Removal of the tooth nerve: methods, indications and contraindications -

Causes Possible complications What to do about pain? How to relieve pain? Prevention
The vitality of the tooth, in particular its sensitivity, is ensured by the neurovascular bundle (pulp). Removal of the pulp (depulpation) is a forced measure, which is resorted to for serious indications (pulpitis, hilar cyst, damage to the pulp chamber due to trauma, etc.). Painful discomfort for several days after depulpation is a normal tissue reaction to the intervention. But if a tooth hurts after removing the nerve and filling the canals after 2-3 weeks

or pain occurs suddenly long after endodontic treatment, this is a good reason to see a dentist.

Even treated teeth should be examined every year to diagnose or rule out complications at an early stage. A pulpless tooth does not hurt, but it is like a time bomb. Poor-quality canal treatment can provoke complications that destroy the jaw bone and cause purulent processes (cysts, abscesses) that are life-threatening. Properly treated canals are the foundation of any restoration. The more modern and high-quality the materials used for their processing, the less likely there are complications.

Indications for nerve removal

Caries has reached the pulp. Initially, caries appears on the enamel, then moves to dentin, then to the pulp. Inflammation increases: acute pain occurs. To eliminate the pain and save the tooth, you need to remove the nerve.
Injuries of various types: impact, fracture, chip. With such mechanical impact, traumatic pulpitis develops. The integrity of the tooth is damaged, the infection penetrates into the pulp. Inflammation occurs and pain appears. Treatment involves removing the nerve.
Retrograde infection. When inflammation occurs at the apex of the tooth root, it then spreads to the nerve.
Orthopedic treatment. Before placing a crown, in some clinical cases it is necessary to remove the nerves. To avoid complications, a severely damaged tooth is first treated: the nerves are removed.
Asymptomatic pulpitis (chronic). The patient does not have acute pain, but the nerve is infected. The patient's complaints may include mild pain in the past.

Memo to the patient after tooth extraction

A gauze swab placed on the wound must be spat out 15–20 minutes after removal.
You should not eat for 2 hours after surgery; then during the day it is recommended to avoid hard and rough foods and chew on the side opposite to the removal.
On the day of surgery, you should not rinse the wound and you should not spit out any clots that form (otherwise there is a risk of a blood clot formed there falling out of the socket and subsequent bleeding).
During the day after the operation, you should not drink or eat anything hot, you should not warm the removal area (put your hand to your cheek, sleep on the cheek on the side of the operation, etc.), and you should not use warm compresses. You should also not visit the bathhouse, sauna or take a hot bath on the day of removal.
You should not drink alcoholic beverages for 24 hours after tooth extraction. It is advisable to refrain from smoking on the day of surgery.
It is advisable to avoid physical activity on the day of surgery.
If bleeding occurs from the hole, you can place a sterile gauze pad on the wound and bite it. To make a tampon, take a piece of sterile bandage or gauze and fold it several times. If bleeding is significant and does not stop within 12 hours after removal, contact the clinic immediately.
After tooth extraction, swelling of the cheek on the side of the operation may occur. To reduce the risk of swelling, you can apply ice or cold objects to your cheek immediately after surgery and during the first 24 hours. The cold should be kept on the cheek for 15–20 minutes, taking breaks every 3–5 minutes. On the second day, swelling may increase; on the third day, it usually subsides.
After the anesthesia wears off, aching pain may occur in the area of removal. If necessary, you can take a pain reliever tablet recommended by your doctor. If the pain does not go away or worsens within 2-3 days, you should consult a doctor immediately.
On the first day after tooth extraction, a slight increase in body temperature is possible.
It is necessary to brush your teeth even after extraction! During the day after surgery, you are allowed not to brush your teeth only on the extraction side. Next, you need to brush all your teeth, but carefully, trying not to damage the socket.

What are the methods for removing a nerve?

Amputation . This method is rarely used: mainly in pediatric dentistry. Its essence lies in the fact that the neurovascular bundle is partially removed. The pulp remains in the roots, and only the coronal part is removed. In adults, it is used in exceptional cases, when the doctor sees that the inflammation has affected only a small part of the nerve.
Extirpation . The pulp is completely removed from the tooth. After removing the nerve, the canals are cleaned, washed, and filled.

Tooth extraction: features

Tooth extraction is a surgical intervention in the oral cavity with the aim of removing an unhealthy or lifeless unit of dentition from the bone tissue. A simple form of surgery involves loosening the tooth and then pulling it out with forceps, a hook, or other instruments. In case of a complex procedure, preliminary cutting of soft tissues, drilling of the bone, etc. is required.

Obviously, complex removal is much more traumatic, and therefore the pain after it is more pronounced and lasts longer.

Let's note other factors that increase pain:

concomitant inflammatory process;
prolonged ignoring of the problem of suppressing symptoms with analgesics;
alcohol abuse.

Sequence of treatment

Diagnostics . After the doctor has examined you and collected your medical history, an X-ray is taken. This diagnosis allows you to evaluate the structure of the tooth and plan treatment. To see the full anatomy of the root canals, a computed tomography (CT) scan is performed - a 3D diagnostic that allows you to see all the structures of the tooth.
Pain relief . Local infiltration or conduction anesthesia is performed. Before the injection, the gums are lubricated with an anesthetic gel so that the injection is not felt.
Setting up insulation . Root canal work should be done in clean, dry conditions. For this purpose, rubber dam (insulation) is used. It is a latex plate that is placed on the tooth. Advantages of isolation: saliva and plaque do not enter the root canals. Medicines and solutions also do not flow into the patient’s mouth.
Preparation of hard dental tissues . The doctor uses a drill to remove the destroyed tissue. To prevent overheating of the tooth, water flows from the tip. The doctor creates direct access to the root canals.
Nerve removal . It is performed with thin sterile instruments similar to long needles. The doctor places an instrument into the root canal and removes the nerve. Machine rotary tools may also be used. This stage is completely painless, since anesthesia was previously performed.
Mechanical and medicinal treatment of canals . The canals are washed with special antiseptic solutions and passed through with instruments. This allows you to completely remove the diseased nerve and relieve inflammation.
Temporary filling . Root canal work is complex, so it is not always possible to treat a tooth in one visit. An anti-inflammatory paste is placed into the canals, a temporary filling is placed, and a further stage of treatment is planned.

For permanent restoration of the crown part of the tooth, ]esthetic dentistry[/anchor] will be required.

What complications may arise?

Pain syndrome is a protective reaction of the body in response to tissue damage or inflammation. It is also one of the main symptoms of developing pathological changes. If you ignore the problem, you may encounter a deterioration in your overall health and serious illnesses: sepsis, phlegmon, amyloidosis.

Local suppuration in the area of the affected tooth can spread to nearby periodontal and periodontal tissues, and then, with the bloodstream throughout the body. The situation is developing rapidly; people with chronic periodontal diseases are at high risk

Inflammation of the periosteum is characteristic of suppuration of remnants of nerve fibers. The pathology is manifested by the formation of a cyst or granuloma, high body temperature, shooting pain radiating to the ear, eye and temporal region

A timely visit to the dentist significantly increases the chances of saving the tooth. The doctor will re-treat the root canals, after which he will fill them with medicinal paste or insert a turunda soaked in an anti-inflammatory solution. After 7-10 days, the canals are closed with a permanent filling. In advanced situations, a decision is usually made to remove the unit

Contraindications

Doctors at the SDent aesthetic dentistry center collect all data about the patient’s condition before starting treatment. In the health questionnaire, the patient notes the characteristics of his body, and the doctor conducts a survey. Planned nerve removal is not performed if:

high blood pressure, hypertensive crisis;
first, third trimester of pregnancy (provided there is no acute pain);
acute inflammatory diseases of the mucous membranes and facial skin;
acute respiratory and viral diseases, etc.

Wisdom tooth removal

Wisdom teeth are considered full-fledged elements of the oral cavity. They are involved in chewing food (if they are located above each other and have contact), and can act as a support for bridges and removable dentures in the future. There are specific indications for extraction in their case. For this reason, the decision about whether wisdom teeth need to be removed is made only by the attending physician.

The most common problem with eighth teeth is their growth. Only some teeth form and grow completely without complications, but often these processes are accompanied by a number of difficulties:

semi-retinated or impacted elements that have formed in the bone tissue, but have not erupted or only partially erupted. Their position can be vertical, horizontal, or with their roots outward. Because of this, neighboring elements suffer, constant pain appears;
violation of position (dystopia). Since wisdom teeth erupt without predecessors (baby teeth), and the jaw bone is already formed and does not develop, the position of the elements is often incorrect. They injure the mucous membrane, overlap other crowns, and put pressure on neighbors. This leads to inflammation. The doctor will determine whether the position can be restored with orthodontic treatment or whether it is better to remove the wisdom tooth;
appearance of a gingival hood. When slowly cutting through the mucosa, an area is formed in which bacteria and food debris accumulate, which are difficult to clean. This leads to acute inflammation, which can provoke the appearance of pus;
destruction, caries. Elements may appear immediately underdeveloped with carious lesions.

The doctor determines whether wisdom teeth should be removed or not based on complaints and the clinical picture. Problems with even one or two teeth interfere with the normal functioning of the entire dental system. Pain appears when opening the mouth and chewing. The bite and position of the incisors may even change.

How a wisdom tooth is removed depends, as in the case of permanent elements, on the condition of the dental system. In the absence of contraindications, manipulation is carried out with ordinary forceps.

General recommendations after treatment

You can eat and drink immediately after treatment;
Until the anesthesia wears off, you should not eat rough food;
in the days following treatment on the side of the diseased tooth, do not chew rough, hard food;
in some cases, anti-inflammatory drugs, painkillers, and oral baths are prescribed;
If a temporary filling falls out, consult a doctor immediately;
If pain occurs after placing a temporary filling, also consult a doctor immediately.

After the anesthesia wears off, the patient may feel discomfort in the area of the treated tooth. If pain, throbbing, or swelling occurs, you should consult a dentist.

How long can your gums hurt after tooth extraction?

Severe pain that interferes with normal life activities lasts no more than 3 days after the surgical procedure. It will take up to 7 days for the discomfort to disappear completely. For complex removal, this period increases to 2 weeks.

If during the rehabilitation period you feel pulsation in the socket, bleeding, or bad breath, then you need to contact a surgeon at the Cerekon clinic as soon as possible, because all these signs signal the development of inflammation.

Long-term consequences after treatment

Patients often experience complications after nerve removal. This is due to many factors: lack of diagnosis, poor quality treatment, incorrect diagnosis, etc. Main consequences:

poor canal filling. A loose filling leads to the re-emergence of bacteria that extend beyond the tooth root. A cyst forms, due to which the tooth is often removed;
tool fragments. The complex anatomy of the canals and low-quality instruments can lead to its failure.
removal of material beyond the root apex. If the filling material is chosen incorrectly or there is too much of it, it extends beyond the root.
Tooth perforation occurs due to aggressive processing.

To avoid such complications, doctors at the SDent clinic recommend contacting us for medical help, as we have a staff of highly qualified doctors, an equipped X-ray room and advanced equipment!

The main causes of pain immediately after depulpation

A feeling of mild pain in a pulpless tooth is acceptable for two to three days after the intervention. A natural reaction is increased sensitivity to temperature stimuli. Such symptoms are caused by traumatization of mucosal tissues and nerve fibers, as well as the formation of a hematoma (local hemorrhage).

Dentists identify several main causes of pain immediately after depulpation:

Contact of filling material with gum tissue. The situation occurs frequently and occurs due to incorrect determination of the channel length or excessive pressure when feeding the composite.
During treatment, the doctor uses very thin needles. Despite their strength, when passing curved areas, there is a high probability that a fragment of the tool may break off.
Allergic reaction of the patient's body to the composite. The condition is dangerous for people seeking dental care for the first time. In this case, the pain syndrome is accompanied by swelling and redness of the oral mucosa, an increase in body temperature, and urticaria and itching are characteristic.

If the pain increases or occurs suddenly a few days after surgery, then this is an obvious reason to visit a doctor.

Oral care after tooth extraction

In the first two weeks, it is better not to brush your teeth at all, as this may resume bleeding and disrupt the entire healing process. Instead of brushing, you can rinse your mouth with hot water and clean your teeth with your finger until a characteristic squeak occurs. After this, be sure to rinse your mouth with special disinfectant solutions prescribed by your doctor. It should be borne in mind that frequent (more than three times a day) rinsing your mouth only slows down the healing process.

If the tooth was removed during the acute stage of the inflammatory process, then the healing of the hole takes longer and is much more painful. In this case, the doctor may prescribe oral or local use of anti-inflammatory drugs. Antibiotic mouth rinses should be alternated periodically to prevent bacteria from becoming accustomed to a particular drug. Lubricating the hole with the juice of the medicinal plant Kalanchoe works well - it gives a very strong analgesic and healing effect - often the wound heals within a few days. To increase biological activity, a plucked Kalanchoe leaf can be kept for 5 days on the bottom shelf of the refrigerator, preventing it from freezing.