Treatment of Pulpitis

The structural components of the tooth are enamel, dentin, pulp, and root cementum. The pulp is a connective tissue with a large number of blood vessels and nerves that support the tooth's functions. Part of the tissue is located in the crown structure, while the rest is in the root canals.

The pulp is a natural antimicrobial barrier where attacks by pathogenic microorganisms are neutralized. However, over time, the tissue's protective forces decrease, increasing the risk of penetration by harmful microorganisms. The weaker the immune system, the less effective the pulp's barrier function.

Inflammatory processes in the pulp tissues are among the most common pathologies of the oral cavity, accounting for 20-25% of all dental diseases.

There are several ways for pathogens to enter, such as through carious cavities, cracks in the filling, gaps between the filling and the tooth wall (рoor sealing of a filling), and periodontal pockets.

If caries develops slowly and is treated in a timely manner, the pulp is not affected by the inflammatory process. However, if the patient does not seek medical attention, the development of pulpitis is only a matter of time. Toxins and microorganisms that cause inflammation penetrate through the dentinal tubules, the permeability of which increases as caries progresses.

The second pathway for microorganisms to penetrate and cause pulp inflammation is hematogenous. In this case, the entry gate for infectious agents are blood vessels that communicate with the root canals. Hematogenous pulpitis is most commonly a complication of flu, sinusitis, frontal sinusitis, and other non-dental infections.

Sometimes, pulpitis treatment is necessary in apparently healthy teeth. Such cases occur when microorganisms enter the cavity through apical micro-openings from infectious foci located in the oral cavity.

Unfortunately, pulpitis often develops as a result of factors associated with dental treatment, especially in cases where outdated equipment and technologies are used (overheating of the tooth during drilling, chemical effects of filling materials), or the specialist's qualifications are not high enough to perform complex manipulations. During the treatment of caries, a number of interventions are made on the tissues of the tooth, which can provoke negative changes in the condition of the pulp and subsequently lead to the need for pulpitis treatment. These include, in particular:

• Overheating of the pulp during preparation;
• Excessive dehydration of tooth tissues;
• Inadequate adherence to aseptic techniques;
• Incomplete or insufficiently high-quality treatment of the carious cavity;
• Irritating effects of certain medications and filling materials;
• Trauma to the pulp during deep carious cavity preparation.

Diagnostic errors can lead to incorrect selection of the treatment approach for pulpitis. The dentist must assess the condition of the tooth based on X-ray, computed tomography, and other diagnostic methods.

The consequences of erroneous actions include common complications such as perforation of root canal walls, pulp exposure, and instrument fracture (with fragments remaining in the root canal). Prior to immediate treatment of pulpitis, it is necessary to check the quality of the instruments, and during manipulations it is important to monitor the force of impact on the tissues, avoiding excessive force.

Thus, the need for pulpitis treatment after visiting a dental clinic is a consequence of medical errors during diagnosis, manipulations, the use of outdated equipment, insufficiently high-quality materials, and instruments. The presence of high-tech medical equipment, which is used correctly and rationally by highly qualified specialists, greatly reduces the risk of erroneous actions at all stages of treatment.

Very often we don't have the time or opportunity (and fear is also not the last reason) to visit a dentist when a tooth hurts. We take painkillers, try various folk remedies, use "proven and 100% effective" advice from friends and relatives. In the best case, nothing helps, the effect of the painkiller ends, and seeking help from a dentist becomes inevitable.

But, as sad as it is, more often we observe the worst option - the tooth stops hurting. And believe me, it was not garlic or a piece of cotton wool soaked in a solution of propolis or a decoction of pumpkin tails placed in the tooth cavity or on the gum, not applying baconor a tampon with analgin - this only indicates the transition of inflammation of the nerve to a new level. The so-called "temporary relief", when pulpitis turns into periodontitis (inflammation of the bone tissue around the root of the tooth) or chronic inflammation of the tooth nerve.

There are several medical classifications of the disease based on the use of different criteria. Thus, according to the etiological (cause) factor, the following types of pulpitis are distinguished:

• Infectious
• Toxic
• Traumatic
• Iatrogenic

According to the degree and nature of changes in pulp tissues, pulpitis can be hyperemic, exudative, alternative, proliferative, or dystrophic.

By anatomical features, several forms of pulpitis are classified: localized (partial, limited), diffuse (total, spread).

By clinical features: acute, chronic, complicated by periodontitis, secondary (exacerbated), open and closed aseptic pulpitis.

Generalized classification, based on the stages of the pathological process and the nature of the course of the disease, provides for the identification of several forms of pulpitis:

1. Acute inflammation of the pulp:

• Hyperemia of the pulp
• Limited serous
• Diffuse serous
• Purulent
• Traumatic

2. Chronic inflammation of the pulp:

• Fibrotic
• Hypertrophic
• Gangrenous 
• Calcific

3. Exacerbation of chronic pulpitis.
4. Pulpitis complicated by periodontitis.

This is not a complete classification of pulpitis used in dentistry. It is important to understand that the variety of forms and manifestations of the pathology requires an individual approach to treatment, as well as the use of the latest technologies and methods that allow not only to save the tooth, but also to restore its functionality by 100%.