Acute and chronic pulpitis: diagnosis

Chronic pulpitis is a form of pulpitis, inflammation of the pulp. Pulp is the soft tissue of the tooth, which is responsible for the blood supply to its hard tissues and consists of nerve endings, blood vessels and connective tissue. As a rule, chronic forms of pulpitis occur when acute forms are suppressed, but sometimes they can be a primary process without an acute stage.

Chronic pulpitis is an inflammatory process of the nerves and blood vessels of the tooth, which gradually causes severe changes in structure and function. If the disease is present, a person reacts sharply to cold and hot foods and experiences pain while chewing solid food. Pathology can be accurately determined using x-rays and electroodontodiagnosis. The development of the chronic form occurs in the absence of proper treatment of acute pulpitis.

Fact: the disease is much more often detected in the chronic form rather than in the acute form. People aged 20-50 years are at risk.

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Causes of pulp inflammation

The main cause of pulpitis is the penetration of infection into the pulp cavity, in which a bundle of blood vessels and nerves is located.

The causative agents of the disease can be both pathogenic (Staphylococcus aureus) and conditionally pathogenic (lactobacillus) microorganisms. They can penetrate into the tooth in several ways:

• through the dentinal tubules in case of poor oral hygiene, accumulation of bacterial plaque and stone in the gum pockets;
• through cracks in the enamel caused by tooth trauma;
• through cracks due to a fracture of the dental crown;
• through the apical opening of the root canal against the background of periodontitis, osteitis and other chronic inflammatory processes of the oral cavity.
• Inflammation can also occur after treatment of deep caries

What does pulpitis look like in the photo?

In this section, clinic patients can see what tooth pulpitis looks like in the photo:

It is important to remember that dental pulpitis is a serious and dangerous disease that can cause a lot of discomfort and harm to health. However, with timely treatment of the disease, it is possible not only to save the tooth, but also to leave the pulp completely viable. Every patient can count on high-quality and effective treatment by making an appointment with a dentist. "Dent Academy", where the best specialists work, there is no place for negligence and mistakes.

Etiology of pulpitis

Based on etiology, which implies the nature of the inflammatory process, pulpitis is divided into three types. The classification is carried out depending on the nature of the irritant acting on the pulp:

1. Infectious pulpitis develops in acute, but more often chronic diseases of the teeth and oral cavity (caries, osteomyelitis, periodontitis, etc.). In rare cases, the infection enters the root canal and pulp through the circulatory system from other units of the jaw or internal organs.
2. Traumatic pulpitis develops when a tooth is damaged with the opening of a traumatic cavity (crack, chip) into the pulp. Occurs with sports injuries, crown and root fractures.
3. Iatrogenic, that is, occurring after dental treatment . Occurs after treatment of deep caries, when the internal tissues of the teeth are irritated by the use of chemical, mechanical or thermal irritants.

Knowledge of the etiology helps the dentist select the most appropriate treatment methods and avoid complications in the future.

Why does chronic pulpitis develop?

The pulp is the soft tissue of the tooth; inside it there is a nerve and blood vessels that feed it. Like any organ, the pulp is characterized by a protective reaction to the invasion of infection - inflammation. In this case, swelling, suppuration and attacks of sharp throbbing pain occur. This is acute pulpitis.

Any infection can lead to inflammation of the pulp. Patients with deep caries, gum disease, sinusitis, osteomyelitis of the jaw, abrasion of teeth, and traumatic exposure of the pulp become ill especially easily.

The infection penetrates the dentin:

• through a crack in the root;
• with blood flow through vessels;
• from a carious cavity.

If the patient postpones going to the dentist, after 1-2 days, collagen fibers are produced in the pulp and the first stage of the disease begins - fibrous pulpitis.

Acute pulpitis can become chronic:

• As a result of the vital activity of pathogenic microorganisms: lactobacilli, staphylococci, streptococci. For example, after suffering from infectious diseases: rubella, influenza, ARVI.
• After a tooth injury: dislocation, fracture, incorrect treatment, or if the patient does not go to the dentist for acute pulpitis.
• When exposed to chemicals and dental materials.

Symptoms

Inflammation of the pulp is not difficult to differentiate already at the stage of examining the oral cavity and interviewing the patient. This disease is characterized by:

• sudden onset of pain and its intensification at night;
• a gradual increase in pain intensity and duration in the first 3-5 days from the onset of the disease;
• irradiation (spread) of pain to the ear, eye, chin, depending on the location of the diseased tooth.

A characteristic feature of pulpitis, which makes it possible to distinguish it from caries and other dental pathologies, is a sporadic increase in pain, which is not associated with thermal, mechanical or other effects on the tooth.

Symptoms that will help you diagnose pulpitis yourself

Knowing the main symptoms of the disease, it is quite possible to independently diagnose it in yourself and consult a doctor for therapeutic measures. Pulpitis has quite specific symptoms and differs from caries in that pain when the pulp chamber is damaged can occur without external irritants and spontaneously. With carious lesions, pain syndrome always appears against the background of external influences: for example, when eating, as a reaction to sour or sweet foods, to temperature stimuli. Moreover, when the provoking factor is eliminated, the pain quickly subsides (usually within ten minutes). If the factor is eliminated, but the pain does not go away, there is every reason to suspect pulpitis.

Pain with pulpitis usually occurs at night and is not as unbearable as with periodontitis.

Attacks of pulpitis pain can intensify and then disappear, while acute periodontitis is characterized by constant, severe pain, which interferes not only with eating, but even with speaking.

Different forms of pulpitis may have their own unique symptoms. For example, with prolonged attacks of aching pain, you can suspect the development of chronic pulpitis. Symptoms of the chronic form of the disease may be similar to those of chronic periodontitis, however, against their background, fistulas do not form, the gums do not hurt or swell.

When talking about the symptoms of pulpitis, it is important to make the following useful remark: any toothache is already a reason to see a doctor. Teeth don’t just hurt; there is always a reason that needs to be identified and eliminated. This approach will help you avoid complex dental treatment and associated costs and keep your teeth healthy and strong for many years.

Forms and types

The classification of pulp inflammation divides the disease into two forms according to the nature of the development of the pathology:

1. Acute pulpitis is a first-time inflammatory process that lasts from 3 to 5 days and is accompanied by intense symptoms.
2. Chronic pulpitis is a long-term inflammation that develops in the absence of treatment for acute pulpitis. Symptoms tend to periodically worsen, and in the intervals between them there is no discomfort or it is very mild.

Both forms have several subtypes, which differ in localization, degree of spread, and the nature of the development of the inflammatory process.

Types of acute pulpitis

There are four types of acute pulp inflammation:

1. Focal pulpitis . It is diagnosed during primary inflammation, when the carious cavity reaches the pulp. The localization of the pathological focus is the upper part of the tooth. This type of disease is accompanied by the most intense symptoms and signs of inflammation spreading along the trigeminal nerve and nearby lymph nodes.
2. Diffuse pulpitis . Diagnosed 1-2 days after the onset of acute inflammation. The lesion is located throughout the coronal part of the tooth, sometimes down to the neck and root part of the pulp. Attacks of pain last relatively short time and worsen when the patient lies down.
3. Serous pulpitis . An advanced form of acute pulpitis, accompanied by painful pain symptoms that do not subside.
4. Purulent pulpitis . The final stage of acute inflammation, in which a focus of suppuration forms in the pulp. The process is accompanied by signs of acute intoxication of the body, increased pain when eating warm and hot food. Symptoms weaken when cold is applied to the diseased tooth.

Classification of chronic pulpitis

Chronic pulpitis occurs in three types:

1. Fibrous inflammation is the most common variant and lasts about 3 months after the initial inflammation. It is accompanied by bleeding of the pulp when touched, periodic pain in the tooth when it comes into contact with cold or hot food.
2. Hypertrophic inflammation is a condition accompanied by the formation of a polyp inside the pulp. It looks like a piece of gum growing out of a tooth. Pain with this type of chronic pulpitis is minimal or absent.
3. Gangrenous inflammation is the most dangerous pathological process, which is accompanied by active necrosis of tooth tissue. Accompanied by an unpleasant putrid odor from the mouth.

Good to know! In addition to the listed types of acute and chronic pulpitis, dentistry distinguishes deep root, two- and three-channel inflammation, as well as pulpitis under a filling.

Complications

In the absence of adequate treatment, pulp inflammation spreads beyond the boundaries of the root canal, to the periodontium and periosteum. In addition to the formation of a purulent focus (abscess) that opens onto the mucous membranes of the oral cavity next to the affected tooth, there is a possibility of developing more serious complications:

• flux or inflammation of the periosteum, which leads to the loss of a diseased tooth, and sometimes healthy teeth located nearby;
• osteomyelitis or purulent inflammation of the bone, which requires complex, expensive therapy;
• phlegmon - lesions of the soft tissues of the face, their “melting” with purulent exudate.

Each of these complications can, with a certain degree of probability, lead to life-threatening conditions, for example, sepsis.

Treatment

To treat pulpitis, exclusively surgical methods are used - vital or devital removal of the pulp followed by filling the cavity. During vital removal, the doctor injects an anesthetic and removes the inflamed pulp tissue with a bur or mechanically. During devital removal, the pulp is first exposed to special drugs that kill the neurovascular bundle.

Important! Treatment of a tooth with pulpitis with arsenic is an outdated method that is used extremely rarely.

After careful mechanical treatment of part or all of the pulp, the doctor performs a filling in several stages: first, he isolates the root canals, then places a photopolymer filling in the tooth crown. If a significant part of the crown is destroyed, there is intense purulent and necrotic processes, the doctor may remove the tooth.

Pulpitis of baby teeth

Pulpitis of baby teeth is dangerous because the pathological process from the affected tooth can move to the rudiments of permanent units. If the inflammation has not become irreversible, biological treatment is carried out. This gentle technique involves suppressing infection and the inflammatory process with maximum organ preservation of the pulp and neurovascular bundle.

Good to know! In case of pulpitis of primary teeth, it is extremely undesirable to remove the nerve from the tooth and fill the root canals, since this part of the teeth is not yet formed.

After using antiseptics and anti-inflammatory drugs, preparations with calcium hydroxide and calcium hydroxyapatite are placed into the pulp. These products will stimulate the formation of secondary dentin within a week. Only after this the doctor will place a permanent filling.

Diagnosis of the disease

Chronic pulpitis cannot heal on its own. The patient may experience acute pain, flux, and progressive inflammation at any time. Which, in turn, leads to the formation of a cyst, phlegmon, and fistula.

Any pain in the teeth and gums should be diagnosed immediately.

The dentist’s task when chronic pulpitis is suspected is to establish the form of inflammation and the nature of the process.

For this use:

• Probing and tapping the tooth. This way you can determine the level of pain sensitivity, and therefore the degree of damage to the nerve bundle.
• Electroodontodiagnosis (EDD) is an assessment of the sensitivity of the pulp to electric current. High sensitivity indicators indicate serious destruction of the vascular bundle, lower ones indicate its viability. This is the most accurate study of the degree of damage to the nervous system.
• X-ray. The image shows fibrous growths, calculus deposits and traces of deformation in the root canals.

In difficult cases, the doctor may prescribe a computed tomography scan of the tooth.