Chronic fibrous pulpitis: causes, treatment
Chronic fibrous pulpitis is one of the major diseases of the pulp, responsible for protecting the cavity of the tooth from exposure to pathogenic and conditionally pathogenic microflora. The disease occurs as a result of prolonged untreated carious lesions of the tooth or inadequate treatment. If the decay for a long period of time can wear latent and does not show a symptomatic pattern, the intensity of signs of the onset of pulpitis is a color tint. Dentistry today offers a number of effective treatments for chronic fibrous pulpitis with the possibility to save your own tooth.
Chronic fibrous pulpitis refers to inflammatory diseases of the soft tissues of the tooth. Pulp is the main protective function of the tooth from external influences of negative factors affecting the destruction of the enamel and structure of soft or hard tissue. In addition to protection, the pulp provides the necessary power to the tooth important trace elements. Chronic disease is a secondary process of acute pulpitis. Many patients can remove pain by anesthetics and antibiotics alone, not going to the doctor. Acute symptoms of pain and inflammation may be temporarily relieved but the disease again makes itself felt. Incorrect therapeutic tactics have provoked repeated outbreaks of exacerbation of the disease, goes deep into the structural tissues of the tooth and contributes to the rapid development of the fibrous pulpitis. The fibrotic process due to decomposition and substitution of granulation tissue. The main causes of fibrous pulpitis include:
- untreated caries;
- the primary process in the temporary teeth (milk occlusion in children);
- the autopsy crown of the tooth (with subsequent purulent content in the region of the pulp);
- violation of the technology of caries treatment (lack of treatment, incorrect overlay strip and other nuances);
- injections in the gums;
- surgical operations in the oral cavity;
- reaction to some medications.
A detailed study of the fibrous pulpitis, including the results of laboratory histological examination of the material, there is a pronounced proliferation of connective tissue with a high content of collagen fibers, the change in the morphological structure of the cells. With the development of morphological and structural changes detected by hyalinosis of collagen formation and calcification of dentin.
The clinical picture
During clinical observations of patients with acute and chronic form of pulpitis symptoms are very different. If in the first case, no dental treatment is no patient, chronic process accompanied by periodic occurrence of pain. Chronic pulpitis long time can not manifest itself acute pain, causing only minor discomfort under the influence of cold or too hot food. Among all the symptoms and the chronic course are the following:
- aching pain in the tooth;
- the increase in body temperature to 37-38 degrees;
- periodic radiating pain;
- increased reaction to cold and hot food:
- the formation of granulomas on the gums with purulent contents.
Discomfort the patient is experiencing especially in the evening or night hours, but the pain you can stop at the local imposition on the affected tooth cavity analgin lidocaine and other anesthetic solutions. During routine examination of the oral cavity of the patient, the dentist reveals a pronounced caries dental cavity. At the core of successful treatment lies in accurate differentiation of chronic fibrous pulpitis acute forms of pulpitis of different etiologies.
The definitive diagnosis is made on the information of the General clinical and dental history of the patient, disturbing phenomena, a General examination of the oral cavity, additional instrumental methods of examination (x-ray). When excessive fibrous pulpitis acute toothache is replaced by the reduction of discomfort, which can occur when a mechanical impact on the affected tooth (for example, when chewing, bite of solid food). The tooth has a relatively wide and deep carious cavity with softened dentin content. In some cases, the pathological transformation of the cavity in the tooth under permanent seal. General diagnosis involves the following activities:
- visual inspection of the oral cavity;
- identification of the affected tooth;
- the method of percussion of the tooth (tapping), and palpation;
- the termoproby;
Polerowanie problem tooth and tapping rarely causes a painful reaction. At therapeutic probing, the patient often experiences acute pain, there is bleeding. The goal of the extensive diagnostics — the absolute exception of running caries, focal or gangrenous pulpitis, periodontitis (including chronic form).
In the treatment of chronic fibrous pulpitis the use of innovative approaches. In some cases, you can save not only the pulp but also the whole tooth. After the diagnosis is determined the optimal method of therapeutic treatment. When interviewing the patient revealed that the problem tooth was previously treated and the clinical situation was accompanied by a sharp pain. Modern dentistry offers the patient two methods of treatment of chronic fibrous pulpitis:
- vital method;
- devital method.
Vital method refers to progressive techniques, without the use of toxic drugs and medicines. Cleaning out the cavity of the tooth is performed under local block anesthesia. Then, the dentist extends the channels and removes the inflamed pulp. Upon completion of the operation area of the tooth treated with an antiseptic. Devital method is almost never used, but was very popular not so long ago. The disadvantages of this method is the exceptional toxicity of drugs used, the blackening of tooth enamel, high risk of recurrence of inflammation. Chronic pulpitis can be treated only by surgery, which involves removal of the inflamed pulp. The extermination is carried out only in the presence of allergic reactions of the patient to used in the treatment of dental drugs, as well as obstruction of channels (the situation for elderly patients). Modern methods treat gentle, allowing to keep the structure of the tooth unchanged.
Prevention is the timely treatment to the dentist at the first sign of carious destruction of the tooth. Other measures to prevent disease systemic cleanse the mouth of impurities, carrying out preventive medical examinations. The exception of pulpitis:
- inspection at the dentist at least twice a year;
- exclusion from the diet of corrosive products;
- timely treatment of caries;
- a thorough examination of the oral cavity while taking serious medications;
- hygiene teeth brushing and rinsing after every meal.
This is especially true for patients with a complicated clinical history if necessary, the use of potent toxic drugs (chemotherapy for cancer, treatment of surgical diseases). With timely treatment of pulpitis it is possible to save a natural tooth, without resorting to deletion. Parents should closely monitor the oral cavity of their children because of the blurring of the first symptoms of pulpitis and that it is often impossible to visually assess the condition of the mouth a little patient.
Chronic fibrous pulpitis is the end stage of caries development. The disease duration may vary from one month to several years. In the case of ignoring symptoms and not going to the doctor, you can even lose a tooth. In addition to tooth removal may be followed by inflammation of the jaw bone, the formation of flux, fistula, changes in bone structure of the jaw, generalized sepsis, and other complications. Timeliness in resolving dental problems is the key to a beautiful and perfect smile for years to come.
Features of pulpitis in children
Pulpitis has no gender and age differences. He is as likely to occur in children and adults. Fibrous pulpitis in children in the presence of permanent dentition can occur when the milk bite. Children pulpitis often occurs at the closed cavity of the tooth. Pulpitis chronic cases, on the milk bite has no effect on permanent teeth. The symptoms of inflammatory process of the pulp in children include:
- pain after a meal;
- sensitivity to cold or hot food;
- the increase in body temperature.
The insidiousness of the disease in children is the inability of the primary definitions of pulpitis. If adult patients in a predominant amount observed extensive carious lesion of the tooth, then the children, 80% of all cases of inflammation of the pulp occurs under the seal.
The shorter the period of illness at the time, the stronger and more intense these symptoms. In pediatric dentistry provides the following methods of treatment of the fibrous pulp changed:
- Treatment with preservation of the pulp. The method is effective when the immaturity of the root system of the tooth, while root and crown part can function after treatment. Of the drugs used iodine or Fortran. Pasta Fortran does not shrink, can be used as a contrast agent while x-rays can reliably control the process of filling. In addition, prolonged substance has a powerful antiseptic action.
- Partial amputation of the pulp. The essence of the method consists of removing the coronal pulp with preservation of the root part. This method of treatment does not apply to temporary teeth, but is acceptable if you have a pulpitis of the permanent teeth.
- Complete removal of the pulp. The operation consists of removing all parts of the pulp — the root and the crown. After extraction, the dentist carefully sealing the channels.
- The removal of the tooth. If you can’t use other gentle methods, with a strong structural destruction of the tooth pulp and tooth extraction is the most appropriate method of solving dental problems. Before removing the tooth doctor adequately assess the situation and eliminates the possibility of alternative methods of treatment.
Treatment of chronic fibrous pulpitis in children is not always performed in a single procedure. Often requires multiple treatment sessions. Single stage allows you to clean the cavity from the dentin and of the pulp, and the second cleansing of the channels and filling.
Phasing procedure allows to prevent the risk of recurrence of the inflammatory process, because after the poor treatment the worsening of the disease is extremely high.