Pulpitis: classifications, species, clinic. Classification of methods of treatment of pulpitis

Surprisingly, the fact is that the disease, like pulpitis, has more than 20 classification approaches. Dentists themselves use different methods of assessing the type of disease in their work, but note that none of them is capable of 100% accurately describe all the features of this insidious disease. Dentists note that they need a more convenient and capacious classification of pulpitis, which would characterize the disease from all the necessary positions.

Why is it necessary to classify pulpitis?

The presence of such extensive systematization of this dental disease is associated with various approaches to attempts to describe the disease. Different types of classifications of pulpitis suggest to consider them from different positions: the causes of the onset and development, the clinical picture, the progression, the circumstances of the deep processes in the canals of the tooth, and others.

Describing from all angles the pulpit classification has not yet been developed. Therefore, dentists have to embed the existing clinical picture from a single patient in the framework of existing methods of its evaluation. Some classification schemes were developed dozens of years ago, but even now they are used in the practice of diagnosis and treatment of pulpitis.

The first attempts to systematize this disease of the teeth were undertaken in the 20s of the last century and were called upon to describe the pulpit as accurately as possible. These classifications were rather complicated and cumbersome. That is why the specialists conducted continuous work to improve the methods of describing the disease. With a periodicity of 5-10 years, a new classification was proposed that was based on earlier schemes, but had some new position in describing the pattern of pulpitis.

WHO classification

The end of the 20th century, namely, 1997, for dentistry was marked by the introduction of the international classification of diseases of the 10th revision, which is known by the abbreviation ICD-10. It was approved by the World Health Organization, and in 1999 it became widely used in dental practice to diagnose and treat pulpitis. This system is the name of the codes and their decoding to describe the clinical picture of the disease. Classification of pulpitis in the ICD includes the following items:

• Diseases of pulpal and periapical type tissues are proposed to be designated using K04 code.
• Directly pulpit is encrypted K04.0.
• The initial stage of the disease, characterized by hyperemia, is designated K04.00.
• Acute pulpitis is offered to encrypt K04.01.
• If an abscess is found, code K04.02 is inserted.
• The chronic form of pulpitis is designated K04.03, and if ulcers are diagnosed, it is suggested to encrypt the diagnosis in the form of K04.04.
• If the patient has a pulpal polyp in a chronic form, then it is designated K04.05.
• When the disease of the neuromuscular tissue of a tooth of another specified nature is put K04.08.
• If the cause of pulpitis is unclear, this is indicated by code K04.09.
• Necrotic or gangrenous phenomena in the pulp are denoted by the code K04.1.
• If the degenerative processes, such as denticles, pulp stones or calcifications, are observed by the dentist, he designates them with the code K04.2.
• In the case of an abnormal formation of hard tissue in the region of the pulp, the mark K04.3 is made. And, if this is an irregular (secondary) dentin, then it is denoted by the code K4.3X. It is worth noting that in this situation calcifications and stones in the pulp are eliminated.
• At apical periodontitis of an acute nature, which is caused by changes in the neurovascular tissue of the tooth, the code K04.4 is put.
• If, however, the dentist believes that he has pulpal and periapical tissues before him, which do not fit into the above points, he puts a mark of K04.9.

This classification of pulpitis according to WHO, according to dentists, is not entirely convenient. However, it is still used as an official scheme for compiling statistical reports of specialists on the work done over a certain time period. Codes and ciphers for this classification doctor must put in the card and the patient's coupon. Many dentists admit that they often have to write down the diseases they have treated within the framework of the scheme proposed by WHO, although they use it in completely different convenient ways of characterizing the dental pathology.

Characteristics of pulpitis by its origin

This classification of pulpitis and periodontitis takes into account the causes of this disease. According to this criterion, dentists distinguish 4 types of the disease:

• Infectious.
• Traumatic.
• Concretive.
• Medicated or chemical.

Let us consider in more detail each pulpitis, whose classifications describe the causes of its occurrence.

Infectious pulpitis

This type of disease is caused by the activity of bacteria that secrete toxins and provoke inflammation of the vascular and nerve bundle of the tooth. In 9 cases out of 10 microorganisms get from the carious cavity inside the dentinal canals or affect the open surface of the nerve. Less common is retrograde pulpitis, when microbes penetrate the tooth through the hole in the top of the root. This occurs with infectious diseases, such as ARD, rubella, osteomyelitis, sinusitis or periodontitis. In isolated cases, infection can be hematogenous. The surest aspect to recognize pulpitis is etiology. Classification by this principle is often used by doctors.

Traumatic pulpitis

It is worth noting that the injury is the cause of the pathological process, which can lead to pulpitis. In this case, the sterility of the tooth cavities is impaired and their infection occurs with the further development of inflammation of the neural bundle. Sometimes it is not the integrity of the tooth that is broken, but its correct location (dislocation or subluxation). In this case, the pulpitis is of a closed character and progresses without the involvement of microorganisms.

Injuries may be of a domestic nature, be obtained as a result of an accident or injury, or may result from inept medical intervention. For example, when grinding a tooth "under the crown," pulpitis often occurs as a consequence of perforating tissues. This phenomenon needs immediate correction. It is very important that the doctor adheres to the scheme: pulpitis - classification - clinic - treatment. With the consistent work of a specialist, almost anyone, even the most difficult case, can be corrected, avoiding a mass of unpleasant complications.

Conjunctogenic pulpitis

This type of pulpitis occurs due to some formations in the canals of the tooth - denticle or petrificates. They grow in the cavities of the canals and squeeze the blood vessels. As a result, microcirculation is disturbed, edema is formed. The consequence is pulpitis.

Medication or chemical pulpitis

This classification does not usually describe the pulpitis, but in fact, it often occurs and is caused by a medical error. This happens if the dentist uses strong substances (alcohols or ethers) in preparing the caries cavity or periodontal pocket , or a technical error was made during sealing.

Classification by Platonov

Despite the fact that this type of assessment of the disease was proposed by Professor Platonov back in 1968, he is still used by dentists in practice. This classification of pulpitis and periodontitis has its shortcomings, but it is good for its simplicity and convenience. The professor in his methodology combined three approaches: assessment of pathological processes in the pulp, the nature of the course of the disease, and the localization of unpleasant sensations. This rather simple, but capacious system for assessing the disease has come to the liking of many specialists, which explains its current relevance. In this systematization, the main aspects of such a phenomenon as pulpitis - etiology, pathogenesis are considered. The classification of the disease according to Platonov is as follows:

• Pulpitis of acute type: focal form (acute pain, localization of which is understandable to the patient) and diffuse appearance (indefinite localization, giving off along the trigeminal nerve on the face).
• Pulpitis of a chronic nature: hypertrophic (expansion of the pulp with the filling of the cavity of caries), gangrenous (necrosis of the nerve and vessel bundles) and fibrous (degeneration of the tooth tissues).
• Exacerbation of pulpitis of chronic form.

This classification and pulpitis clinic greatly simplify the work of dentists, especially in budget clinics. As a rule, in such circumstances, the doctor does not have enough time to find out the reasons for the toothache. To determine the type of disease, it is enough to ask the patient a couple of questions.

Classification by Gofung

This method is quite popular with dentists, as it describes the most important aspects of such pathology as pulpitis - classification, clinic, treatment. He gives an idea of the stages of the disease, takes into account the various clinical indices and the morphology of the pulp changes during the inflammatory process. According to this system, the following forms of the disease are distinguished:

• The acute form of pulpitis: partial (reversible, can be cured by biological means with preservation of the nerve), general (diffuse, covers the whole pulp and is treated by extirpation), general purulent (extensive and irreversible disturbances of the pulp, is treated by vital extirpation with prevention of periodontitis).
• Chronic form of pulpitis: simple, hypertrophic (these two types are excellent for treatment with the ability to preserve the root), gangrenous (destructive form, is treated by extirpation in several visits to the doctor).

Classification according to the AIM

This method of morphology of the neurovascular bundle is a direct continuation of the Gofung method. Classification pulpitis MMSI includes the point of exacerbation of the chronic form of pulpitis and takes into account the feature of inflammation in the tooth previously treated. According to this morphology, the disease is divided into:

• Acute forms of pulpitis: focal or diffuse purulent, serous.
• Chronic types of pulpitis: gangrenous, fibrotic or hypertrophic.
• Exacerbation of chronic pulpitis: fibrous or gangrenous.

Exacerbation of the gangrenous type of pulpitis can cause complications of periodontal disease, since anaerobic microflora is actively developing in it. If partial removal of the nerve does not solve the problem of inflammation, complete extirpation or repeated mummification of the channels usually completely solves the problem.

Classification by Vinogradov

Classification of pulpitis in children is performed according to the system of Professor Vinogradova, which suggests that the diseases of temporary teeth should be clearly separated from permanent ones. The doctor explains that the inflammatory processes in the milk and molars occur differently. The professor recommends taking into account the specificity of the location of the tips of temporary teeth and, in the treatment method, insists on the refusal of the full passage of the canal. This can damage the rudiment of the baby's permanent tooth.

Classification of pulpitis in children includes the following items:

• Pulpitis of milk teeth of acute nature: serous (proceeds rapidly, the focal form turns into a diffuse one), purulent (quickly covers the whole pulp and can go to chronic).
• Pulpitis of a constant row of acute teeth: acute serous total or partial, acute purulent general or partial.
• Chronic pulpits of temporary and permanent row of teeth: simple, proliferative or hypertrophic, gangrenous.
• Exacerbation of chronic pulpitis of temporary and permanent teeth: most often occurs against the background of a simple chronic pulpitis.

A feature of the inflammatory process in the temporal tooth is that it is likely that the process will spread to the inter-root space. This is because the dentin in this zone has a high degree of permeability. This phenomenon is dangerous, as it can provoke disturbances in the formation of the root of the molar tooth, change the period of its eruption, and reduce its resistance.

Chronic pulpits of temporary teeth are characterized by the fact that they can arise as primary forms, bypassing acute phases. They can be asymptomatic, but insidious in that they spread fairly quickly to periodontal tissues. Therefore, you should carefully monitor the condition of the oral cavity of children and do not neglect the treatment of infant teeth.

Peculiarities of treatment of pulpitis

Classification of methods for treating pulpitis is directly related to the diagnosis. It is from the skillful identification of the degree of complexity of the disease will the success of therapy depend.

If an appeal to the dentist was made at the beginning of the development of pulpitis, then the doctor produces a biological method for its treatment. It is as follows: the nerve from the tooth is not removed, a special calcium-containing and antihistamine is used. As a result of this treatment, the inflammation in the pulp passes, and the dentin is formed. The seal is placed on the cleared carious cavity.

If a timely call to the doctor did not occur, then the possibility of biological treatment was missed. At this stage, the dentist will have to figure out which patient has pulpitis. The concept, classification and methods of diagnostics will help to do this as accurately as possible.

A method of partial removal of pulp is often used. Under the influence of anesthesia, a part of the nerve is withdrawn at the level of the crown, while the root zone remains viable. After this, a preparation with calcium is laid, and the tooth is sealed. If necessary, physiotherapy is performed, anti-inflammatory therapy is prescribed. This method is recommended for children whose upper limbs are not yet sufficiently formed.

As the dental practice shows, in most cases, complete nerve removal is used. This can be done under anesthesia or by applying a devitalizing paste containing arsenic. This substance is very toxic, and the bandage should be taken at the exact time prescribed by the doctor. After this, endodontic treatment is performed , during which the canal of the gutta-percha tooth is filled .

After such treatment, an X-ray is taken to check the quality of the manipulation made in the channels. If they are filled to the top, a seal is applied.

In the case of almost complete destruction of the tooth, the doctor uses a pivotal caul insert to restore the tooth. Each specialist will say that it is guaranteed to help determine the pulpitis classification. Treatment is a logical continuation of a thorough diagnosis of the patient's teeth.

The appeal to the dentist in the early stages of pulpitis is beneficial to the patient. Treatment in this phase is almost painless and inexpensive. If you start the disease, then periodontitis can develop, which is much more difficult and longer to treat.