Diagnosis of pulpitis and treatment methods

Pulpitis is an inflammation that affects soft tissues, and it is accompanied by vascular-neural structures that affect the cavity of the tooth. This ailment is characterized by progressive paroxysmal pain, often it extends to the entire jaw, gives into the ear, the temporal region and intensifies at night. Pulpitis does not pass by itself, it is necessary to urgently appeal to the dentist. After the reference to the expert, the diagnosis of pulpitis will be assigned, and the best method of treatment is chosen after. If the patient turned on time, then the outcome of treatment is favorable. If you delay and wait for what will happen next, then the consequences can be very serious: periodontitis or a surrounding cyst. Pulpitis can manifest itself in several forms and each is accompanied by its specific symptomatology.

Pulpit: classification

After the diagnosis of pulpitis, the doctor can prescribe the right therapy, which will result in the complete cure of the damaged tooth. Pulpitis, depending on the stage and features of the course of the disease manifests itself in several forms:

• Acute pulpitis is divided into focal and diffuse. The acute form is the initial stage of pathology. Inflammation is located in the closest proximity to the carious cavity. Symptomatics manifests itself in the form of sharp spontaneous pain, which can last from a couple of minutes to half an hour. After that, she can calm down and do not bother for several hours, but at night, sharply intensify. Also, there may be discomfort in the tooth, which arises from the effects of stimuli, and it does not go very long. In this case, the patient can easily indicate which tooth hurts, and then the diagnosis of pulpitis will be facilitated.

• Acute diffuse pulpitis. During this stage, inflammation spreads to the entire pulp. The patient suffers from attacks of severe pain, relief is rare, and it is short-lived. And after the process from serous to purulent, the pain becomes permanent, and it simply does not have to endure it. It is felt in the temporal part, in the ear and on that half of the jaw, from which side the tooth hurts. From the reception of hot food or drinks, the pain intensifies, and from the cold calms down. This stage can last up to 14 days, and if the diagnosis of pulpitis has not been performed during this time, then it goes into a chronic stage.
• Chronic pulpitis is of several types: fibrotic, hypertrophic, gangrenous and retrograde. Fibrous pulpitis chronic appears after the acute form passes into the chronic. This period is accompanied by severe aching pain, most often it occurs when eating or breathing in cold air. Hypertrophic form occurs at the time when the carious cavity is connected to the cavity of the tooth. After this, the pulp grows and an outgrowth is formed, which is called the polyp, which fills the free space. The patient feels pain when chewing, bleeding appears. Gangrenous form manifests itself at a time when pulpitis was not detected in time, the diagnosis was not performed in a timely manner, which resulted in a putrefactive infection in the diseased tooth. The patient has a smell from the mouth, pains. Retrograde type - a chronic form, accompanied by the formation of periodontal pockets, it is in them and the infection is going. Bacteria, passing through the root canals, affect soft tissues and cause their inflammation. The bone tissue of the root dissolves, in this case immediately it is necessary to conduct therapy and do everything possible to remove the pulpitis. Diagnosis, treatment with experienced specialists will help to keep nearby teeth. It is important to seek help on time.

Only modern techniques will help to easily identify pulpitis in the early stages. The clinic, the differential diagnosis in which can be carried out, is in any city. They will help to make an accurate diagnosis.

In our modern times, when technology does not stand still, it is not difficult to identify any disease at an early stage. Using innovative methods and equipment, it is easy to diagnose pulpitis. Diagnosis in modern medicine can be of several types, and each of them is quite effective. So, with what the process begins, after the patient asked for help:

• Detailed survey. The doctor writes down all complaints of the patient, finds out the reason for the treatment, the nature of the pain and the area of its manifestation. Such a survey helps to make a more accurate diagnosis.
• Oral cavity examination. It is carried out with the use of special tools, the doctor examines all the teeth where the seals were previously placed, checks the gums for the presence of inflammatory processes.

• Sounding. The dentist examines the oral cavity with a probe. This procedure allows you to determine with the maximum accuracy the degree of development of the disease. When probing, it is possible to establish the state of dentin at the bottom and walls of the carious cavity, what is its depth, and also examine the pulp from the outside. But the main thing in this procedure is to establish a connection between the carious cavity and the pulp chamber.
• Temperature tests. This diagnosis of acute pulpitis or any other form involves exposure to high and low temperatures on the tooth pulp. This method helps to supplement the picture and learn about the condition of soft tissues.
• Electroodontodiagnosis. This method is based on checking the pulp reaction for electric current. The higher the manifestations of inflammation, the higher the strength of the current. This method allows you to determine how deeply affected the neurovascular bundle, and to identify where the focus of inflammation is located. The deeper his location, the stronger the current, and if the pulp is completely gone, the patient will feel a push.
• X-ray. Using it, you can find out the peculiarities of the tooth structure, determine how much the disease developed, and see the results of the therapy that was previously performed.

But there is one more special method which allows to define a chronic fibrous pulpitis - differential diagnostics. But what is it?

Differential diagnosis of pulpitis

This method of diagnosis is ideal in cases where it is necessary to distinguish deep caries from chronic pulpitis, because both these ailments require a special approach to treatment. In pulpitis, the pain that arises from the action of stimuli does not pass for more than 20 minutes, and when caries it stops immediately as soon as the irritant is removed.

But in order to distinguish pulpitis from exacerbated chronic periodontitis it will be quite enough just to knock on a sick tooth. If a patient has periodontitis, then a knock will cause discomfort.

Diff. The diagnosis of pulpitis of the hypertrophic form will allow to reveal the bleeding of the tooth under mechanical influence, this symptom will become a confirmation of the diagnosis, the pain in this case is not strongly pronounced.

If the patient has fibrous pulpitis, then the diagnosis will allow you to notice under the dentine layer in the carious cavity how the pulp is visible. If you touch the probe at this point, the patient will feel a strong pain.

During the diagnosis of hypertrophic form, it is necessary to exclude another diagnosis - the growth of the gingival papilla. If it is a papilla, then it can be pushed back by a probe.

Differential diagnosis of acute pulpitis and the inflammatory process in the trigeminal nerve helps to determine the pain, which is greatly enhanced at night. But if it is neuralgia, then at night it passes.

After the diagnosis of chronic pulpitis or any other form has been performed and the diagnosis is made, a certain method of therapy is chosen for each specific case, only in this way it is possible to achieve a stable positive result of treatment.

How to treat forms of pulpitis?

Peculiarities of pulpitis therapy depend on the form of pathology, as well as on the stages of the development of the disease, in simple terms, from the neglect of the disease. The earlier a patient seeks help from a specialist, the higher the chances of maintaining a tooth. After this or that form of ailment is revealed, for example, chronic pulpitis (the differential diagnosis in the formulation of the exact diagnosis is very effective), the doctor will choose a method of treatment that will give a good result. But let's take a closer look at what methods doctors use to treat each form of pulpitis.

Acute pulpitis

This form of the disease is treated in three stages:

1. Removal of pulp, affected by inflammation, the procedure is under anesthesia, and in the future the patient is recommended drug therapy of root canals.
2. Sealing of the root canals, in this case the doctor uses a special sealant.
3. Restoration of the crown of the tooth, a sealant will come to the rescue.

Serous pulpitis

This is one of the most common forms, it can be of two types: diffuse or focal. Both of these forms are easily treatable if therapy is started in the early stages. First, the doctor clears the tooth from dentin, affected by caries. Then a seal is inserted, but a lining with calcium is needed, and bandages with an antibiotic are also used to help the dentine to form again. But antibiotics will help only if the patient does not have a chronic form of the disease.

And if the process has been developing for a long time, then in this case the doctor can recommend the removal of tooth pulp and nerve.

Purulent pulpitis

This form is considered one of the most dangerous. After all, pathology can be both focal and diffuse. With a focal variety, the pulp is partially affected, and when diffuse completely. This form is treated only surgically. The doctor clears the root canals, using the vital or devital method. This treatment is very difficult, so it is better to entrust this work to a qualified specialist.

Cure this form for one day does not work, on the first day of the visit the doctor conducts such manipulations:

• Anaesthetizes, dissects and clears the carious cavity of dental tissues affected by caries;
• Disinfects the cavity with antiseptics;
• Using a probe, opens the horn of the pulp;
• Inserts a paste with arsenic into the tooth so that it helps to kill the nerve;
• Puts a temporary seal.

The second visit to the doctor provides for such procedures:

• Removal of the temporary seal;
• Removal of pulp from the root canals;
• Treatment channels antiseptic;
• Tooth filling ;
• Restoration of the crown of the tooth.

Traumatic pulpitis

This form can be treated, both conservatively and surgically, all depends on the degree of pulp injury. If it is exposed at the neck of the tooth and only a small part of it, and the tooth itself is not affected by caries, then conservative treatment will give good results. And if a piece of tooth splits off and the pulp is hit hard, the doctor will remove it so as not to provoke the development of the inflammatory process.

Chronic pulpitis

With this form of pathology, conservative therapy is not effective. The only correct solution is to apply the surgical method. The complexity of this form is that the patient can for a long time not guess that his tooth is sick. You can detect pathology only if you do an x-ray.

Depending on the form of the ailment, the doctor will use one of the most effective methods. The best is considered a combined method, when the doctor uses several treatment options at once, in order to achieve a full recovery.

Fibrous pulpitis

If a patient has chronic fibrous pulpitis, then the therapy is to remove the pulp, affected by fibrosis. The procedure consists of several stages and is conducted under local anesthesia:

• The carious cavity is opened and cleared of caries;
• Antimicrobial treatment;
• Resection of the septum;
• Removal of part of the coronal pulp that fibrosis affected;
• Expansion of canals and removal of pulp with fibrosis;
• Treatment with antiseptics;
• Setting a temporary seal.

A few days later the temporary filling is replaced by a permanent filling.

Hypertrophic pulpitis

This form is characterized by proliferation of granulations of pulp tissue, resulting in impaired blood circulation. Depending on the extent of the lesion, the doctor can apply one of two methods of treatment:

• Partial removal of pulp, only affected areas;
• Complete removal of pulp if it is completely affected.

If the pulp is removed completely, in this case it is very important to clean the root canals well, and then seal them. If all procedures are performed correctly, then the inflammatory process does not appear.

Gangrenous pulpitis

This is one of the most serious forms, when the entire tooth is affected, and the pulp is covered with ulcers. The therapy of this form is considered one of the most complex. The most optimal method is the complete removal of pulp, or pulpectomy. The procedure consists of the following stages:

• anesthesia;
• The carious cavity opening and its thorough cleaning;
• Removal of the coronal part of the pulp;
• Expansion of canals and removal of pulp, affected by inflammation;
• Cauterization of the nerve with electrocoagulation, thus preventing bleeding;
• Drying;
• Use of an antiseptic dressing;
• Canal filling.

Diagnosis of acute focal pulpitis or any other form will help to accurately establish the diagnosis, as well as determine the affected area. Only in this case the doctor can precisely pick up treatment and will spend it as it is possible more carefully.

Even a small toothache should force to visit the dentist, so as not to start the disease and save the tooth. Any pathology, and teeth, this also applies, is easier to cure, if identified in time at the initial stage of development. The modern level of development of medicine is such that visiting a dental office is not always accompanied by pain, diagnosis of pulpitis and its treatment can be carried out completely painlessly.