Traumatic pulpitis clinic diagnosis treatment. Symptoms and treatment of traumatic pulpitis: what do you need to know about this disease? Method of surgical treatment of traumatic pulpitis

It is better to begin treatment of traumatic pulpitis as quickly as possible after the injury. In any case, you should immediately contact your dentist to assess the extent of the injury. A simple examination will make it clear whether intervention is necessary for a traumatic disease and how serious it will be.

Traumatic injuries, depending on the severity of tissue destruction, lead to pulpitis or necrosis of the neurovascular bundle. Shallow cracks or chips are relatively safe: they do not cause an acute reaction. However, treatment is definitely necessary, despite the absence or mild severity of symptoms. Injuries to dentin contribute to the entry of microorganisms into the pulp and can provoke manifest pulpitis.

The greatest risk of disease occurs when an open pulp appears. Damage to the crown without opening the pulp zone, with exposure of the dentinal tubules, leads to acute pulpitis and post-traumatic necrosis of the neurovascular bundle.

Even more severe injuries cause the formation of a blood clot - the best nutrient medium for bacteria. Therefore, within a day signs of acute inflammatory process. If left untreated, pulp necrosis occurs in about a week.

The therapeutic approach depends on the volume of traumatic pulpitis and the period that has passed since the tooth was damaged. A root fracture without contact with the oral cavity heals after the clot appears. Strong displacement of parts of the crown can cause circulatory problems and tooth death. The same situation occurs with dislocation due to severe damage to blood vessels. If infection does not occur, the state of nerve death can persist for a long time.

To treat traumatic pulpitis, dentists use conservative or surgical methods. For mild damage, they resort to the first method, which is also called biological. It preserves the functions of the pulp. Therapy is effective on initial stages inflammation, in which sharp pains last no more than two days. Treatment includes the following steps:

local anesthesia,
removal of damaged tissues,
applying a therapeutic pad to the bottom of the cavity for accelerated restoration of dentin, prevention of inflammation,
restoration of the coronal part with filling material, inlay.

Conservative treatment is carried out in one or two visits. In the first case, a permanent filling is immediately placed. In the second, a therapeutic overlay is first installed, and then a permanent filling is installed.

Surgical treatment consists of opening the pulp, partial or complete removal of the pulp, and subsequent filling of the root canals.

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Assessment of pulp blood flow.

In the 80s, a report appeared on the use of laser Doppler fluorometry to assess the state of blood flow in the pulp, but before clinical stage the technique was not completed. Rheoodontography also did not go beyond a promising technique for assessing the blood supply to the pulp and turned out to be quite complex and unrepresentative. In teeth with damaged pulp, due to the fact that inflammation is often localized, the response to electrical or thermal stimuli may come from the remaining undamaged pulp. Thus, inflammation can be localized in the area of one pulp horn, and in the area of other horns the pulp may be non-inflamed and react in a normal way. Thus, indicators can be characteristic of a healthy pulp, while it is damaged, often irreversibly. On the other hand, when the pulp does not respond to irritants, this does not always indicate its death - the pulp can form a large number of secondary dentin and isolate oneself, to a large extent, from strong stimuli.

In interesting studies by Seltzer and Bender, an attempt was made to establish a correlation between pathohistological data and the results of using clinical tests. At the same time, a correlation between the diagnosis and some clinical tests was revealed, but this connection turned out to be weak and, thus, uninformative. In the domestic literature, the diagnosis was clearly based on the nature of the pain. Moreover, Gofung wrote that pain, its intensity, duration, and prevalence are what the dentist should (and I must sadly add, forced) use when making a diagnosis. But the main problem is that pain does not reflect the nature of pathological and anatomical changes in the pulp, and, to be more precise, does not always reflect the nature of changes in the pulp. The division of pulpitis into acute and chronic in the clinic is based practically on the division of pain into acute and aching. However, from the position today it is known that acute pulpitis (with all morphological characteristics acute inflammation) cannot fundamentally arise as a result of caries as the most important and common cause of pulpitis. Acute pulpitis can occur in response to trauma (any), including iatrogenic nature. No wonder Yavorskaya E.S. and Urbanovich L.I. allocated

Three different types of injury:

- accidentally exposed pulp,

- accidentally wounded pulp,

- pulpitis when the crown of a tooth is fractured.

It is to these forms that we leave the definition of “acute pulpitis”. But these forms are less characterized by acute, spontaneous, paroxysmal, night pain. Famous adjectives that must be present when describing a medical history (outpatient card) to confirm the diagnosis of acute pulpitis. There are no acute, paroxysmal, spontaneous pains ( different intensity, duration, radiating or not, etc.), there is no acute pulpitis. This was the logic of the diagnosis. But let's return to the book of Seltzer and Bender. They themselves indicate that “the characteristics of pain (acute, dull, local, diffuse, pulsating, intermittent, prolonged, radiating) do not have significant diagnostic value, contrary to the outdated point of view.” I quote verbatim (according to the publication “Tooth Pulp.” - Seltzer, Bender. Moscow, 1971, p. 206): “Among the subjective symptoms, the fact of the presence or absence of pain should be noted,” and that’s all. The remaining characteristics of pain, according to the authors, are not important for making a pathologically based diagnosis. We, brought up on the presence of acute, paroxysmal, nocturnal pains, stubbornly hold on to them, and in any systematization of pulpitis, we have a modified (and often worsened) Gofung classification. More than one generation of dentists has been trained on it.

But time is running. Views are changing. After all, no one blames Rubin for wanting to develop a method of electroodontodiagnosis, with a clear breakdown of the forms of pulpitis into shelves. Previously, students learned by heart the indicators of electroodontodiagnostics - 2 - 6 μA, characteristic of a living, non-inflamed pulp, 20 - 30 μA - for acute limited pulpitis, etc. But today there is not even a scale for assessing the electrical excitability of the pulp (We do not at all deny the need for a clear determining the electrical excitability of the pulp. As will be shown later in Chapter 7, an accurate dynamic study of the electrical excitability of the pulp at stages conservative treatment is an important diagnostic sign.). The pulp response to electrical stimuli is either present or not. But even such an answer does not carry clear information and requires clinical rethinking. In some cases, the absence of a pulp response during electrodiagnostics does not speak in favor of pulp necrosis, and even more so, a response of 2 - 6 μA may well occur in an irreversible (dying) state of the pulp. This is an axiom today.

Despite the fact that the Gofung classification is a systematization of pain, today, with thoughtful use, I do not at all call for abandoning it. It is convenient in the clinic, quite simple, reflects a certain clinical characteristics pulpitis. But it does not reflect histological changes in the pulp and therefore cannot be used to justify treatment methods. By the way, Zeltser’s and Bender’s classifications cannot be used clinically, except for dividing them into curable and incurable forms. In group studies, there is still a connection between clinical symptoms and pathohistological changes. But in each specific case this connection may not be present, and the symptoms can be very diverse. Thus, according to Seltzer and Bender, in teeth with intact pulp there is no reaction to electricity in 6% of cases, and in 39% - the reaction is different from normal indicators(let’s immediately make a reservation that the authors do not provide normal indicators). In case of irreversible pulp conditions, in 20% of cases the reaction to the current is “normal”, that is, the same as in intact teeth. I emphasize that in 20% of cases, that is, in 1/5 of cases, it indicates the absence of damage.

The same analysis can be applied to temperature stimuli. And we will again unambiguously come to the conclusion that during statistical processing this connection will emerge unambiguously. But we clinicians are not dealing with groups, but with an individual suffering, often cruelly, person. The patient can tell us that he previously had short-term attacks of pain from cold water, in the evening the pain intensified and became throbbing, but today, when he consulted a dentist, the pain went away and he currently feels comfortable. It is very likely that the patient initially had a reversible condition, which progressed to an irreversible condition, and at present the pulp is completely necrotic.

We specifically moved on to analyzing pain as the most classic symptom of pulpitis. But, unfortunately, the picture is the same here too. And from the data of the same Seltzer and Bender it follows that pain, mild to moderate, occurs in 13% in the case of intact non-inflamed pulp, with acute pulpitis in 25%, with chronic pulpitis with partial necrosis in 60% (in addition, in a significant number of cases they are absent). Despite the fact that increased pain is associated with increasing severity of the disease, there appears to be no clear pattern. And even more so in each specific case, when it is necessary to make the correct diagnosis.

Based on this, clinicians today cannot fully rely on histopathological classifications and are forced to use simple classification, assessing the regenerative capabilities of the pulp. There are three forms:

- reversible pulpitis;

- irreversible pulpitis;

- pulp necrosis.

The reader should be aware that inflammatory reactions in the pulp can be localized and widespread. The pulp may be affected in one area, but not in another. These differences within the same pulp contradict the data described in previous textbooks and clearly interfere with the correct diagnosis. (The view that increasing pressure in the dental pulp impinges on the apical vessels and quickly leads to the spread of inflammation to the entire pulp was refuted by Vaa Hassell in 1971).

As we have already said, traditionally pulpitis, which gives symptoms of spontaneous pain, is considered acute, and if it is asymptomatic, it is classified as chronic. This division, as we have already written, considers cases of pain, and not the nature of inflammation, which is found during histological examination. Painful attacks can vary from short acute attacks after a long time dull pain to severe throbbing pain. The pain may be aggravated by irritants such as cold water, or may be spontaneous. Its character from the moment of its occurrence usually changes over time and as the process in the pulp progresses. Grade pain symptom is extremely important, but first of all we must decide the question: is the condition of the pulp reversible or not.

With pulp necrosis and the presence of periodontal changes.

The question of further fundamental tactics is resolved quite simply - it is necessary to treat infected root canals (if there are no sufficient grounds for tooth extraction), then resolving the issue of the reversible or irreversible condition of the pulp in case of pulpitis requires a thoughtful approach. The proposed classification can probably include: intact non-inflamed pulp (with caries), atrophic pulp (regardless of the factors causing it - age, pathological processes - abrasion, caries, etc.).

In this expanded form, classification of pulp conditions may look like this (we specifically emphasize the term “pulp conditions” rather than pulpitis):

- intact non-inflamed pulp;

- atrophic pulp;

- reversible pulpitis;

- irreversible pulpitis;

- pulp necrosis.

The first two pulp conditions do not require treatment. The rest require treatment methods that differ significantly from each other, even if root canal treatment is performed. In this regard, a thorough clinical examination should primarily be aimed at assessing the condition of the pulp and, accordingly, carefully justifying the treatment strategy. In this regard, we emphasize that we need to focus on the long-term prognosis of treatment outcomes.

It should be emphasized that there is no correlation between clinical symptoms and histological manifestations. Interestingly, even pulp necrosis does not correlate with clinical symptoms.

Reversible pulpitis.

It is a transitional form, a condition that can be caused by caries, erosion, abrasion, surgical procedures, including the removal of dental plaque, as well as trauma. Without pretending to be complete, however, for reversible pulp condition The following symptoms should be highlighted:

- the pain is not acute;

- pain does not occur spontaneously;

- pain comes from causative factor(mostly cold) and does not last long after the stimulus has disappeared;

- the causative pain is not of an increasing nature, but gradually or immediately disappears;

- pain is difficult to localize, since the pulp does not have proprioceptive sensitivity;

- no periapical radiological changes;

- percussion is painless.

Irreversible pulpitis.

Usually occurs as a result of stronger stimuli above the list or may be further development reversible condition of the pulp. This condition is characterized by the following symptoms:

- pain can occur spontaneously or from stimuli;

- the pain is acute or increasing;

- It's a dull pain has an increasing character and is intensified by heat;

- pain can last a long time - from several minutes to hours;

- with periodontal involvement, pain can be localized;

- widening of the periodontal fissure may be visible at a later stage;

- hyperplastic pulpitis is a form of irreversible pulpitis.

It occurs as a result of proliferative chronic inflammation of the young pulp.

When the pulp is involved in the process, hard tissues are also involved. Pulp calcification is one of the most common processes. Physiological secondary dentin is formed after tooth eruption and completion of root formation. It is deposited on the bottom and roof of the tooth cavity and over time can lead to almost complete closure of the cavity. Tertiary dentin is deposited in response to external stimuli as either reactive or reparative. Reactive dentin is a response to non-toxic stimuli, and reparative dentin is deposited in response to damage to the dentinal tubules directly under the source of damage.

Internal resorption is associated with an increase in dentinclastic activity, which we will discuss below.

Periapical lesions.

include:

- acute apical periodontitis;

- chronic apical periodontitis;

- aggravated chronic apical periodontitis.

Many clinical tests are used to evaluate the condition of the pulp, but none of them can generally be considered definitive. Usually in the clinic they use, in addition to the obligatory anamnesis, examination, probing, percussion, also methods of electroodontodiagnosis, cold test, radiographic examination, preparation without anesthesia.

Analysis of pain syndrome.

Initially, information about pain is obtained through a survey. It is necessary to find out the type and intensity of pain. The patient may describe the pain as sharp or dull, shooting or throbbing, deep or superficial. The more the pain interferes, as they now say, with the quality of life, the more intense it is, the more likely it is that an irreversible condition occurs. According to localization, pain can be localized or non-localized, and it can be in any orofacial area, and not radiate from the area of the affected tooth. Incentives matter causing pain, or its spontaneous nature, duration of pain. The longer the pain lasts after the stimulus is removed, the more likely it is that the condition is irreversible.

When conducting electrical testing of the pulp, devices are used that produce current of various voltages with maximum strength current of several milliamps or microamps. When a sensation occurs in the tooth, the lowest value of the current that causes this sensation is recorded. In most cases, in clinical studies healthy teeth, the excitation threshold in molars turns out to be higher than in the teeth of the frontal group. An increase in the threshold of excitability in a tooth can occur with damage to the pulp, as well as with significant deposition of secondary dentin with a normal and intact pulp. In the absence of a response, the pulp is usually necrotic or, on the contrary, the tooth has a healthy pulp with a very large deposition of secondary dentin, up to the closure of the root canal orifices.

The interpretation of these data is very important, since in the absence of a pulp response (that is, with presumed necrosis), other research methods must confirm or exclude the presence of living pulp. A cold test can be useful, which to this day is one of the most informative. At the same time, using a stream of cold water for it sharply reduces the diagnostic value of the method. Typically, a cold test is carried out on a dried tooth using a cotton swab with frozen ethyl chloride crystals. Applications cause a painful reaction in the front teeth with normal condition pulp. Cooling sprays (in particular Cooling Spray) can be recommended. The test works worse in molars, due to their large mass. A positive response indicates living nerve fibers, a pronounced (long-term) response indicates inflammatory changes in the pulp, a negative response may indicate pulp necrosis or significant deposition of secondary dentin. The most important criterion, in addition to the presence or absence of pain, is its duration. Prolonged pain is always a sign of pulp damage. However, this indicator cannot be assessed as an indicator of a reversible or irreversible condition.

The thermal test is usually carried out with heated gutta-percha applied to dried dentin, lightly lubricated with Vaseline. Positive reaction indicates the safety of the nerve elements of the pulp; if there is no answer, the pulp is necrotic or there is a lot of replacement dentin. It is believed that the heat test is especially effective in diagnosing irreversible pulpitis - the pain is prolonged when heat is applied, but some authors (Dummer et al., 1980) do not find that the heat test is more informative than the cold test.

Despite today's demands to work without pain, the diagnostic value of dissection without anesthesia is very important. This procedure is performed when other tests are insufficient for diagnosis. If there is dentin sensitivity, we can talk about the presence of living pulp, but not about its health. Sensitivity may not occur when pulp necrosis or when there is extensive deposition of secondary dentin (including peritubular dentin).

After all tests have been completed.

The clinician must finally confirm the diagnosis. The task is to resolve the issue:

- intact pulp;

- inflamed:

a) reversible,

b) irreversible;

- pulp necrosis;

- periodontal granuloma;

- periapical abscess.

Analysis of all information.

Received after initial examination, should ultimately lead to a definitive diagnosis. The clinician, based on his experience, based on the results of the examination, can, in accordance with his knowledge, more or less clearly determine the nature of the pathological process. At the same time, procedures aimed at preserving living pulp must be based on an accurate assessment of the condition of the pulp. Only then will the treatment be successful. At present, it is difficult to talk about a clear pattern, however, acute, spontaneous, paroxysmal localized, and even more so diffuse, pain is characteristic of irreversible forms of pulpitis. Practitioner it is necessary to understand that the presence of such pain excludes the use of a conservative approach to the treatment of pulpitis, since there is usually liquefaction necrosis with the development of perifocal inflammation (which can be characterized as a purulent or serous-purulent process). Moreover, a history of such pain is a factor that should limit attempts at conservative pulp treatment, especially if the tooth is to be used as a support for a bridge. In all cases, the appearance of pain on percussion is, even in the presence of a living pulp identified using other tests, an indicator of an irreversible condition of the pulp or complete necrosis, unless the cause of painful percussion is periodontal disease. From our point of view, there is no fundamental difference in the assessment of these conditions, since both of them are irreversible conditions and require an unambiguous approach to the endodontic treatment of infected canals.

The use of diagnostic tests should, to one degree or another, confirm the suspected diagnosis. We have already said that the presence of pain during percussion, lack of sensitivity during electroodontodiagnosis, reaction to cold, and absence of pain during diagnostic preparation speak in favor of complete or partial necrosis of the pulp, but even in this case, errors are possible due to the presence of periodontal manifestations, atrophic and sclerosing changes in the pulp, which must be taken into account when making a diagnosis.

A special group of damaged pulp is:

Group of traumatic injuries. And first of all, these are mechanical and thermal damage to the pulp as a result of preparation. The principle of “do no harm” remains the most important principle in dental treatment. Treatment should not be more dangerous than the disease for the sake of which it was undertaken. It is better not to treat than to treat poorly. This is an axiom for the fate of the tooth. It must be emphasized that today’s technology of tooth restoration with modern composites has confronted the dentist with the task of almost ideally restoring the color and shape of the tooth. This is often only possible with complete removal of the discolored dentin. This is a special problem that requires special presentation, and it goes far beyond the scope of our book. Here we especially want to emphasize that the pursuit of aesthetics takes the doctor away from his main task - preserving the tooth as an anatomical and functional unit in the dental arch. Tooth preparation, even if all technological requirements are met, using water cooling and preparation modes, is almost impossible without dissecting the processes of odontoblasts, especially in areas not involved in pathological process. And caries itself, due to the formation of dead paths, sclerotic and secondary dentin, protects the tooth from damage during preparation, since it cuts off the pulp and dentin with living processes of odontoblasts from the cutting instrument.

The situation changes significantly if dentin remains untouched by caries. In this case, the odontoblast is always damaged.

For the pulp, there is no fundamental difference as to what caused the damage. It reacts with an inflammatory reaction and the greater the damage, the more odontoblasts die, and since this all happens simultaneously, then inflammatory reaction(in contrast to the slow progressive process of caries) occurs quickly, as acute inflammation. The degree of inflammation depends on the depth of the damage, on the degree of involvement of unaffected dentin, on the speed of rotation of the instrument, on the type and type of burs, on the pressure and, accordingly, the amount of heat generated during work and on a number of additional factors that must be taken into account when preparing a tooth.

The relationship between the depth of the cavity and the degree of damage must be understood, first of all, in the sense that deep caries is almost always clinically and morphologically accompanied chronic inflammation pulp. Additional trauma can exacerbate the process and cause an irreversible condition. To a much greater extent, the length of the preparation site has a significant impact on pulp damage due to the dissection of odontoblast processes. We do not currently take into account thermal and chemical damage, but only mechanical damage. Considering that there are about 15 thousand dentinal tubules per 1 mm2, damage even in such a small area can be very significant. This circumstance is especially important when cavities form in healthy dentin. Equally important is the increase in temperature. Pohto and Sheineu (1958) showed that an increase in temperature of 5 - 7 degrees causes irreversible reactions in the pulp.

Traumatic pulpitis is much more often a consequence of iatrogenic damage than household dental trauma.

Inflammation of the pulp can manifest itself not only as a result of an infectious lesion, sometimes this process can be caused by various injuries or mechanical damage. Especially often, children who experience inflammation and pain in the tooth area due to various injuries turn to dentists with this form of damage. In dentistry, this form is called traumatic pulpitis. This type of lesion has certain characteristics and symptoms.

There can be a large number of reasons that can cause a traumatic form of pulpitis, but they are not related to the internal pathological processes of the tooth and other pathologies of the body. Usually this form is caused by external factors. The main reasons for the appearance of traumatic pulpitis include the following:

The occurrence of a crown fracture. In these cases, the pulp area is exposed and further infection is observed;
Sustaining a tooth injury as a result strong blow or falling. Usually with this type traumatic injury units of the anterior dentition suffer;
Mistakes of specialists during general health procedures surgical interventions for dental health. During these procedures, exposure of the pulp or some form of traumatic injury may occur.

As a result of a chipped tooth, through the destroyed edge, saliva with various bacteria and microbes enters the tooth, this leads to inflammation of the pulp tissue and the development of traumatic pulpitis.

It is worth noting that pediatric dentists most often encounter traumatic pulpitis, because it is children who are often exposed to various injuries, in which damage to the maxillofacial part is observed. This disease in children can manifest itself in both primary and permanent dentition. In most cases, damage to the upper central and lateral incisors is observed; sometimes damage to the lower units of the dentition can be observed.

Symptoms

In addition to the reasons for the appearance of this form of pulpitis, you definitely need to know what symptoms it is accompanied by. Symptoms will help identify the presence of this disease. But still, only a dentist should diagnose and treat this form of damage.

Important! The brightest and most noticeable sign of the presence of traumatic pulpitis is the appearance of sharp pain while eating. A painful reaction can occur when exposed to absolutely any irritating factor.

Therefore, with this form, drinking hot tea or cold water will be very difficult, and sometimes simply impossible.

Traumatic pulpitis is a type of non-infectious disease; it occurs as a result of mechanical impact on the tooth in everyday conditions, for example: chipping when eating or trauma from a fall.

Pain may occur when the tooth is touched lightly. Another one appears characteristic feature The presence of this form of pulpitis is the appearance of a sharp putrid odor from the mouth. Usually this sign indicates the presence of damage to the wisdom tooth. However, no hygiene products can eliminate this smell - neither toothpastes, nor balms, nor sprays.

How to treat

If you suddenly notice signs of traumatic pulpitis, it is better to consult a doctor immediately. The dentist will be able to diagnose and carry out appropriate treatment.
Therapeutic therapy is carried out according to the following scheme:

First of all, the doctor administers anesthesia so that there is no pain during treatment;
Next, the cavity is cleared of lesions;
The doctor must treat the affected area with antiseptic drugs;
After this, a calcium hydroxide gasket is installed;
Next, a temporary filling is installed;
During prolonged pulpitis, the canals are filled and a permanent filling is installed.

Attention! Traumatic pulpitis, like other types of pulpitis, is a serious tooth damage that must be identified and eliminated in a timely manner. You should not delay treatment; it is better to carry it out at an early stage, when the process has not yet gone so deep.

Saliva with microbes and bacteria enters the tooth through a chip, and the nerve becomes inflamed. The types of traumatic pulpitis include acute and chronic. Dentists divide injuries leading to this disease into two types.

Types of traumatic pulpitis

Damage resulting from a fall, bruise, or collision. People often come to the dentist with traumatic pulpitis after skiing, skating, skateboarding, cycling, or rollerblading. Children often get injured on a swing, as well as from a ball or puck flying into their face. During blows, bruises, falls, the front teeth usually suffer upper jaw– the crown chips, the pulp is exposed. Injuries also occur when trying to chew something hard - for example, a nut.

Damage caused by a doctor's error. As a rule, such situations arise during caries treatment. In this case, inevitable infection of the pulp occurs. If such a damaged tooth is filled without treating pulpitis, it will hurt, and inflammation will cause acute form will turn into chronic traumatic pulpitis.

Diagnosis of traumatic pulpitis

This type of disease, like other types of pulpitis, requires immediate treatment before complications begin. The dentist will conduct a diagnosis, including:

examination in the dental chair;
x-ray or computed tomography;
electroodontodiagnostics.

Electroodontometry analyzes the condition of the pulp using alternating current - diseased and healthy teeth react to it differently. This study is performed instead of an x-ray or as an addition to it. Accurate diagnosis traumatic pulpitis helps the dentist draw up an optimal treatment plan.

It will not be superfluous to know what symptoms manifest the clinic of traumatic pulpitis. A damaged tooth reacts sharply to hot/cold food, even cold air causes discomfort, and any touch to him is very painful. If the pulp was injured during dental treatment, the patient feels a sharp pain. Trauma to a wisdom tooth is accompanied by a sharp putrid smell, which hygiene products cannot cope with.

Conservative method of treatment of acute traumatic pulpitis

Treatment of acute traumatic pulpitis depends on the degree of damage. If it is minor, with little pulp exposure, it will be sufficient conservative method. It is also called a biological method of treating pulpitis - it involves preserving the pulp with all its functions. Such therapy is effective at the very beginning of inflammation.

Stages of conservative treatment

Local anesthesia relieves pain.
The dentist removes damaged tissue.
To prevent inflammation, apply to the cavity healing pad.
A filling is placed on the crown of the tooth - permanent if everything is done in one visit, and temporary if the treatment takes place in 2-3 visits.

Surgical method for treating traumatic pulpitis

It is not always possible to cure traumatic pulpitis conservative method, it is often necessary to use a surgical method. It is used if the crown of the tooth has broken off and there is significant exposure of the pulp - inflammation can turn into chronic form. Surgical method Treatment of traumatic pulpitis takes place in two stages.

First stage

The tooth is treated with an antiseptic and anesthesia is administered.
The dentist cleans the cavity and partially or completely removes the pulp.
The cavity is well dried, after which a therapeutic pad with an anti-inflammatory drug is applied.
A temporary filling is placed.

Second phase

The temporary filling is removed, and the oral cavity is once again treated with an antiseptic.
A medicinal paste is applied and a permanent filling is placed.

How much does it cost to treat traumatic pulpitis in Moscow clinics?

The cost of therapy depends on the degree of damage - the larger the chip, the more expensive. In Moscow clinics, prices for pulpitis treatment start from 6,000 rubles for a single-canal tooth and reach 12,000 rubles. The price tag is also affected by which tooth the problem arose with. On the chewing one, you can limit yourself to only treatment, and the anterior one, as a rule, also has to be restored. This increases costs by at least 3,500 rubles. Treatment methods for traumatic pulpitis also differ in cost: conservative methods require more time and effort from the dentist, which means they are more expensive. The surgical option to remove the pulp will be cheaper.

The development of the inflammatory process in the pulp chamber of the tooth, the cavity where the nerve endings and blood vessels are located, loose connective tissue, may be a consequence of mechanical stress. A tooth injury, even one that is not accompanied by a crown fracture, requires the attention of a Good Dentistry specialist. Timely request for medical care allows you to preserve the tooth in the jaw, prevent the death of the nerve and the transition of the inflammatory process to periodontal tissue.

Causes of acute traumatic pulpitis

A pathological process develops in the pulp in the following cases:

violation of the integrity of the crown, in which the pulp can be exposed and become additionally infected;
impact on the tooth surface;
exposure and injury to the pulp during dental treatment.

Most often, nerve damage occurs while performing dental procedures observed during treatment deep caries. It can be difficult to remove all destroyed tissue without damaging the walls of the pulp chamber. If the doctor uses a drill or probe to penetrate the tooth cavity, they try to preserve the nerve. And only if the biological treatment method turns out to be ineffective, then depulpation of the tooth is carried out with further filling.

The incisors and fangs are most often damaged, since it is the front teeth that suffer the greatest number of injuries. The inflammatory process can equally likely develop in both permanent and baby teeth.

Symptoms

The inflammatory process in an injured tooth manifests itself as follows:
there is discomfort and pain when biting;
temperature sensitivity increases significantly;
pain and discomfort at rest with the rapid development of the pathological process.

If a crown or root is fractured, there is no need to wait for symptoms. This condition in itself requires seeking medical help. In other cases, after an injury, it is permissible to monitor the condition of the tooth.

Treatment

Medical tactics in identifying traumatic pulpitis are determined by many factors, the decisive of which is the degree of involvement of the nerve and blood vessels in the pathological process, the likelihood of infection of the contents of the pulp chamber.

At the stage of examination and diagnosis, the use of painkillers and anti-inflammatory drugs is acceptable. However, it should be remembered that they are not capable of leading to recovery, but only alleviate the patient’s condition for a while.

Also applicable:

conservative treatment method;
complete or partial removal of the pulp followed by filling.

Conservative treatment (biological method) has its own indications and a number of limitations. The chances of saving the nerve decrease every hour, so postponing a visit to the doctor when symptoms appear is harming yourself.

The biological method involves the use of drugs with antibacterial and anti-inflammatory effects. They are applied to the area of exposed pulp under a temporary filling. Additionally, physiotherapy may be prescribed, aimed at calming the inflammatory process and stimulating regeneration.

For several days after the temporary filling is installed, the patient is under medical supervision. The appearance of pain and other unpleasant symptoms in the tooth indicates ongoing inflammation in the pulp chamber, which requires complete or partial removal of the nerve. The subsidence of inflammation allows you to install a permanent filling, keeping the tooth alive.

Surgical treatment involves removing the pulp, cleaning the root canals and filling. This method of treatment is not a priority in dentistry, since a “dead” tooth is less resistant to physical activity and more fragile. However, in most cases of late seeking medical help, the dentist has no choice.

An alternative complete removal pulp can be a partial depulpation method, in which only part of the nerve is removed from the pulp chamber, while the nerve fibers and vessels located in the root canals remain intact.

Similar to the biological treatment method, after partial removal of the pulp and installation of a temporary filling, the patient spends several days under observation. Treatment is considered complete if the patient has no manifestations of the inflammatory process and a permanent filling can be installed. Continued inflammation requires cleaning the canals and filling them.

Prevention

It is not always possible to prevent dental injuries in everyday life and in sports. However, it is within our power to promptly contact “ Good dentistry» at the Ozerki metro station for treatment. The earlier caries is treated, the lower the risk of developing traumatic pulpitis. The sooner treatment of pulpitis is started, the higher the likelihood that it will be possible to save neurovascular bundle, nourishing and innervating tooth tissue.

Prices for dental treatment

Service	Price
Treatment of caries
Treatment superficial caries	3,200 rub.
Treatment of average caries	4,300 rub.
Treatment of deep caries up to 1/2 tooth destruction	5,500 rub.
Treatment caries icon	7,000 rub.
Treatment of pulpitis
Treatment of pulpitis - one tooth canal	7,000 rub.
Treatment of pulpitis - two tooth canals	8,500 rub.
Treatment of pulpitis - three tooth canals	10,900 rub.
Treatment of periodontitis
Treatment of periodontitis - temporary filling of the 1st canal	3,500 rub.
Treatment of periodontitis - temporary filling of 2 channels. tooth	4,500 rub.
Treatment of periodontitis - temporary filling of a 3-channel tooth	6,050 rub.
Treatment of periodontitis - permanent filling of the 1st channel	4,100 rub.
Treatment of periodontitis - permanent filling of 2 channels. tooth	RUB 5,750
Treatment of periodontitis - permanent filling of 3 channels. tooth	RUB 7,550
Fillings and sealing
Temporary filling made of light-curing material	400 rub.
Filling with chemically cured composite	1,900 rub.
Filling with glass ionomer cement	2,200 rub.
Filling with light-curing composite (Estelite)	3,100 rub.
Unsealing is simple	1,500 rub.
Unsealing is difficult	1,800 rub.
Other
Application of devitalizing paste	1,800 rub.
Removal foreign body from the tooth canal	RUB 3,800
Application of medicinal dressings	600 rub.
Restoring the coronal part of a tooth with a fiberglass pin	5,800 rub.
Restoring the corner or incisal edge of a tooth	5,000 rub.
Tooth restoration using SHS	7,500 rub.
Treatment of stomatitis	750 rub.