Acute pulpitis: symptoms and treatment

Toothache often occurs against a background of progressive carious process, when the depth of bacterial destruction reaches the apical part of the tooth. Acute pulpitis is often the result of untreated caries with prominent symptom is throbbing pain when the patient is forced to seek help from professionals. Among all dental diseases acute pulpitis is a leader that is equal to 20% of all clinical situations. With timely treatment of opportunistic diseases of the tooth, while respecting the prevention of the risk of pulpitis reduced to a minimum.

Pulpitis as a disease

Acute pulpitis means the beginning of a pathological process localized inflammatory lesion in the soft dental tissue located in the basal part of the tooth. In progressive pulpitis pathogenic microorganisms distributed in polovoy chamber where are located the blood vessels, nervous the smallest end. Its origin acute pulpitis takes from carious lesions, which long time was destroying the enamel, the hard tooth structure. The physiological structure of the teeth characterized by the following:

  • the crown part that hangs over the gums;
  • the neck of the tooth, passing in the root section;
  • the root of the tooth (the tooth fragment in the alveolar ridge).

For pulpitis has a direct relationship with the etiological factors of its formation and may have its own characteristics. No matter what is the etiologic factors of pulpitis (different infection, trauma or toxic effects on the «neural processes» the material of the seal), the inside of the soft compounds and polovoy tissue occur significant morphological and structural changes:

  1. swelling of the pulp;
  2. change and disruption of blood flow;
  3. distinct lack of oxygen;
  4. obstruction of toxins:
  5. necrosis or necrosis of cells.

To the inflammatory process was localized in polovoy cavity, it is necessary that the defeat suffered tooth enamel, the crown part of the dentin. After bacterial microflora vnutrikojnuu strikes soft tissue, the patient experiences severe ongoing pain, often radiating to the whiskey brain and maxillo-facial muscular system.

Etiological factors

The occurrence of the acute process can trigger by many factors, which are based on bacterial or infectious nature of occurrence. Despite the fact that acute inflammation is a frequent complication of deep caries, the paths of infection can be:

  • the downward (decay);
  • up (for sinusitis, periodontitis, acute periodontitis);
  • lymphogenous;
  • hematogenous.

Acute pulpitis can be formed due to the development of extensive or local sepsis when infected by Staphylococcus aureus, Streptococcus. Among other reasons are:

  1. chipped and cracked teeth:
  2. acute trauma to the tooth:
  3. stomatitis;
  4. violation of technology of preparation of tooth cavity;
  5. mechanical damage as a result of treatment of the tooth;
  6. the effect of dental drugs.

Causes of pulpitis can be attributed to infectious or bacterial pathogens on the background of diseases of the upper and lower respiratory tract occurring in the chronic form. Before determining the possible causes of infection of the pulp should be classified disease-specific types.

Types and classes of the disease

Acute pulpitis usually classified in certain areas. Morphological and structural damage to the tooth can accurately identify the cause of pulpitis and to initiate timely the correct treatment. The basis of differentiation for the dentist are often the complaints of the patient and visual examination of the oral cavity of the patient.

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Focal (or serous) pulpitis

The pathological process progresses in conjunction with the appearance of pain in the middle or deep carious lesion of the tooth. Pain after the visual inspection, there is swelling of the pulp tissues. The more pulp is covered with the defeat, the result and duration of pain. Minor impact on the tooth combined with pain and discomfort.

Diffuse pulpitis acute over

The inflammatory process is localized in the entire volume of the pulp tissue in the apical part of the tooth. In diffuse pulpitis hyperemia of the capillary gaps is global in nature. The pain becomes prolonged and the exudate flows into the dentinal channels. Pain in tooth subsided briefly, and after exposure to stimuli (tapping, cold or hot food), only amplified.

Purulent (exudative) pulpitis

When purulent process begins the destruction of the capillary structure of the pulp. Localization of foci at the beginning of the pathological process is patchy, and later converted to full infection of the total volume of the pulp. Purulent pulpitis entails the absolute destruction of all soft tissue apical region of the tooth, and pain, thus, becomes irrepressible.

Difference acute diffuse pulpitis from focal is the extensive localization of pain on the processes and channels of the trigeminal nerve. The pain may radiate to the temporal region, ears, periorbital area, neck. The patient may not always reliably indicate to the dentist the causal tooth, and therefore have to use additional methods of diagnosis.

In focal concentration of pulpitis, the pain is localized exactly in one tooth, and the patient is able to reliably determine the source of pain. Each type of pulp has individual symptoms and often develops from a serous to purulent. Types of pulpitis differently characterize the stages of the inflammatory process, so it is important to identify the form of pulpitis at initial diagnosis.

Signs of pulpitis

In acute pulpitis the patient is experiencing discomfort and severe pain. The main symptom of acute pulpitis is pain that can change its intensity depending on the flow and form of the pathological process. The pain may radiate to the temporal region, ear, nose, throat, aggravated by night and fade by morning. Pain relievers often do not save the situation and the patient is forced to contact the relevant companies. Duration of pain attack depends entirely on the extent of damage of the pulp. The main features include the following:

  • the formation of granulomas around the causative tooth:
  • numbness of part of the mucous membrane of the gums;
  • severe swelling;
  • redness;
  • blood separation when brushing your teeth;
  • easy discharge of solid tooth structure by mechanical action;
  • the increase in body temperature;
  • insomnia and emotional instability;
  • common symptoms of intoxication.
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In acute pulpitis, the treatment is chosen only after a thorough diagnosis. Before treatment it is important to determine the type and form of acute pulpitis, as there are fundamental differences in therapeutic tactics in certain structural and morphological lesions.

Differential diagnosis of

Pulpitis manifest on the General complaints of the patient, according to clinical history, according to the survey of the patient on the subject of the earlier state. Also, the doctor examines the oral cavity of the patient, takes into account the degree of damage. If necessary, apply x-ray or ultrasound scan of soft tissues in polovoy the camera. Additionally take blood tests for immunological status, the biochemical data as well as material to determine the level of immunoglobulins in the liquid of the oral cavity of the patient. Diagnosis is important to exclude conditions like periodontitis, papillitis, alveolitis, neuritis of the trigeminal nerve, severe acute sinusitis. If you are having difficulties in the diagnosis, then resort to the consultation of the doctor-otolaryngologist, a specialist in the field of surgery or neurologist. Treatment of acute pulpitis is a fundamental difference that is determined by the nature or shape of its flow.



The adequacy of treatment is entirely in the relief of pain, elimination of inflammation, restoration of anatomical structure of the tooth. The first thing the doctor will prescribe pain medication, which act is aimed at nevriye channels in the pulp. This opened the cavity is applied arsenic paste, the patient can safely wait for a doctor’s appointment. There are two main methods of treatment: biological and surgical.

Surgical treatment

Surgery is a drastic treatment and is suitable for advanced cases of the destruction of the tooth. Operation is assigned in severe cases the pulp, and also at impossibility of conservative treatment. Patients suffering from chronic diseases that can affect the development of acute pulpitis, undergo complete removal of the inflamed pulp. The algorithm operation consists in the following steps:

  • relief of pain;
  • the opening of cavity of tooth:
  • the removal of diseased pulp:
  • the imposition of medicines:
  • the imposition of antiseptics:
  • final sealing of the channels.

The method allows to remove the pulp, but retains the root structure of the tooth. All treatment methods require the introduction of conduction anesthesia. In the appointment of treatment the doctor is obliged to examine the overall clinical history of the patient, to determine the degree of susceptibility to some drugs, take into account the presence of chronic diseases of organs and systems. Often as anesthetics used are lidocaine or trimecaine.

Biological method

The aim of biological treatment is the complete preservation of functionality and viability of the pulp in polovoy the camera, and a natural tooth shape. The treatment algorithm is the following manipulations:

  1. pain relief;
  2. removing a necrotic dentin;
  3. the opening of cavity of tooth:
  4. antiseptic;
  5. the imposition of a medicine:
  6. filling.
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Final sealing of the channels is acceptable against the background of absolute confidence of the dentist in removing all pathogenic organisms. In frequent cases, many are reinsured and complete treatment on the second visit. Biological method of treatment is often called conservative. This way is acceptable for patients not burdened by having a clinical history in the absence of common somatic diseases. This method of treatment addresses the problem in a few visits.

Possible complications

Against the background of successful treatment with observance of all technological norms, the development of complications are special cases. The main reason for the complications is the lack of professionalism of the doctor and the wrong approach to the diagnosis of any form of acute pulpitis. Outcome of poor work becomes the complete extraction of the tooth with the root part of it. Pain normal can be stored up to 2 days after treatment.

If after treatment of the acute destruction of the pulp, the patient experiences severe pain in the causal tooth, if its intensity is only amplified, it is a direct symptom of complications. Some experts applied the final seal a few days after treatment as it is not always possible to completely clear all the cavity from the bacterial microflora. In such cases, there should be an additional antibacterial therapy.

Prevention and forecasts

Modern dentistry is almost 98% eliminates the risk of complications. But the success of the treatment and prevention of acute pulpitis is not only professionalism, but also in the actions of the patient. To the requirements of prevention include:

  1. annual visits to the dentist;
  2. timely treatment of caries;
  3. adherence to a healthy lifestyle;
  4. selection of high quality toothpastes, brushes;
  5. the choice of qualified medical facilities.

With chronic pulpitis signs of acute forms is characterized by periods of exacerbations. The possibility of developing a chronic process even more, forcing the doctor to resort to advanced methods of diagnostics of the disease. The absence of adequate therapy always entails grave consequences, even loss of the tooth. At the correct actions of the doctor or patient the prognosis of pulpitis is always positive. In almost all cases it is possible to save a natural tooth and to preserve his health. Daily cleaning of patient discipline in relation to their own health — the key to timely and successful treatment of the patient’s tooth.