acute pulpitis
Introduction
Introduction to acute pulpitis Acute pulpitis refers to the inflammation of acute pulp tissue. The infection source mainly comes from the deep marrow. The infection of the pulp can cause root tip infection through the apical foramen. The clinical feature of acute pulpitis is acute onset. The main feature is severe Pain, the general analgesic drugs are not effective, and can be developed into pulp gangrene in the later stage. The main treatments are open pulp and drugs to relieve pain. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: pulp disease
Cause
Causes of acute pulpitis
Infection (40%):
The most common cause of pulp inflammation is infection. Invasion of the bacteria and its toxins into the medullary cavity by any cause can cause inflammation of the pulp. The pulp tissue enters the pulp cavity in the center of the tooth through the apical foramen, and is surrounded by hard dentin and enamel. Under normal circumstances, it will not be attacked by bacteria, but when the hard tissue of the tooth is damaged due to various reasons. The bacteria can invade the infected pulp. Among them, dental caries is the most common cause of loss of hard tissue of the tooth. When the caries damage the enamel, reach the deep layer of dentin, and even pass through the dentin to reach the pulp cavity, the bacteria in the mouth will infect the pulp and cause inflammation of the pulp. . Other causes include tooth defects caused by abnormal tooth development, accidental crown fracture of the pulp, and direct damage to the pulp. In addition, in severe periodontal disease, the periodontal pocket is deep to the apex, and the bacteria can also enter the medullary cavity by the apical foramen or some small branches of the root to cause pulp inflammation.
Rickets (30%):
Rickets, commonly known as fangs and fangs, are bacterial diseases that can cause pulpitis and periapical periodontitis, and can even cause alveolar bone and jaw inflammation. If left untreated, the lesion continues to develop, forming a cavity, and eventually the crown is completely destroyed and disappeared. The final result of its development is tooth loss.
Pathogenesis
Acute pulpitis can be developed by pulpal hyperemia and can also be caused by an acute episode of chronic pulpitis. According to the process of inflammation development, it is divided into the serous phase and the suppurative phase. During the serous phase, plasma oozes from the dilated blood vessel wall, causing tissue edema. Subsequently, polymorphonuclear leukocytes also leaked from the blood vessel wall, forming infiltration of inflammatory cells and necrosis of odontoblasts. In the transient serous phase of pulpitis, the exuded white blood cells are continuously necrotic and liquefied, forming an abscess, which is acute suppurative pulpitis. There is a large amount of leukocyte infiltration in the affected area, white blood cells liquefy, tissue necrosis, and pus formation.
Prevention
Acute pulpitis prevention
Oral hygiene
Stick to brushing your teeth in the morning and evening or after eating, rinse your mouth after meals, and remove the food residue and bacteria left in your mouth in a timely manner. The use of fluoride toothpaste has a certain effect on preventing rickets.
Children's diet should be diversified, and appropriate hard and tough foods can promote the growth of their jaws and teeth. Don't let children sleep with candy, because sugar in the mouth is sour and easy to corrode teeth and get sick.
After the permanent teeth of 6-12 years old, the pits are closed in time, that is, the pits and grooves of the teeth are sealed with a layer of resin material to prevent harmful substances such as food debris and bacteria from entering the teeth, thereby preventing rickets.
2. Treatment of food impacted teeth
For the timely treatment of teeth with misaligned wisdom teeth and food impact, improper dentures and braces are treated in time.
3. Oral examination
Regular oral examination.
4. Treatment of rickets
The shallow cavities should be filled with appropriate materials after removing the damaged dentin to prevent further damage; the deep dental caries should be treated according to the specific conditions. Dental pulpitis caused by rickets or periapical periodontitis, to remove bacterial infections in the pulp cavity or around the roots, to protect the teeth through root canal treatment. For the crowns and roots that have lost their therapeutic value, they will be removed in time and in time.
Complication
Acute pulpitis complications Complications
Later, it can develop into pulp gangrene.
Symptom
Acute pulpitis symptoms Common symptoms Toothache Teeth cold and hot pain Dental damage Dental structure abnormal enamel corrosion
The main symptom of acute pulpitis (including acute exacerbation of chronic pulpitis) is severe tooth pain with typical clinical features.
The first is spontaneous paroxysmal pain. Suddenly, severe pain occurs without any external stimulation. The pain has a process of persistence and remission. Therefore, it has the characteristics of paroxysmal or paroxysmal aggravation. Secondly, it is nighttime pain. Patients often have difficulty falling asleep because of toothache, or wake up from sleep. Third, temperature irritation can exacerbate pain. When eating hot and cold foods, it can stimulate pain or exacerbate existing pain, often not dare to brush with cold water.
In the late stage of pulpitis, it is also characterized by "heat pain and cold relief". Thermal stimulation can cause severe pain. On the contrary, cold air or cold water can relieve pain. At this time, patients often use temporary cold water to relieve pain. Finally, pain Can not be self-positioning, when the pain occurs, most patients can not clearly indicate the location of the tooth, and the pain is often radiated to the upper and lower jaw teeth or head and face on the same side of the tooth.
Examine
Examination of acute pulpitis
an examination
X-ray or oral cavity photography to see if there is acute pulpitis.
The X-ray film of the tooth is simply referred to as "teeth", also known as the intraoral standard. Its area is 3 x 4 square centimeters. A tooth can display 3-4 teeth. The teeth show a white obstructive image on the tooth. Among them, enamel is the strongest, and dentin and cementum are less resistant than enamel. The pulp cavity has a black transparent image, and the root canal to the apical hole is a tapered image.
Diagnosis
Diagnosis and diagnosis of acute pulpitis
diagnosis
1. Severe pain, the nature of pain has the following characteristics:
(1) spontaneous paroxysmal pain;
(2) nighttime pain;
(3) Temperature stimulation aggravates pain;
(4) Pain cannot be positioned by itself.
2, the teeth can be found close to the medullary cavity or other hard tissue disease of the tooth, or see the filling of the crown, or deep periodontal pocket.
3, probing can often cause severe pain, and sometimes can be found in tiny pores.
4. During the temperature test, the affected teeth are in the early stage of inflammation, and their reactivity is enhanced; late inflammation is dull.
5, in the late inflammation of the teeth, there may be a slight pain in the vertical direction.
Differential diagnosis
Acute pulpitis has typical pain symptoms (spontaneous paroxysmal pain, hot and cold pain, nocturnal pain, distraction pain can not be located), teeth can certainly be found to have dental damage or other causes of dental pulp lesions. The endodontic temperature test results can help locate the affected tooth, and the determination of the affected tooth is the key to the diagnosis of acute pulpitis.
1, acute pulpitis, trigeminal neuralgia
The onset of trigeminal neuralgia generally has a "trigger point" of pain that causes pain every time the patient touches it. When patients complain about their medical history, they often ignore this point and should be specifically asked in detail. In addition, trigeminal neuralgia is less likely to occur at night, and cold and hot temperature stimulation does not cause pain; the typical pain of acute pulpitis can find the cause of pain.
2, acute pulpitis, sputum papillitis
Spontaneous pain can also occur in papillitis, but the pain is characterized by persistent pain. The response of the affected tooth to the temperature test can also be transiently sensitive. The patient is more likely to be positioned for pain. During the examination, the nipple of the patient indicated that the nipple was congested and edematous, and the bleeding was detected. The tenderness was extremely obvious. There are signs of food jamming or a history of food impaction between the adjacent teeth. Dental hard tissue damage and other diseases that can cause pulpitis are generally not detected.
3, acute pulpitis, acute maxillary sinusitis
In the case of acute maxillary sinusitis, the pain in the maxillary posterior teeth of the affected side may be similar to that of pulpitis. However, the pain that occurs in acute maxillary sinusitis is persistent pain. The maxillary canine and molars on the affected side can be affected at the same time, causing pain in two or three teeth. The tooth that can cause pulpitis cannot be detected. Tissue disease, the tooth response to the temperature test is the same as the control tooth. The anterior wall of the maxillary sinus can be examined for tenderness. At the same time, the patient may be accompanied by symptoms of upper respiratory tract infection such as headache, nasal congestion and purulent sputum.
