Dental pulp necrosis is a disease in which there is necrosis of the cells of blood vessels and nerves in the root or crown of the tooth. This disease occurs as a result of a tooth injury or caries, passing with complications. The disease can pass without any symptoms. However, in most cases, patients report prolonged aching pain, which becomes the reason for going to the dentist. Diagnosis of the disease can be made using x-rays and temperature tests.
Causes of pulp necrosis
Pulp necrosis is a form of pulp inflammation that has been observed for a long time. Necrosis is the death of pulp cells, the final stage of the inflammatory process. This disease can occur in both men and women at any age. It is important to establish the presence of inflammation in the tooth and pulp necrosis in time, since cell death creates favorable conditions for the vital activity of bacteria. In the future, inflammation can go to other areas in the oral cavity.
The causes of pulp necrosis can be very different. They are divided into four main groups:
- Thermal . In most cases, the thermal cause of pulp necrosis is the use of tips without prior cooling when installing prostheses. As a result, tissues overheat and die.
- Chemical . This group of reasons includes the use of too aggressive components during the elimination of caries. This contributes to the fact that the active substance enters the tissues of the tooth, under its influence, a burn of the neurovascular bundle begins.
- Bacterial . In this case, bacteria penetrate into the pulp tissues. When examining a neurovascular bundle, a diverse microflora is found. In most cases, necrosis develops due to exposure to streptococcus and staphylococcus aureus.
- Traumatic . This group includes acute or chronic injuries. An acute injury appears as a result of a single blow, as a result of which the blood supply to the tissues of the pulp chamber decreases or disappears altogether. As a result, tissue cells die. Chronic injury occurs with prolonged exposure to the tooth. Cell death is common in the pathology of tooth abrasion, especially in the presence of habits harmful to the teeth, for example, biting on threads or other materials.
Types of pulp necrosis
To date, in dentistry, it is customary to distinguish two types of pulp necrosis:
- Colliquation . This type of necrosis is characterized by the fact that the affected tissue has a flabby structure. This is due to the content of fluid in tissues and cells in large quantities. As a rule, this type of tissue necrosis occurs when the tooth is affected by pathogenic microorganisms and their metabolic products. Also, sometimes colliquation necrosis of the pulp appears as a complication in the treatment of pathology by the biological method. With this approach, the tooth is directly coated with calcium hydroxide.
- Coagulation . This type of tissue necrosis mainly occurs in the presence of a chronic infection in the oral cavity. As a rule, in this case tissue hypoxia occurs, and then cell necrosis occurs. A similar type of necrosis also occurs with injuries, when there is a violation of blood circulation and cell nutrition.
It is worth noting that both types of necrosis occur without pain. Pain appears only if a special type of bacteria, bacteroids, joins the general process of inflammation. It is their effect on the tooth that gives a painful symptom when eating hot food.
Symptoms of pulp necrosis in the tooth
Pulp necrosis is a disease that often occurs without any symptoms. It is discovered quite by accident in the treatment of other ailments in the oral cavity, x-rays, computed tomography and other procedures. Sometimes patients turn to the dentist with complaints of a gray shade of tooth enamel. In this case, the dentist opens the pulp chamber. The procedure is accompanied by the release of a putrid odor, which is concentrated in the area of inflammation.
In addition, many patients also complain of prolonged aching pain that occurs after eating hot food. In this case, the pain intensifies as the tissues heat up, and then begins to subside as they cool.
How is the diagnosis carried out?
To diagnose pulp necrosis, the doctor performs a series of procedures. First, the patient voices his complaints, a thorough history of the disease is collected. Temperature tests are a good test for pulp necrosis. If there is necrosis of pulp tissue in the tooth, then when it is heated, the patient will feel aching pain, or will not feel anything.
Also, a patient with suspected pulp necrosis is prescribed an x-ray. According to the results, it will be possible to see tissue changes and an increase in the periodontal gap. In addition, sometimes a doctor undertakes a differential diagnosis. Basically, this procedure is prescribed for irreversible pulpitis.
How is pulp necrosis treated?
With the diagnosis of pulp necrosis, the doctor performs endodontic treatment. This method involves the work of disinfection and clogging of open channels in the root of the tooth. Treatment is carried out in several stages (i.e. not at one time).
- Initially, the dentist performs a complete cleaning of the root canals. With the help of manual or machine tools, various contaminants on the walls of the channels are removed. Then they are all thoroughly washed with antiseptic agents. As a rule, special preparations based on sodium hypochlorite are used, which help to remove dead pulp residues.
- Next, the doctor fills the canal cavity with calcium hydroxide. This substance creates a highly alkaline environment, which has a detrimental effect on pathogenic microflora. The patient walks with him for two weeks.
- Then, after this time, a second appointment is scheduled, at which the doctor treats the canals with antiseptic agents. After that, all channels are sealed.
Prevention of pulp necrosis
- In order not to get pulp necrosis in the tooth, you need to regularly sign up for a visit to the dentist. This will help to timely determine the presence of inflammation in the tissues of the tooth and eliminate it without leading to tissue necrosis.
- In addition, if there is a chronic infection in the oral cavity, it is imperative to sanitize it. After all, bacteria are also a common cause of pulp necrosis.
- Due attention should be paid to old fillings. Sometimes they have some violations of the fit around the edges. This process will entail the penetration of pathogenic microflora into part of the root and crown of the tooth. Well, then the inflammatory process will begin, which, if left untreated, can easily lead to tissue necrosis.
The necrosis of the tissues of the root canals of the tooth is an unpleasant phenomenon, accompanied not only by aching pain, but also by unpleasant consequences in the form of darkening of the tooth. This effect significantly affects the beauty of a smile, which is an important point for many. That is why it is necessary to observe some preventive measures.
