If in chronic form pulpitis can be asymptomatic, then in acute disease, few can survive a couple of days without resorting to a dentist. Usually the pain in the tooth pulp is so pronounced that sleep, appetite disappears, the body temperature often increases, migraine attacks occur, the sensitivity of the tooth to any effect is maximized.
Types and causes of tooth pulpitis
Disease of the tooth pulpitis is an inflammatory process in the pulp, which usually appears as a result of untreated caries under the influence of irritating factors. Inflammatory process begins after infection of a site of a pulp which adjoins to a carious cavity. Sometimes pulpitis occurs as a result of destructive changes in the periodontium( gum).Coke bacteria( streptococci, staphylococcus, diplococci, etc.) cause inflammation. Often the disease develops on the background of a retrograde infection that has fallen into the pulp from the maxillary sinus or periodontal pocket( for example, with periodontitis or osteomyelitis).
Sometimes improper preparation of the tooth during the installation of the crown leads first to a burn, and then to an inflammation of the pulp. In some cases, sharp tooth injuries( root fracture, crown injury) or incautious pulp dissection during caries treatment become the cause of tooth pulpitis. To provoke a pulpitis can also pathological erasure of a teeth or the overestimated filling. In some cases, pulpitis develops as a result of exposure to unfavorable chemical or temperature factors. As chemical agents provocate strong antiseptics, alkaline medical pads, materials with a high content of acrylic resins, silicate cements, etc.
There are several forms of pulpitis: acute( including focal and diffuse), chronic( fibrotic, hypertrophic and gangrenous) andchronic at the stage of exacerbation.
The main symptom of pulpitis of the tooth is pain:
- In the acute form of pulpitis , pain occurs spontaneously, usually at night and has the nature of seizures. If you do not immediately take any measures, the process will begin to progress, affecting the branches of the trigeminal nerve. Thus, the nature of pain in pulpitis will increase many times.
- In chronic pulpitis tooth pain occurs usually under the influence of any stimulus( hot drink, strong pressure on the tooth, etc.).Only after removal of the stimulus pain in pulpitis, in contrast to caries, does not subside, but continues for some time and may even intensify.
Pain occurs due to exudate pressure on the dental nerves.
As a rule, the cavity of the tooth with acute pulpitis is closed, so the outflow of exudate is impossible, as a result, and there are attacks of pain. When the exudate accumulates in large quantities, it exudes outward through the dentinal tubules under pressure. After this, the swelling of the pulp tissues decreases slightly, and the pain subsides for a while.
Chronic, acute and retrograde pulpitis of teeth
With chronic pulpitis, the tooth cavity is open: in this case, the exudate pressure does not reach a great strength, so there is no pain attack.
Pulpitis is usually accompanied by a large carious cavity, with the exception of retrograde pulpitis. With chronic pulpitis, the dentist's instrument freely penetrates into this cavity. The patient's tooth is particularly sensitive to cold, warm, sour and sweet, so pain occurs during tapping. In acute tooth pulpitis, an X-ray image gives an idea of the changes that are characteristic for the granulating or fibrous form of periodontitis.
Acute focal serous pulpitis is characterized by sharp paroxysmal pains that last for 20-30 minutes and are localized most often in only one tooth. Periods without pain last for 5-6 hours. At night, the pain is more intense. Pain can provoke a mechanical, thermal or chemical stimulus. When examining the tooth, the first thing that will strike the eye is a large carious cavity, touching the bottom of which will cause pain, although tapping on the tooth will be almost painless, because the mucous membrane around it remains uninflammated.
When acute diffuse serous-purulent pulpitis , severe pain attacks occur, which are transmitted to the jaw, ear, or temple( i.e., along the trigeminal nerve).The duration of attacks is 3-5 hours at intervals of 30-40 minutes. Pain can provoke any stimulus. At night they are especially painful. As a rule, a person suffering from such pains, already on the second or third day, turns to the doctor, because with time the pain gradually increases. The sick tooth also has an extensive carious cavity in this case.
Each type of pulpitis has its own specific pains and some additional symptoms.
For example, with chronic pulpitis, the pain will periodically appear under the influence of various stimuli, then disappear.
With retrograde pulpitis , the pain character is the same as in acute purulent pulpitis, only more intense, but there is no carious cavity.
Diagnosis of pulpitis occurs on the basis of patient complaints and after a detailed examination of the tooth. Thermodiagnostics and electrodontometry are performed, which allow differentiating pulpitis from caries, trigeminal neuralgia, maxillary sinusitis, periodontitis and other inflammatory processes. X-ray examination helps to reveal the degree of destruction of tooth tissues.