Pulpitis (pulpitis; from lat. pulpa - pulp) is an inflammation of the pulp of the tooth.
Etiology. The most frequent cause of pulpitis is the dental caries; significantly smaller role played by other pathological processes, which also has been a violation safe enamel cover tooth (increased erosion, necrosis of enamel and others).
Uncovering of dentin pulp (in particular, extensions of odontoblasts and located in the dentin nervous elements) becomes more exposed to mechanical, thermal and chemical (waste products of microbes, food residues, saliva) stimuli. Result of degenerative changes (vacuolization layer odontoblasts, education listopadovka cavities, net atrophy) and inflammatory nature. Frequent, but light irritation usually lead to the development of chronic inflammation. Intense irritation can lead to the development of acute inflammation, such as burns pulp (as a result of incorrect preparation under an artificial crown or injury.
Pulpitis can occur in cases when the dissection is performed under cooling of the intensity of the inflammatory process depends on the pressure exerted on the dentin, the preparation. Most often acute inflammation or exacerbation of chronic pulpitis is caused by infection in the pulp chamber through dentinal tubules or via emerging communication between the cavity and the pulp chamber, through top hole root (in the deep pathological periodontal pockets, and sometimes when sinusitis, when the roots of the corresponding upper teeth deep in the maxillary sinus), with broken tooth or jaw.
In the infected pulp is determined by the diverse flora (found on the mucous membrane of the mouth, digestive tract, respiratory tract); prevail coccoid forms. What germs are the agents of pulpitis, unknown. Introduction in the pulp chamber putrefactive bacteria can cause gangrene pulp. After filling, i.e. after the termination of the message pulp camera with oral infected teeth can become sterile (germs are killed in the products of their own currency). Suggested that microbes will be destroyed by phages.
Pathological anatomy. Pulp is a connective tissue formation (see the Teeth). At the inflammatory process in it are determined microscopically the same morphological changes observed in any of the connective tissue. Macroscopic picture is determined by the character of the inflammatory process. Red and juicy pulp indicates acute pulpitis; availability drops pus - o purulent process; pale and thin, the pulp is about fibrous degeneration; lush granulation - on hypertrophic pulpitis; gray-black or dark-brown (with a characteristic smell) pulp - of gangrene. However, in the clinic, the opportunity to explore the pulp is very rare.
Over and symptoms. The main symptom of acute pulpitis - spontaneous paroxysmal pain. Also typical pain attacks under the influence of temperature irritation, and pain can arise from the cold, and from hot or only from the cold, or only from hot. The mechanism of this pain has not been studied; apparently, they are closely associated with the pathology of the cardiovascular system of the pulp. Percussion tooth can be painful, due to either a concussion inflamed pulp, or the transition of acute inflammation to the periodontium (in the latter case, the pain will be and when namazyvanii or pressure on the tooth). When combined picture of acute pulpitis and severe periodontitis (see) can be correct to speak about acute polypeptidesee.
In chronic pulpitis spontaneous pain no, they arise under the influence of mechanical, chemical, thermal stimuli (sometimes just change the temperature of the surrounding air) or pressure changes in the pulp chamber (in sucking air out of it or rises to a considerable height). Often chronic inflammatory process applies to the periapical tissue (chronic polipeptidna).
The diagnosis. Substantial help to assess the state of the pulp has electroodontodiagnosis (see the electric diagnostics). In the initial stage of acute pulpitis elektrovozoremontnij tooth or little or no change. With the progression of the process, elektrovozoremontnij increasingly reduced. The existence along with the areas of decreased elektrovozoremontnij areas, normally respond confirms the limited pulpitis. The decrease in excitability in all areas of the tooth says diffuse process. No reaction on currents of less than 50 MCA indicates the death of the crown pulp and lack of reaction to the currents of less than 100 MCA - death and the root of the pulp. These figures are obtained by study of the tooth with his sensitive points. After the amputation of a coronal pulp most accurate picture of the state of the root pulp can be obtained by examining elektrovozoremontnij from the mouth of the root canal. Normal response to electrical stimulation (while no other clinical symptoms) suggests that there remained a normal pulp. In these cases more correct to speak of "partially deponirovano tooth." Acute inflammatory process in the root-pulp (acute root pulpitis) is typical of acute pulpitis clinical picture. Chronic inflammatory process in the root-pulp (chronic root pulpitis) is characterized by only a pronounced decrease in elektrovozoremontnij.
Under the influence of mechanical, thermal or chemical injury in the pulp of the tooth with unopened pulp camera may come total (elektrovozoremontnij missing) or partial (elektrovozoremontnij lowered) necrosis. Gangrene, determined on the basis of a characteristic smell, and sometimes the form of pulp, too, is total (elektrovozoremontnij missing) or partial (elektrovozoremontnij is reduced).