When we have a toothache, most often this is a consequence of inflammation of its pulp. Pulp (from lat. pulpa - soft) is a living and sensitive tissue of the tooth. Unlike dentin (hard shell), the pulp contains living cells - odontoblasts, as well as blood vessels and nerve fibers. Their function is to create hard tissue.
Causes of pulp disease
There are several reasons for pulp disease. This may be chemical damage, errors in plaque treatment technology, or overheating during the preparation procedure. But the main reason, of course, is the spread of plaque and caries.
Caries negatively affects dentin. Its accumulations destroy the shell with toxic substances, and the dental pulp remains defenseless against bacteria. Its inflammation is called pulpitis, which requires immediate treatment.
Types of pulpitis
Depending on the stage of pulpitis, its types can be distinguished:
- spicy;
- acute purulent;
- chronic form;
- chronic hypertrophic form;
- chronic gangrenous form.
Acute pulpitis is characterized by pain when exposed to an irritant. Timely treatment and filling of damaged dentin eliminates inflammation. But without treatment, inflammation of the pulp takes on a dangerous chronic course. The pulp may enlarge and bleed.
With hypertrophic pulpitis, granulomatous growths and incipient changes in the lymphatic vessels and blood channels are observed. In the last stage, the nerve may turn into fibrous tissue. Connective tissues gradually die off, and there is also a risk of losing a tooth.
In addition to pulpitis, other damage to the living tissue of the tooth is also isolated.
Reactionary changes in the pulp
We list their main manifestations and causes.
Circulatory disorders in the pulp
There are several pathological processes in the blood flow of the pulp:
- in acute pulpitis, the phenomenon of hyperemia is observed. That is, the inflow of blood prevails over its outflow;
- edema;
- intrapulpal hemorrhages;
- thrombosis;
- vascular embolism;
- pulp ischemia.
Doctors believe that some circulatory disorders in the tooth are associated with a protective function. For example, the edema that occurs with hyperemia should restrain the development of pulp inflammation.
Atrophic and dystrophic changes
These phenomena can occur either as a result of pulpitis, or on the basis of impaired metabolism. The course is characterized by the fact that odontoblasts and connective tissue cells (pulpocytes) gradually die. As a result, the soft tissue of the tooth becomes "mesh".
tissue necrosis
Necrosis is painless. But this is the last stage of inflammation. If the inflammation is not eliminated in advance, the tissues begin to gradually die off. When the cells die from the mouth, an unpleasant odor is felt.
Appearance of denticles
Denticles are hard formations directly inside soft tissues. It is observed with a long chronic course of pulpitis. To date, there is no exact explanation of the reasons for their appearance, but there is an assumption that these "growths" contribute to the isolation of dead pulp cells from still living ones. It is pointless to remove them, to treat too. In some cases, their presence interferes with any dental procedures.
Intrapulpal cysts
Cysts are cavities in tissue. They can occur for various reasons. They hit the walls of blood vessels. Sometimes they get to the collagen fibers.
Calcifications
Calcifications are sometimes also referred to as a disease of the pulp. These are a kind of calcium capsules that fill the connective tissue of the pulp. Although these formations of calcium can form in any soft tissue of the body. Calcifications are absolutely not treated, but in some cases they can resolve themselves.
Diagnosis of diseases of the soft tissue of the tooth
There are several ways to find out what is happening inside the tooth. Diagnostic methods allow you to determine the degree of inflammation and choose the appropriate method of treatment.
- Electroodontodiagnostics (EDI). By passing a certain amount of current through the tooth, one can judge the reaction of its nerve fibers to the pathogen. A decrease in the electrical excitability of a tooth indicates that it is affected by pulpitis, periodontal disease or periodontitis. A decrease in the reaction to 100 μA indicates damage to the root pulp.
- Thermodiagnostics . Aching pain in the tooth with a change in body temperature by 6–7 ° C will indicate one or another kind of inflammation. This method in dentistry is very old, and therefore time-tested.
- X-ray of the jaw . On x-rays, you can see the deformation of the periodontal gap, the cavity from caries, or the presence of denticles.
- Rheodentography (RDG) captures the pulse of blood flow in the examined tooth. Comparing the pulse in a healthy and inflamed tooth, the doctor can give his opinion.
Pulpitis treatment
To begin with, the doctor needs to provide all the information he needs. The history of your illness is called an anamnesis. What is the nature of the pain - paroxysmal or prolonged, aching or possibly sharp. All information about your condition is essential for a correct diagnosis and is essential for treatment. Elimination of inflammation of the pulp provides for biological, surgical and biological-surgical.
With the biological method of treatment, the actions of the doctor are aimed at preserving the pulp and restoring the hard shell. If it is not possible to restore the pulp, its upper coronal part is removed. The cavity left after the amputation of the pulp is filled with a therapeutic ointment. And then a permanent filling is placed. This is a biological-surgical treatment.
With complete surgical removal of the pulp, the risk of complications is the least. The doctor completely removes the root pulp, and the tooth actually dies. But at the same time, the process of intoxication can be stopped.
If the inflammation is not treated, a number of complications can occur over time, such as:
- abscess;
- acute periodontitis;
- inflammation of the bone tissue;
- bone marrow inflammation.
Prevention of pulpitis
As a preventive measure, dentists are strongly advised to monitor the condition of the oral cavity. At the first symptoms of inflammation (pain when chewing, hypothermia), it is better to come for an examination to the dentist, who will give timely recommendations on caring for your teeth. These recommendations include brushing your teeth twice a day with products that suit you. In general, an annual examination is necessary, as over time the dentin shrinks and becomes vulnerable. Therefore, it is better to visit the dentist before a long and difficult treatment of severe pulpitis is required. Remember this.
