Electroodontodiagnosis

Under the generalized long experience ruby L. R., who during 26 years was engaged in scientific, medical and pedagogical activity in Moscow medical stomatological Institute. The section presents data on the study innervation of the staff of the dental pulp in age aspect. Covers the basics of electroodontodiagnosis. The description of this method of research of elektrovozoremontnij the tooth nerve in the norm and at diseases of teeth and periodontal tissues. Designed for dentists.

Author Professor L. R. Rubin belongs to a prominent role in deepening theoretical and practical knowledge necessary for using of physical methods of diagnostics and treatment in clinical dentistry. He prepared a special cadre of physicians-dentists; on his initiative and with his participation, seminars and conferences devoted to the issues of physical therapy in dentistry.
Noting the imperfection of the common diagnostic tools dental diseases such as various kinds of pathological processes in the tissues of the teeth, and, in particular, in the pulp, the author believes that the most promising method of differential electric diagnostics. A prerequisite to the presentation of the method electroodontodiagnosis intended as General information about the specifics of innervation of the teeth, irritability them, data on reactivity of the pulp of teeth are normal, degenerative and regenerative States its etc. as well as information about the mechanism of irritating action of electric current, bioelectrical phenomena, laws polar irritation and other processes related to the application of electroodontodiagnosis.
Under the technique electroodontodiagnosis described the devices and methods of their use in the clinic during the direct lesions of teeth and in some pathological processes in the jaws.
The section will bring substantial benefits to the practical dentists.

Contents

Electroodontodiagnosis is the definition of reaction is sensitive to the tooth nerve irritation electric shock. Diseases of pulp in the pathological process in one way or another are involved and its nervous elements that affects their excitability and conductivity. The definition of elektrovozoremontnij sensitive nerve of the tooth network, thus, the ability to judge the state of the pulp. The study used a special device that causes irritation both DC and AC (the latter should be resorted to only in cases when because of a pronounced polarization of dental tissue research DC becomes impossible). Mnogotomnym potentiometer allows you to smoothly regulate the voltage supplied to the patient. The amount of current flowing through the tooth is measured using microammeter in the circuit of the patient. The stimulation pulses are applied by means of a button, allowing you to close and razmyat chain patient. The intensity of the pulse to increase until the tooth will not appear the first faint sensation of pain is what the patient should be known (to pronounce the sound "a"). If irritation shock tooth, even with partially preserved pulp, there is a slight feeling of pain shot, burning). If the pulp completely destroyed, there tactile sensation (touch, push, because in the first place irritation exposed pariament, richly equipped with tactile fibers. Tactile feeling can arise in the teeth with preserved pulp - when neuritis alveolar nerves and after anesthesia, when first off pain sensitivity.
To include the patient in the chain are applied two electrodes. The passive electrode (lead plate size 10X10 cm) with moist hydrophilic gasket is placed on a back surface of a brush and fixed with a bandage. The active electrode (wire of stainless steel, strengthened in the special electrode holder of an insulating material; the working part is wrapped with a thin layer of cotton wool wetted tap water) sterilized by boiling. Electrode holder before you study carefully wipe alcohol. The study tooth is lined with cotton rolls and using a cotton balls dried it in the direction from the cutting edge to the neck. The tooth should be free from plaque, stone (at least in areas subject to investigation). The active electrode is placed on the sensitive points of the tooth: the middle of cutting edge in front teeth, peak cheek hillock on the premolars, the top of buccal-medial thigh - molars. From these points, the reaction is called when the minimum current. In carious teeth, along with the usual sensitive points of the study is conducted and the bottom of the cavity (pre-process it, but removing the extent possible softened dentin, well dried and examined in 4-5 points of the bottom). A study of dentin spend dry electrode (without wool). When determining elektrovozoremontnij teeth the great seal (when mounds destroyed), large approximal located carious cavities or in cases where resistance Bugrov very large and received Max. voltage current is not enough to cause a reaction, a study should be made with fillings, grooves, and in the front teeth - lingual side over the hummock. The results obtained here give only a rough idea about the state of the pulp. For more
accurate data, the teeth have respomsibility. In cases where the mouth of the channels available for research, should determine the excitability of each channel separately, which gives the most realistic idea about the state of the root pulp. To avoid errors related to the leakage current, the doctor examining the teeth should work in rubber gloves. Instead of metal dental mirrors you want to use a plastic spatula. A study carried out together: one keeps an active electrode on the sensitive point of the tooth, the other is sitting at a machine and, irritating tooth short current pulses, determines the threshold force that creates the first impression.
Healthy teeth (regardless of group membership) react on currents from 2 to 6 mA. Threshold reaction to the currents of less than 2 ua or more 6 MCA shows abnormal changes in the teeth.
Increased irritability, i.e. the reaction to the currents of less than 2 ua, most often observed in periodontitis and teeth, exposed to permanent injury (for example, if pathological bite).


Reduction of elektrovozoremontnij, i.e. the threshold reaction to the currents greater than 6 MCA can be caused by different reasons. One of such reasons can be the disease of the branches of the trigeminal nerve (which supply a sensitive fibers tissues), it supranuclear ways, or relevant departments of the cerebral cortex. Diagnostics in these cases is no problem: along with the violation of excitability of all teeth supplied by the affected branch of the trigeminal nerve, is determined disorder surface sensitivity on the relevant parts of the skin and mucous membranes of the oral cavity. Much more often the reason for decline of excitability is tissue damage pulp and involving in pathological process of the nerves located in the lesion. What is more sharply expressed changes in the pulp, the lower elektrovozoremontnij tooth. If in the study of the tooth from all sensitive points, the reaction occurs only on currents more than 60 MCA, it indicates loss of the crown pulp; emergence reaction on currents above 100 MCA says about death and the root of the pulp.
These characterizing elektrovozoremontnij data is correct in relation to the teeth with perfectly formed by the roots. Elektrovozoremontnij teeth with open apex is closely dependent on the stage of development of roots: the growth of roots, it has improved and by the time they complete the formation reaches the normal figures.
Modern classification, and therefore, diagnosis of caries, is based only on data about the depth of the defeat of his hard tissues. The treatment is reduced to filling defect filling material. Meanwhile in dental caries in the pulp is often seen as degenerative changes (deposition of calcium salts, net atrophy, vacuolation in the layer of odontoblasts, education rather large listopadovka cavities and other), and inflammatory nature. These changes may be so pronounced that require special therapeutic intervention (amputation of the crown pulp or even deportacia tooth). To determine these changes in the clinic only in the study of elektrovozoremontnij tooth.
The diagnosis of acute and chronic pulpitis put on the ground in pain, history and some of the image data. However, to choose the right method of treatment (conservation pulp or her necrotization), to establish the severity of the process and its length is not always possible. Attempts to prove these cases on the character of pain (their intensity, frequency, duration) lead to gross errors. This is evidenced by the large percentage (80-90) discrepancy between clinical and pathoanatomical diagnosis. Pain is not always equivalent to the severity of the process. Small in length hearth can cause excruciating pain and broad, diffuse process often proceeds without pain. If pain is severe elektrovozoremontnij may be little or no change (demonstrating a few of the expressed morphological changes in the pulp tissue) and, on the contrary, with little apparent pain can be dramatically reduced (indicating severe morphological changes in the pulp). Proper use of the data electroodontodiagnosis contributes fairly accurate establishment of the state of the pulp and the right treatment.
Plays a significant role of electroodontodiagnosis and when periodontitis teeth with impassable root canals. Pulpitis treatment of such teeth is performed, as a rule, by amputation. Further changes remaining in impassable canals pulp is usually not traced, although these changes depends on periodontal health and tooth in General. In some cases, pulp in the root canals are not changed (elektrovozoremontnij within the normal range) and serves as a reliable barrier to the periodontium; in others, it quickly perishes (elektrovozoremontnij missing); in some cases the inflammatory process acute and gives a typical clinical picture of acute pulpitis, the outcome of which is or death root pulp, or the transition to a chronic (elektrovozoremontnij usually more or less reduced). But most of the inflammatory process from the very beginning is chronic. In the propagation process on capitalnew region at the forefront are the changes in the periodontium. Therapeutic measures in these cases aimed at combating periodontal disease without taking into account the state of the pulp. This treatment is futile. The treatment is also aimed at elimination of the inflammatory process in the root-pulp or necrotization, promotes the elimination of the pathological process in periodontal and preservation of the tooth.
In people who have suffered jaw osteomyelitis, often there is a hidden flowing necrosis and infection pulp in the result of infection (through the apical hole) and thrombosis of the pulp in a seemingly healthy teeth. The affected teeth become the centers of secondary infection and cause of the recurrence of osteomyelitis. These teeth must be trephinated and appropriately treated, and channels them carefully sealed.
So on the elimination of critical phenomena osteomyelitis it is necessary to conduct electroodontodiagnosis all of intact teeth sore jaw, not only in the hearth osteomyelitis process. When osteomyelitis should be borne in mind that nevozmozhnosti teeth may be the result of and involvement in the process alveolar nerves; it is determined on the basis of the research data excitability teeth and sensitivity of the mucous membrane supplied by the relevant nerve. To differentiate nevozmozhnosti teeth resulting from the loss of pulp from nevozmozhnosti, the reason of which is damage to the alveolar nerve, falls and injuries to the jaw. For injuries teeth should never rush into trepanation, even in cases of complete lack of excitability. Patients should appoint appropriate therapy and re-examine the affected teeth. Experience shows that in some teeth anxiety recovered, others, on the contrary, it, gradually going down, disappears. In this group of patients pulp necrosis some teeth are asymptomatic. Such teeth through a given period of time can become a source of a number of complications (cysts, osteomyelitis). Therefore the patient who sustained teeth, it is necessary to investigate not only the teeth, which he feels the pain, but the teeth adjacent to them, and antagonists.
Fractures root in the field of apical third and even on the level of its mid-with deportacia tooth should not hurry. If the apical part of the root remained alive pulp (which is established on the basis of data electroodontodiagnosis), with the right treatment is full consolidation of fragments. It should be borne in mind that the x-ray picture clearly shows the location of the fracture, as the newly formed dentin cure is less then usual.
For large radicular cysts are not always easy to define "guilty" tooth. The color of the teeth, which radiograph immersed in the cyst, are not often changed. Only electroodontodiagnosis can help determine which of the tooth "proceeds" of the cyst. However, sometimes the root tip perfectly healthy teeth can be projected on a very limited area of the vacuum, which begins in the apex of the root of the adjacent teeth, but on the radiograph is not fully defined. To clarify the diagnosis in these cases is possible only with the help of electroodontodiagnosis.
Electroodontodiagnosis, however, not only helps to make the diagnosis. Its role is much broader, as it allows you to trace how the dynamics of the pathological process and the effectiveness of therapy.