Our teeth are not only dense organic tissues covered with hard tooth enamel. Hidden inside each tooth is a complex system of blood vessels and nerve endings, which is necessary to maintain the health of the dentition. The sensitivity of soft tissues in the oral cavity is tens of times greater than the sensitivity of other organs. Therefore, any infection that gets inside the tooth causes inflammation and severe pain. Pathology is also provoked by temperature changes: burns or hypothermia. Unbearable pain forces a person to treat pulpitis and seek help from a dentist.
Will we treat him or let him live?
Often the fear of doctors forces us to make do with improvised methods. We take painkillers, fast, endure, in the hope that the sharp pain will go away on its own. Is it really possible to “wait out” an exacerbation, or is it better to get professional help in time? Let's figure it out.
To find the right method of treating a disease, you need to know the origins of its occurrence. The core of the tooth, or pulp, is responsible not only for tooth sensitivity, but also for the production of dentin. The tissue strengthens the tooth from the inside.
The anatomical features of the pulp depend on the type of teeth. In the lateral row, as a rule, there is a chamber with three dental canals. The front row and incisors each have one branch. It is logical that molars are much more difficult to treat than canines or premolars.
Pathological changes in the pulp tissue form swelling, causing unbearable pain. The pain intensifies upon contact with hot food or when pressing on the tooth.
Prerequisites
The most common cause of inflammation of the dental nerve (pulp) is the presence of caries. And in a deep stage. The infection reaches the soft tissues through the destroyed tooth tissue, provoking an inflammatory process. A similar situation occurs when a filling falls out or is damaged, when the pulp is “exposed.”
Bacteria can enter the tooth cavity from another source of infection in the body. Inflammation also occurs when a tooth is injured, minerals accumulate in the pulp, or low-quality components are used when filling canals.
Also, treatment of pulpitis may be required if the nerve overheats during preparatory procedures for prosthetics. If there is increased sensitivity, swelling of the pulp can be caused by the use of chemicals during therapy. It is also possible that an infection may accidentally enter the pulp chamber when eliminating a carious cavity.
What is pulpitis?
Pulpitis is inflammation of the dental pulp. Most often, this disease is caused by dental caries. Inflammation of the dental pulp can also develop as a result of dental trauma when the enamel or crown of the tooth breaks. The habit of grinding your teeth (bruxism) can also contribute to inflammation of the pulp. The disease can also be caused by multiple procedures performed on a single tooth (eg, grinding teeth in preparation for crowns or denture bridges, excessive pulp exposure when treating a deep tooth defect).
What is dental pulp?
Pulp is the internal tissue that contains the blood vessels and nerves of the tooth. A healthy and living pulp is a kind of protective barrier; it protects the body from the penetration of harmful bacteria. On the other hand, when a tooth becomes infected, the inflamed pulp becomes a spreader of the disease.
Phases of the disease
Classification of any disease contributes to quick and correct diagnosis and selection of an effective treatment method for the patient. In the case of pulpitis, everything is relatively simple, there are only two subtypes - acute and chronic.
The first type of inflammation occurs with advanced forms of caries. Bacteria destroy tooth enamel and dentin, and the infection enters the pulp. The disease is accompanied by aching, sharp pain, which intensifies with mechanical or thermal effects on the tooth. Severe pain attacks may occur at night.
Interestingly, only adults are susceptible to acute pulpitis. The anatomical structure of a child’s jaw protects him from illness.
This type can be focal or diffuse. Focal inflammation is characterized by local damage to the pulp, located close to the carious cavity. Accompanied by throbbing pain around the affected tooth. Lasts approximately 2-3 days.
Then the process moves to the next stage - damage to all tissues of the dental nerve. The pain syndrome changes from pulsating to constant, unpleasant sensations spread to the entire jaw. Pus forms in the tooth cavity. The phase lasts no more than two weeks. If timely treatment of pulpitis is not started, the pathology enters the chronic stage.
What else can be used - alternative methods
Traditional medicine offers many tips on how to quickly relieve acute symptoms of pulpitis. For example, on the Internet you can find recipes using sprouted wheat grains. They are used to prepare porridge or jelly, which is recommended to be consumed internally every day. Another rather controversial remedy is a garlic compress, which is recommended to be done on the inside of the wrist, opposite the side where the pain comes from.
Alternative solutions to the problem include treatment methods using laser equipment and physical therapy. After complete cleansing of the carious cavities, removal of all anesthetized tissue and restoration of the affected tissue, the tooth is filled.
Eliminate cannot be deleted
A term that patients in all fields of medicine fear is chronic disease. Let's see what the consequences are in our case. Inflammation of the dental nerve with chronic pulpitis lasts from a month to several years. The pain syndrome remains, but becomes less pronounced. Seizures occur periodically. The patient can no longer chew on the side of the diseased tooth. The affected nerve begins to bleed and dentin continues to deteriorate. Chronic pulpitis is also characterized by several phases:
- Fibrous. Relatively “easy” stage. It occurs when carious tissues are not located close to the dental nerve. Unpleasant sensations occur only when you press on the tooth.
- Gangrenous. The pulp tissue is completely infected. The nerve changes color. The pain becomes more noticeable. The tooth is deeply affected by caries.
- Hypertrophic. Bacteria destroy the tooth down to the pulp chamber, connecting both cavities. A polyp grows in the vacated space, causing the nerve to bleed. The pain syndrome persists.
- Exacerbation. The final stage of the disease, when the patient is attacked by periodic attacks of pain, combined with constant aching unpleasant sensations. Pus appears in the tooth cavity, inflammation spreads to the tooth root, and periodontitis develops.
In 90% of cases, doctors treat fibrous pulpitis, less often - the second stage. In general, chronic inflammation is an irreversible process. The only solution is to remove the damaged dental nerve.
Consequences of depulpation
Sometimes patients experience severe pain after depulpation. There may be several reasons for this phenomenon, and here are some of them:
- individual reaction of the body to dental intervention - you need to wait a little, and the pain will disappear by itself,
- mistakes made by the dentist - incompletely cleaned canals or removed nerves, poor quality of filling, use of several types of filling materials at once,
- inflammation of soft tissues – may result from damage to the gums during treatment,
- painful sensations in a neighboring tooth can radiate to the healed tooth and thereby confuse the patient.
If after removing the pulp you experience obvious pain, which also does not subside, you should contact your dentist again. If this is a natural reaction to treatment, your specialist may suggest additional anti-inflammatory measures. If the problem is complications, you will have to unfill the tooth and eliminate the cause of the problem.
Survey
To determine an accurate diagnosis, the dentist conducts an initial examination. Because If pulpitis develops against the background of other diseases, then diagnosis includes 4-5 stages. The procedure begins with communication with the patient. It is important to understand at what stage the inflammation is, which is especially important in chronic pulpitis. Therefore, the doctor asks you to describe in detail the nature of the pain. Then a “manual” examination is carried out using medical instruments (dental mirror, etc.). Additionally, the doctor checks the sensitivity of the affected tooth for temperature changes and exposure to a weak electric current charge.
The examination is completed by an X-ray examination to assess the condition of the dental nerve and canals. After collecting information and analyzing the image, the doctor plans the pulpitis treatment process and coordinates it with the patient.
How to deal with the disease
At the initial stage, it is not difficult to cope with pulpitis. The nerve in the tooth is preserved, and the doctor relieves the inflammation using therapeutic procedures.
The biological treatment method eliminates inflammation through antibacterial treatment of the damaged tooth, without removing the nerve. After removing carious tissue and disinfecting the pulp chamber, the dentist applies a compress with calcium hydroxide and fixes a temporary filling.
Then, after 3-7 days, during a follow-up visit, the doctor takes an x-ray. If there is no inflammatory process, then a permanent filling is installed. However, this technique requires a highly qualified doctor, so it is rarely used. For example, with traumatic inflammation of the dental nerve.
Preserving the pulp is important because... If it is present, the tooth is constantly strengthened due to the production of dentin. Conservative therapy has age restrictions - it is carried out up to 30 years.
Treatment of pulpitis at the GALA DENT clinic
When we talk about the treatment of pulpitis, we mean the treatment of tooth canals, or, as they also say, endodontic treatment. Its task is to first remove the infected, inflamed pulp, and then clean and disinfect the tooth canals.
You can do this in two ways:
Conservative method, preserving the “nerve” of the tooth.
This treatment method is used much less frequently, because... gives an unstable forecast. It is possible to save the pulp only if its inflammation was minor and partial, or the opening of the pulp chamber occurred spontaneously and the pulp was not inflamed at all. In this case, the doctor applies a special treatment composition to the exposed areas of the pulp, which “preserves” the nerve, creating a protective layer. After which a seal is placed on a special gasket.
Using a surgical method, with the removal of the “nerve” of the tooth - depulpation.
In this case, complete removal of the pulp can be carried out:
- “alive” - a vital way to treat pulpitis,
- after preliminary mummification of the pulp with a special preparation - a devital method of treating pulpitis.
- Our doctors prefer to treat pulpitis for our patients in 2 visits using the method of devital extirpation with removal of the mummified “nerve”.
This method does not require excessively strong anesthesia and provides a stable long-term prognosis.
On the first visit, under ANESTHESIA, the doctor cleans the tooth cavity from destroyed tissue, opens the pulp chamber and applies a special arsenic-free paste to the pulp to mummify the pulp for about 7 days. A temporary filling is placed on top.
After 7-10 days, at a second appointment, the already dead pulp is removed - depulpation is carried out, after which the tooth canals are cleaned and disinfected.
Next, the tooth canals are filled with gutta-percha and a permanent filling is installed with restoration of the chewing surface.
The quality of canal filling is controlled by x-ray.
If the crown of a tooth is severely damaged, it will need to be restored using an inlay or a crown. The prosthetic stage is very important in order to strengthen the tooth and prevent its destruction.
Partial and complete nerve removal
Partial extraction of the pulp is also acceptable if the coronal component of the nerve is separated from the root. To prescribe surgery, there must be a large volume of intact periodontal tissue.
The procedure is performed under anesthesia for patients under 45 years of age.
In practice, pulpitis is treated surgically. The nerve is completely removed, which saves the patient from relapse and re-treatment.
Pulp removal occurs in two ways:
- Extraction of living nerve.
- Preliminary killing of the pulp (devitalization) with further removal.
In the first option, all work is carried out in one session. The dentist removes the affected tooth tissue, thoroughly disinfects the cavity, and then removes the inflamed nerve. At the final stage, a filling is installed.
If it is not possible to remove the living nerve from the tooth, it is treated with medical paste made from arsenic or paraformaldehyde. After 1-2 days, the pulp dies and is painlessly removed. Patients cannot always visit the doctor the next day; in this case, the dentist fixes a less concentrated composition for up to two weeks. A temporary filling is placed on top. During the next visit, the doctor treats the canals with an antiseptic and fills the tooth. Important: this method of treating pulpitis is not applicable in the presence of pus and dead tissue in the pulp.
First visit:
Anesthesia or is it painful to remove a nerve from a tooth?
How painful is it to treat pulpitis: It is definitely very painful if you decide to do it without anesthesia. Fortunately, modern anesthetics can completely solve this problem. If you still feel pain after anesthesia, this may be due to the anesthetic not being strong enough or the anesthesia technique being used incorrectly. The latter usually happens when the doctor tries to anesthetize large molars in the lower jaw (mandibular anesthesia, which is complex in technique, is performed there).
An example of anesthesia (video) –
Drilling out all carious tissues with a drill -
Firstly, at this stage all carious tissue is removed. Secondly, healthy tooth tissues are also partially removed, namely all tooth tissues above the pulp chamber and the mouths of the root canals. This is necessary to ensure visualization of the root canal orifices and ease of their processing with instruments. In Fig. 6-7 you can see the boundaries of excision of hard tooth tissues in the treatment of pulpitis. Figure 8 shows a view of the root canal mouths after they have drilled into the required amount of tooth tissue.
Tooth isolation from saliva –
This is done using a rubber dam. Isolation is necessary to prevent infection from the oral cavity from getting into the root canals along with saliva. This is standard international practice, but in Russia a rubber dam can often be seen only when a doctor fills a tooth. Normally, any work with root canals should be carried out using a rubber dam.
Removal of pulp from the tooth crown and root canals –
It is carried out with special tools designed to work in canals.
In Fig. 9 you can see tooth pulp wound around such a tool. By the way, video 1, which we posted above, shows the process of pulp removal. The video below clearly shows the moment when the tooth pulp is removed from the root canal (time – 1 minute 5 seconds). Treatment of pulpitis: video of nerve removal from a tooth
Measuring the length of root canals in a tooth –
This is one of the most important stages, because... if the length of each channel is determined incorrectly, it will cause -
- or underfilling of the canals, which will lead to complications after the end of treatment,
- or refilling the canals, which can lead to long-term pain and injury to the mandibular nerve.
Measuring the length of the canals is ideally carried out using a combination of the x-ray method and the use of an “apex locator”. In this case, first, special K-file instruments are introduced into each root canal in turn (Fig. 10), which are connected to the apex locator using a thin electrode (Fig. 12). The K-files are gradually advanced deeper into the root canal until there is a signal on the apex locator screen that the tip of the instrument has reached the apex of the tooth root.
It is necessary to measure each channel in turn, because The length of each channel is unique and there are no exact standards. After the measurements are completed and the data are recorded, K-files are simultaneously inserted into all channels (each to its own depth), and a control x-ray is taken (Fig. 11). The apex locator sometimes makes mistakes, so the x-ray will show how accurately the length of the canal was measured and whether adjustments are needed.
Mechanical processing of channels –
A budget option for mechanical treatment of root canals involves the use of manual files (K-files or reamers) - in Fig. 13 you can see a K-file in the root canal. The dentist rotates this instrument by the handle with his fingertips, and the cutting edges of the instrument excise chips from the walls of the canal, expanding it. The purpose of mechanical treatment is to widen the canal so that later it can be properly filled.
A better and more expensive processing option involves the use of an endodontic micromotor and special nickel-titanium files with shape memory. Mechanical processing of each channel is carried out to the depth determined at the previous stage. This is necessary to ensure that each root canal is filled exactly to the root apex. During the expansion process, it is very important to constantly rinse the canals with antiseptics, which is necessary for disinfection, but first of all, to wash out the shavings from the canal (24stoma.ru).
Mechanical treatment of root canals:
In video 1, you can see in detail how the expansion of root canals is carried out with ordinary hand instruments (for this, hand-held K-files of different diameters are used - from smaller to larger). In video 2, the dentist processes root canals using an endodontic micromotor and ProTaper Gold nickel-titanium profiles.
Placing a temporary filling –
After the canals are washed and dried to remove excess moisture, turundas soaked in antiseptic are left in them, and a temporary filling is applied to the tooth. The cost of treatment is calculated based on the number of root canals in the tooth.
How is therapy carried out?
The process of extracting the dental nerve may require 2-3 visits, depending on the number of roots in the tooth. The time interval between sessions is prescribed by the doctor, in accordance with the diagnosis.
Traditionally, treatment of pulpitis consists of 4 stages:
- Application of local anesthesia. Nerve endings are very sensitive to any impact, so painkillers are indispensable.
- If caries is present, the affected tooth tissues are first removed. Sometimes it is necessary to remove a healthy part of the tooth to gain access to the pulp.
- Using a special tool, a pulp extractor, the dental nerve is extracted. Depending on the stage of the disease, the pulp is pre-treated with arsenic or extracted alive.
- The dental canals are measured and thoroughly disinfected.
After treatment, the tooth is filled: first the root canals, then the upper, coronal part of the tooth. In difficult cases, for example, with chronic pulpitis, the doctor fixes filling materials only in the canals in order to track a possible relapse of the disease. If inflammation reappears, then intermediate therapy is prescribed using antibiotics.
After installation of a permanent filling, the patient may experience pain. This usually lasts no more than 2-3 days, with a reaction to cold foods and drinks. If the discomfort continues, then the inflammatory process has resumed, and you need to visit the dental office as soon as possible.
Rinsing
The most popular procedure that helps get rid of pain, swelling, relieve inflammation, and remove pathogenic bacteria. For rinsing, use a variety of herbal decoctions (sage, chamomile, calendula, bay leaf, willow bark, elderberry, basil, calamus), solutions of hydrogen peroxide, soda, propolis, and alcohol tinctures diluted in water.
Important! The rinse should be warm, but not hot; high temperature promotes the development of purulent inflammation.
Sage
It has an analgesic, sedative and antiseptic effect. You should rinse your teeth and gums with a decoction of sage every 2-3 hours.
Hydrogen peroxide
Excellently disinfects the oral cavity, removes bacterial plaque, and helps localize the inflammatory process. Rinse your mouth with an aqueous solution of hydrogen peroxide several times a day.
Soda
Rinsing with soda allows you to relieve pain for a while and disinfect the surface. You need to dilute a spoonful of baking soda in 200 ml of warm water, rinse 3-4 times a day.
Propolis and calamus
They have an analgesic and disinfectant effect. Mix a tablespoon of calamus with a teaspoon of propolis alcohol tincture and dilute with boiled water. Use for daily rinsing for one month. You can also apply a piece of propolis to a sore tooth; the pain usually goes away within a few minutes.
willow bark
Has anti-inflammatory and analgesic effects. Brew 2 tablespoons of crushed bark, let it brew, strain, use for rinsing and mouth baths.
Bay leaf
It disinfects the oral cavity well and helps relieve swelling. Pour one tablespoon of leaves into a glass of boiling water and let it brew. Use for rinsing.
Elderberry and knotweed
Mix elderberry and knotweed flowers in 1:1 proportions, steam two tablespoons of the mixture in a thermos. Rinse every two hours. Helps with acute pain.
Pomegranate
Excellent prevention of pulp suppuration, relieves inflammation, swelling, pain. Soak the peels of two pomegranates in a water bath for two hours, strain and rinse your mouth 5-6 times a day.
Children's horror stories
The phases of disease progression at a young age are approximately the same. But unlike adults, children's pulpitis develops many times faster. A small hole in the tooth is enough for the infection to cause inflammation in the pulp chamber. Accelerated pathological processes can lead to infection of the soft tissues around the tooth, which can lead to problems with the growth of molars. Therefore, if a child complains of toothache, it is important to consult a doctor immediately.
The question often arises: is it possible to treat pulpitis or is it still necessary to remove the dental nerve in children? An experienced dentist always strives to preserve both the baby tooth and the pulp. Because the absence of teeth in a row can affect the location of neighboring teeth, change the bite, and even diction.
In the case of baby teeth, the dentist uses special filling materials that dissolve over time and do not interfere with the growth of the permanent dentition.
Gentle drugs that are hypoallergenic and safe for babies are used as pain relievers.
Quick ways
If you experience severe pain in the tooth area in the evening or on holidays, when you cannot see a dentist, you must use medications that are often present in the family medicine cabinet:
- Non-steroidal anti-inflammatory drugs . In addition to quickly eliminating pain, these drugs help relieve inflammation, reduce swelling of soft tissue and reduce elevated body temperature. The most common drugs in this group are Nurofen, Diclofenac, Ibuklin, Ibuprofen.
- General painkillers help to quickly relieve acute pain for a period of up to 5-6 hours. These include Ketanov, Pentalgin, Nimesulide.
- Antibacterial and local anesthetic agents .
If you have a carious cavity that has caused the development of pulpitis, you should use antimicrobial drugs such as Metrogildent ointment, Betadine cream, Dentinox dental drops. They will help neutralize pathogenic microflora that develops in a damaged tooth and leads to the development of an inflammatory process. - Clove oil . This component has a pronounced anesthetic effect. To relieve pain when the integrity of the tooth is not damaged, applications with this substance are used. 4-5 drops of oil are applied to a cotton pad, which is applied to the site of inflammation for 7-10 minutes. If there is a carious cavity, you can apply a few drops into it.
- The analgesic drug Finlepsin is used in case of inflammation of the ternary nerve and the presence of various acute pains, including dental pain. Helps eliminate discomfort and improve mood.
We will talk about the symptoms and methods of treating inflammation of the facial trigeminal nerve in the next article. And here is a list of strong painkillers for toothache.
Indications during pregnancy
There is a myth that it is impossible to treat teeth while expecting a baby. This misconception can have serious consequences. Infection, for example in the form of caries, through blood vessels can spread throughout the body.
It is also a mistaken belief that x-rays harm the development of the fetus. It has been proven that modern equipment has a minimal radiation dose that does not affect the body. It is much more dangerous to bring the inflammatory process to a chronic state. Therefore, you should not delay treatment of pulpitis or caries when symptoms appear.
The process of bearing a child is associated with a decrease in immunity, and as a result, with increased sensitivity to bacteria and infections. Tooth enamel in pregnant women is not as strong, because... All nutrients are aimed at the growth of the baby. Therefore, the appearance of pulpitis and deterioration in the condition of the dentition is a normal phenomenon.
The second trimester is considered the optimal period for receiving dental care. During this period, the child is protected by the placenta from harmful substances. However, if an inflammatory process occurs in the dental nerve, it is not recommended to delay treatment so as not to expose the baby to unnecessary risk.
During pregnancy, the doctor chooses a gentle treatment method, when the filling is fixed only in the dental canals. If possible, without the use of anesthesia. After childbirth, the patient is given a permanent filling. X-ray examination is carried out only in emergency cases.
Folk remedies
In addition to traditional remedies used to relieve pulpitis, traditional medicine will also help relieve pain. Here is a small list of the most effective of them:
- A couple of drops of clove oil, applied to a small piece of cotton wool and applied to the sore spot, will reduce the severity of pain after some time. You can also try applying dried cloves, only before applying it you need to chew it a little, otherwise the essential substance will not be released;
- Fresh or salted lard applied to the inflamed area relieves pain well;
- Gargling with decoctions of St. John's wort, sage, chamomile, cloves, and elderberry flowers is very useful. You can also use an infusion of wine vinegar and mint and raspberry leaves. However, the preparation time for such an infusion is three days, so there is no need to talk about emergency assistance when using it;
- Another version of the decoction is prepared from two tablespoons of chopped turnips, which is poured with a glass of boiling water and boiled for ten to fifteen minutes;
- Suitable for relieving pain and rinsing with water with a drop of tea tree oil, as well as a solution of salt and soda;
- Alternative medicine also suggests applying the following remedies to an inflamed tooth: ice, raw beets, a leaf or stem of wild garlic crushed to a pulp, leaves of coltsfoot or horse sorrel, plantain root, juice from angelica leaves, propolis, “Asterisk” balm. , iodine (you should be very careful with the last three remedies, as they can severely burn the soft tissue of the gums and cheeks);
- Acupressure in the area of the inflamed area is very effective in reducing pain, if it does not cause even more pain.
One of the most favorite means of relieving all types of pain in Russia is alcohol. However, most often they try to take it orally, which should not be done, since pulpitis and alcohol are bad traveling companions. The only correct use of alcohol-containing drinks for inflammation is applying a moistened cotton swab or rinsing, but even here it is important to remember a few simple rules:
- Do not use pure alcohol!
- Do not rinse your mouth with sugar-containing drinks; only pure ones will do: gin, vodka, whiskey, cognac.
- Do not swallow the drink after rinsing.
Of course, alcohol can relieve pain for a short time and disinfect the problem area, but it will not cure inflammation.
Despite the fact that all these methods relieve pain for a short time, pulpitis still cannot be cured with tablets, so you should not put off visiting a doctor. Even if you are very afraid to treat pulpitis, anesthesia will make this procedure completely painless and quick. The process of tooth depulpation is carried out as follows: the damaged area is drilled out, the doctor uses special tools to remove the inflamed pulp and cleans the tooth cavity. If it is not possible to completely clean out all the soft tissue, arsenic, or rather a paste containing this substance, is used to treat pulpitis. It mummifies and dissolves the remaining pieces of nerve and pulp. Then the tooth cavity is thoroughly cleaned, disinfected and sealed.
Inflammation of the nerve in the wisdom tooth
Eights have their own specifics, and the doctor often chooses to remove the tooth. The complexity of therapy is due to the anatomical features of the third molars. Curved roots, lack of access to the tooth, partial overlap of the gums equates the treatment of pulpitis in figure eights to jewelry work. And it requires experience and high qualifications of a doctor.
An inflamed nerve in a wisdom tooth can be treated by filling the canals. Provided that there is access to the root and the dental canals have good patency. It makes sense to preserve a tooth in the presence of an antagonist tooth, if the tooth is involved in the chewing process and is used when installing a prosthesis.
