Contraindications to the procedure
As with any other medical procedure (dentistry is no exception), there are certain contraindications to the method of devital amputation. First of all, it should never be carried out by patients with hypersensitivity to devitalizing agents.
In addition, the procedure is prohibited during the course of pulpitis of a purulent form. In addition, if the root of the tooth has not yet been formed, this is also a direct contraindication.
Carrying out a devital procedure
Each of us is well aware that dental treatment must be carried out in a timely manner to avoid complications. It may reach the loss of a tooth. But only dairy ones are updated, then the constants already grow. And if one of them is lost, then a new one will not appear.
The pulp amputation process is often associated precisely with the beginning of the tooth loss process. After all, after its holding, he loses his vitality. And all because in the absence of connective tissue, nutrition to bone tissue is not delivered. And since there is no nerve, it is impossible to send a pain signal in case of tooth damage. In this regard, many dentists try to save the pulp.
In the case of the appointment of such an operation, it is performed during three visits by a patient to a specialist (at least). The stages of devital amputation themselves are as follows:
- Disclosure of the tooth, the imposition of a devitalizing composition and an airtight dressing.
- The bandage is removed.
- The preparation of the pulp chamber is carried out.
- The visible portion of the pulp is removed.
- The root canal is treated with medication and dried.
- An obstruction of the root canal of the tooth is performed.
- A seal is placed.
A similar technique may be suitable for those patients who are prone to the appearance of an allergic reaction to the anesthetic drugs used in dentistry. Now it is worthwhile to disclose the steps in more detail.
First trick
On the first visit, the dentist conducts an external examination of the tooth and, if necessary, cleans it of deposits. And since devital amputation is rather painful, application anesthesia is used. After anesthesia, the doctor prepares the cavity. The affected dentin is removed, the cavity itself is treated with an antiseptic and dried with a cotton swab.
Then the pulp horn is opened and a special paste is placed on the nerve. Then the cavity is closed with artificial dentin. It is worth noting that during the exposure to the placed paste, pulp irritation occurs, and therefore the pain syndrome may intensify. For this reason, the doctor recommends in such cases to take some kind of pain medication - Ibuprofen, Ketanov, Analgin, Paracetamol.
In the case of using paste with arsenic, the time of the next visit depends on the specific treatment:
- single-rooted teeth - in a day;
- multi-root system (2 or more) - after 2 days.
If, during the treatment of acute pulpitis, a paraformaldehyde composition was used, then the next dose is delayed for a slightly longer period - about a week or two (6-14 days).
Second trick
A second visit is strictly necessary and it is very important here to arrive at the appointed time without delay. Otherwise, the risk of developing serious complications increases. Mostly, everything is connected with the use of paste based on arsenic. It’s poison. But as we found out, the composition also contains other components, among which one will restrain its distribution through the nerve.
Upon arrival of the patient, the doctor removes the temporary filling, and then once again dissects the carious cavity. Part of the pulp is removed from the crown cavity by an excavator or by the dental bur itself, after which it is treated with an antiseptic ("Chlorhexidine").
At the final second stage of the treatment of inflammation of the root of the tooth, the inside of the crown is dried. Then, the healing paste is already placed in the cavity, and once again it is closed with a temporary filling.
Third visit
The third time, the patient is prescribed a reception after a certain period of time (from 3 to 5 days). The doctor removes a temporary seal. After this, it is necessary to cover the pulp stump with thick resorcinol-formalin paste (or “Forfenan”). The bottom of the tooth cavity is closed by an insulating pad. At the end, a permanent filling is already placed and, if necessary, the bite is adjusted.
The procedure for amputation of the dental nerve is quite laborious for doctors. And in relation to patients, it can be very painful and prolonged. It is for this reason that it is necessary to timely treat dental diseases without starting a lesion.
Night Dentistry
Everyone faced a toothache, and one who has passed a similar situation for some reason can be considered lucky. After all, about the pain that occurs in case of tooth damage, he can only guess from the rumors of others. However, such, probably, can be counted on the fingers.
Moreover, the pain syndrome can catch at the most inopportune moment. In such cases, many act wisely, heading to the nearest dental clinic. Even if a tooth starts to hurt during the day at work, you can always get permission from your superiors to leave. But what if the strong and aching discomfort found a person at night?
Today this is no longer a problem, since almost every city (in large cities, for sure) has round-the-clock dental clinics. At the same time, night dentistry, in contrast to a day visit to the clinic, has its own advantages. And above all, there is no big and nervous queue. And if you have your own car, you can get there without traffic jams, although it’s quite difficult and dangerous to drive in this state. Therefore, the best option is a taxi.
Complications
Sometimes after the operation, certain complications may begin. In particular, the following cases are observed:
- Periodontal irritation is a response to separation of a nerve, accompanied by painful sensations. It usually goes away after taking the pain medication.
- Mucosal burn. May occur when devital amputation is not performed correctly. In this case, the affected area should be treated with an antiseptic, as well as anti-inflammatory therapy.
- Perforation of the dental root system. A similar complication is associated with a violation of the technique of dental surgery. The result is a perforation of the root wall. This ends with the development of the inflammatory process, up to the appearance of osteomyelitis.
- The development of traumatic periodontitis. The cause may be getting the filling material beyond the root canal.
At the same time, complications may also arise due to patients' non-compliance with the doctor's recommendations after the procedure. For example, if, at the end of the first stage of treatment (when a special paste is applied), you do not arrive at the specified time for the second stage of treatment of tooth root inflammation, then this threatens the development of periodontitis.
In other words, in any case, it is worthwhile to consult a doctor for qualified help. And even more so in no case should you endure a toothache, hoping not for traditional medicine. Yes, they can bring relief, but this is a temporary measure so that you can reach the nearest dental clinic.