Removal of the tooth nerve in the TOP 1 clinic in Moscow

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1 Pulp - structure, functions, features

2 Why is a tooth without pulp considered dead?

3 How long does a tooth live without pulp?

4 What can lead to the need to remove a “dead” tooth: 4.1 There are several rules by adhering to which patients can prolong the use of the tooth:

Inflammation of the “nerve” of the tooth (pulpitis) is not always accompanied by severe toothache. A chronic infectious process can occur in a tooth unnoticed, leading to significant tooth destruction, the formation of a cyst on the root of the tooth, and even tooth loss. This pathology is an indication for tooth depulpation—removal of its “nerve.” Sometimes such news can come as a surprise to a patient if he did not suspect the presence of chronic pulpitis. At the same time, we are often asked - what will happen to the tooth later, after pulp removal? How long will the tooth live after this procedure, how will its condition change? We'll talk about this in the article.

Tooth removal

Depulpation (depulpation of a tooth) is the removal of pulp, connective tissue consisting of blood vessels and nerve endings. Removing the tooth nerve and cleaning the canals is designed to relieve the patient from pain, inflammation and further complications. However, the tooth, having lost its blood supply, becomes dead and, therefore, more fragile.

Dental treatment and nerve removal is one of the most common dental procedures. This is partly because patients turn to the dentist only in case of unbearable pain, when it is no longer possible to do without depulpation. Removing the nerve of the tooth and filling the canals allows you to preserve the natural tooth, which is a priority for endodontic treatment.

Indications for depulpation:

extensive caries
classic pulpitis and infectious pulpitis (bacteria penetrate through the root apex)
trauma and damage to the tooth affecting the pulp
if it is necessary to install crowns or classic bridges

Many patients who come to the dentist's office with toothache are interested in the question: is it possible to save the pulp? Today, there are methods of biological treatment (preservation of the entire pulp) and vital amputation (preservation of the root pulp), but many favorable factors must converge for them to be carried out. For example, biological treatment is not carried out after 25 years.

What ways to get rid of toothache are there?

Let's start with the fact that if you are experiencing severe throbbing pain, you should not endure the pain. The dentist will conduct a detailed diagnosis and be able to identify the cause; it could be damage to soft tissues or incompletely cleaned canals. Next, you will be prescribed effective treatment.
Under no circumstances should you search the Internet for methods to relieve pain at home and self-medicate. You need to identify the exact cause and undergo treatment. Otherwise, the disease will progress and inflammatory processes will spread to neighboring teeth.
If, in addition to pain, you experience any other unpleasant symptoms, for example, severe swelling, discharge, fever, etc., you should also consult a doctor immediately.

Removal of tooth nerve with arsenic

Removing pulp using arsenic is considered an outdated treatment method, which is almost never used today. The procedure was quite simple: the tooth was prepared using a drill, then the root canals were expanded, medicine was applied to remove the nerve in the tooth, after which a temporary filling was installed for 2 - 3 days. The negative side of such treatment is that arsenic is a strong poison that has a detrimental effect on both the tooth and the tissues surrounding it. With the advent of new safe techniques, the need for arsenic has disappeared.

Is it possible to cure such a tooth?

You can cure, but you cannot resurrect. The dentist will remove all affected tissues, nerves, root canals, expand them, clean them and treat them with an antiseptic, and then seal them hermetically so that infection does not enter from outside. The crown, if more than half of it is preserved, will be restored with a filling. For more severe lesions, an artificial crown will be installed. However, in case of extensive inflammation, the tooth can be removed and replaced with a prosthesis - an implant.

A “dead” tooth must be shown to a doctor, otherwise there is a risk of complications from the infection, which will develop into gumboil, osteomyelitis. A cured tooth can perform its function fully, but it can withstand the load worse, so its service life is significantly lower than that of “living” teeth.

Modern method of depulpation

Today, depulpation is carried out using a pulp extractor - a thin metal rod with teeth that can penetrate even remote areas of the root canals. The apex locator device helps determine the depth of the canal to reduce the risk of injury. After the procedure, a temporary filling is usually installed, but a permanent one can also be installed if the doctor does not see the risks of complications and has high-precision instruments on hand, for example, a dental microscope.

Low quality filling material

Today, almost all modern clinics use exclusively composite light fillings. However, just a few years ago, you could walk out of the dentist's office with a metal amalgam in your tooth or a regular cement filling. If you still have such “old” fillings, then there is a high probability that the tooth tissues hurt precisely because of this material. Over time, such compositions may lose their properties, crack, and dry out. Sometimes a filling, having greater hardness than tooth enamel, can destroy the crown. Even keeping a filling in place for a long time does not guarantee the health of this organ and a positive result of treatment.

Allergic reaction

The inflammatory process in tooth tissues, as is known, can be provoked by both an infectious factor and an allergic one. Tooth tissue can sometimes produce this effect in response to medications or interaction with a filling. Although composite light fillings are characterized by minimal allergic properties, individual reactions of human tissues sometimes give such a result.

This problem can be solved quite simply: the filling with the harmful allergen is removed, and a composite with a different chemical composition is installed in its place. For the future, it is advisable for you to remember which particular filling caused a negative reaction in your body, so that the next time you visit another dentist, you can warn him about this feature.

Installing a temporary filling

A certain method of treatment, when a temporary filling is installed, involves placing a medicinal substance at the bottom of the carious cavity, which strengthens and nourishes thinned dentin tissue. Or it could be a drug that destroys the nerve tissue of the tooth. Its effect often produces a painful reaction from the pulp chamber, as a result the filling seems to hurt. Therefore, you should not perceive such discomfort as a treatment error. At the appointed time, go to your dentist, who will remove the temporary filling and install a permanent photopolymer.

If the pain becomes unbearable, you need to take a good dose of analgesics. As a last resort, it is allowed to open a temporary filling at home, remove the medicine from the carious cavity and cover the hole with a temporary tampon. A visit to your dentist within 24 hours is required.

In order to never find yourself in a situation of repeated treatment, you need to choose your dentist wisely. Pay attention to the reviews of your friends, the level of qualifications of the specialist and the general experience of medical practice. For example, the LeaderStom network of clinics takes the issue of personnel selection very seriously: all dentists have the most prestigious professional titles and regalia, gained through successful work experience. This gives an almost 100% guarantee of high-quality, competent dental therapy.

Tooth after depulpation - complications

A fragment of the instrument remained in the dental canal

A common complication associated with negligence or inexperience of the doctor. Repeated treatment involves removing instrument fragments and refilling the canals. Due to a number of factors, removal of a foreign body can be very difficult. Pain after removal of a nerve in a tooth does not occur very often, so in some cases the doctor recommends leaving everything as it is if the complication does not manifest itself.

Incompletely removed nerve or insufficient filling of dental canals

The most common reason for pain after depulpation. In such a situation, an inflammatory process develops that spreads to the root apex, provoking the formation of periodontitis, gumboil and cysts. If your tooth aches after nerve removal (several days or more), then you need to consult a doctor who can check the quality of the tooth canal filling.

Resealing

Extraction of filling material beyond the root apex. In mild cases (with a small amount), the tooth hurts when pressed for some time after the nerve is removed, after which the pain goes away. If the excess material is large, then surgical intervention is necessary to avoid the development of complications.

Perforation of the wall or root

Mechanical damage that leads to the formation of a perforation (hole) in the wall, floor of the tooth cavity or root. After the nerves are removed, the tooth continues to hurt. The pain is usually aching and paroxysmal.

Darkened tooth after nerve removal

If the tooth darkens after removal of the nerve, this may be caused by poor filling material or poorly performed depulpation. Also, over time, a dead tooth can become cracked and more vulnerable to dyes. This is partly why the front tooth, after removing the nerve, is subsequently covered with a crown or veneer.

Symptoms of tooth pulpitis -

Pain with pulpitis can be of varying degrees of severity - from minor pain, which is provoked by thermal irritants, to acute paroxysmal spontaneous pain, which makes you want to climb the wall. Given the difference in symptoms, it is customary to distinguish 2 forms of this disease. Below we have described what pulpitis symptoms and treatment will have in each of these cases.

Acute form of pulpitis – this form is characterized by acute paroxysmal pain that occurs especially at night.
It is typical that the pain increases, while pain-free intervals become shorter and shorter. As a rule, pain occurs spontaneously, i.e. without the participation, for example, of thermal stimuli. However, during the pain-free interval, in some cases it can be provoked by cold or hot water. With pulpitis, it is typical that after the removal of the irritant, the pain persists for about 10-15 minutes (this makes it possible to distinguish pain with pulpitis from pain with deep caries). With the latter, the pain stops immediately after the cessation of exposure to the stimulus. Very often, patients cannot even indicate which tooth exactly hurts, which is due to the irradiation of pain along the nerve trunks. The pain increases due to the gradual transition of inflammation from serous to purulent. With the development of purulent inflammation in the pulp, the pain becomes pulsating, shooting, and pain-free intervals almost completely disappear.

Chronic form of pulpitis - in this form the inflammation is unexpressed. Patients usually complain of slight aching pain, most often arising from exposure to heat and cold irritants. Sometimes, by the way, with this form of pain there may be no pain at all. Keep in mind that the chronic form of pulpitis can periodically worsen, and during periods of exacerbation of inflammation, the symptoms will be exactly the same as in the acute form.

When is it time to sound the alarm? Symptoms and stages of tooth decay

There are a number of signs that should alert you. Having noticed one or two of them, a person should become concerned and see a specialist. This:

1. Accumulation of plaque on tooth enamel. Barely noticeable yellowish spots.
2. Bad breath, even the smell of rotten breath. With severe caries, the smell will be very noticeable.
3. Dark spots on the enamel. Painful sensations when eating hot or cold, sweet foods.
4. If you ignore the above-mentioned manifestations of ill health, the situation gets worse. Next, black areas appear in the area of the neck of the tooth or on the root itself, but the latter can only be detected during an X-ray examination.
5. Frequent aching painful sensations appear, and even if you regularly rinse your mouth with herbal infusions and take painkillers, the destructive processes are in full swing.
6. The pain intensifies (especially when a stream of cold air hits the tooth), and the pulp begins to die.
7. The nerve bundle is affected, the pain becomes especially severe.
8. Then, if the person never went to the hospital, he notices with surprise and relief that the pain goes away. However, in reality, the inflammatory process does not stop - the disease spreads to the root area.

Surgery

It is possible to understand what dental pulpitis is and how to treat the pathology in question, including through a detailed analysis of the techniques that require the use of any types of surgical interventions. The main indication for the use of such instructions is the presence in a person of a diffuse, focal and chronic inflammatory process of the fibrous and hypertrophic type. All activities are carried out according to strictly defined instructions:

Anesthesia by introducing local, conduction anesthesia into the body.
Isolate the affected area with sterile pads and pads.
Opening the carious plane and treating the lesions with an antiseptic.
Excision of the coronal part of the pulp extractor.
Expanding the canals and treating them with antiseptic agents.
Preliminary and final filling performed after x-rays.

It is not difficult to guess that only an experienced doctor with a variety of different skills can cope with a series of such procedures at the highest quality level. These are the specialists who work in dentistry.

Treatment of pulpitis with removal of the dental nerve

Another event characterized by a fairly high complexity. As a rule, all medical interventions are performed in two stages. During the first of them, the specialist:

Removes the carious plane.
Removes damaged tissue from the pulp itself.
Treats the excision site with an antiseptic.
Carrying out work on installing a temporary filling.

After approximately one to two weeks, the patient necessarily comes for the second session. As part of the additional (finishing) procedure, the following actions are carried out:

Short-term filling is removed.
Inspection and cleaning activities are carried out.
The oral cavity is exposed to antiseptic agents.
A permanent material is installed to fill the voids in the tooth process.

The main advantage of all processes is the possibility of preserving a healthy dental element. In addition, the person subsequently feels positive effects due to the regeneration of vitality and sensitivity of the pulp itself.

Treatment of pulpitis of a multi-rooted tooth

A devital technique, in which the doctor initially kills the problem area using a special necrotizing paste. In the past, doctors involved in such work used ordinary arsenic, placed in the carious plane for several days.

Today, modern medicine has stepped forward, providing craftsmen with a much wider range of tools. Dental staff use the most gentle drugs that do not kill nerve tissue in the oral cavity. It is not difficult to guess that the use of such substances is a completely safe operation.

Extirpation of pulpitis

Probably the most radical treatment method, which includes a whole complex of processes to remove the inflamed neurovascular bundle, followed by sanitation and filling. The doctor can undertake its implementation only in the case when any other methods of therapy clearly do not lead to success. As in previous cases, the procedure is carried out in a vital and non-vital format: under the influence of local anesthesia or using a necrotizing paste-like drug. Depending on how complex the disease is, the specialist may need from 3 to 4 sessions, the result of which, of course, will be a complete cure of the patient from the specified range of problems.