chronic pulpitis
Introduction
Introduction to chronic pulpitis Since most of the rickets are chronic lesions, there is a long-term continuous stimulation of the pulp, which can cause chronic inflammation of the pulp. In the development of chronic pulpitis, such as polymorphonuclear leukocytosis, the release of lysosomal enzymes also increased, and the inflammation is intensified, clinical symptoms can occur acute. Chronic pulpitis is clinically divided into three categories: chronic atresia pulpitis, chronic open pulpitis, and chronic proliferative pulpitis. Chronic open pulpitis is also known as chronic ulcer pulpitis. Chronic proliferative pulpitis is also known as pulp polyps. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: pulp disease
Cause
Causes of chronic pulpitis
Bacterial, viral infections (50%):
Any invasion of bacteria and their toxins into the medullary cavity 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. . 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.
Other reasons (20%):
Including tooth defects caused by abnormal tooth development, accidental accidental crown fracture of the pulp, also directly damage the pulp.
Prevention
Chronic pulpitis prevention
1. Maintain oral hygiene and develop good hygiene habits. Stick to brushing your teeth in the morning and evening or after eating. After eating, rinse your mouth to remove the food residue and bacteria left between your mouth and your teeth. The use of fluoride toothpaste has a certain effect on preventing dental caries.
2, pay attention to children's diet and oral hygiene, children's diet should be diversified, appropriate to eat hard and tough food can promote the growth of the jaw and teeth, do not let children sleep with candy or eat sweets do not brush gums The mouth is asleep, because the sugar in the mouth is sour and easy to corrode the teeth and get a tooth decay.
3, 6-12 years old children after the permanent teeth erupted in time to do the pit and groove closure, that is, the teeth of the pits and fissures with a layer of resin-based materials to prevent food debris and bacteria and other harmful substances into the teeth to prevent dental caries.
4. For timely treatment of teeth with misplaced wisdom teeth and food impaction, improper dentures and braces should be treated in time.
5. Perform an oral examination every six months to one year.
6, when the caries are treated in time to treat the shallow cavities, after the removal of the damaged dentin, fill with appropriate materials, so that the shape and function of the teeth are restored to prevent further damage. Dental caries with deep cavities should be treated appropriately according to the specific conditions. Dental pulpitis caused by dental caries or periapical periodontitis should remove bacterial infections in the pulp cavity or around the roots. After root canal treatment, the teeth should be preserved. For the residual crown and residual roots that have lost their therapeutic value, they should be removed in time and in time.
Complication
Chronic pulpitis complications Complications
Later, it can develop into pulp gangrene.
Symptom
Chronic pulpitis symptoms Common symptoms Enamel corrosion toothache Dental damage Teeth cold and hot pain Dental structure abnormalities
Generally, no severe spontaneous pain occurs, and sometimes paroxysmal pain or dull pain may occur. Chronic pulpitis has a longer course of disease, and patients can complain of long-term history of cold and heat irritations. The teeth often show occlusion discomfort or mild pain. Patients can generally locate the teeth. Chronic atresia pulpitis: no obvious spontaneous pain, long-term history of cold and heat stimulation. Chronic ulcer type pulpitis: no spontaneous pain, patients often complain of severe pain when food is embedded in the cavity. When cold and heat irritates the teeth, it causes severe pain. Chronic proliferative pulpitis: more common in adolescent patients, generally no spontaneous pain, sometimes eloquent complaints about eating teeth pain or eating bleeding, so long-term do not dare to chew food with the affected side.
Chronic pulpitis
1. chronic closed pulpitis (chronic closed pulpitis)
No obvious spontaneous pain or occasional dull pain. However, cases with acute episodes or cases converted from acute pulpitis may complain of a history of severe spontaneous pain, as well as those who neglect the previous symptoms by ignoring spontaneous pain. Almost all patients have a long history of cold and heat irritations.
2. Chronic ulcerative pulpitis
There was no obvious spontaneous pain, but patients often complained of severe pain when the food was inserted into the cavity. Sometimes you can ask for a history of spontaneous pain. Another typical symptom is that when cold and heat irritations irritate the teeth, they can cause severe pain.
3. Chronic hyperplastic pulpitis
Generally, there is no spontaneous pain. Sometimes patients may complain of toothache or eating bleeding every time they eat. Therefore, they do not dare to chew food on the affected side for a long time.
Examine
Chronic pulpitis examination
Dental examination
Chronic atresia-type pulpitis: investigation of deep-cavity, crown filling or other near-medullary hard tissue disease. The teeth in the probing hole are relatively dull, and there is no visible pulp hole visible to the naked eye after the net humus. The response of the affected tooth to the temperature test and the electrical test is mostly a slow response or a dullness. Most of them have mild pain and are positive.
Chronic ulcer type pulpitis: check for deep body cavity or other near-medullary tooth damage. Because the patient is afraid of pain and long-term use of the teeth, it can be seen that the teeth have a lot of soft dirt and tartar accumulation. Remove the humus, visible through the pores. When using a sharp probe to probe the perforating hole, the pain is not painful, and the pain is deep and a small amount of dark blood seeps out. The temperature test appears to be sensitive. Generally there is no pain.
Chronic proliferative pulpitis: There are red pulp polyps in the large and deep cavities of the teeth. It is painless, but it is very easy to bleed. Due to long-term disuse, it is often seen that the affected teeth and their adjacent teeth have a large amount of tartar accumulation.
Diagnosis
Diagnosis and diagnosis of chronic pulpitis
Diagnose based on:
1. Severe pain, the nature of pain has the following characteristics:
(1) Spontaneous paroxysmal pain.
(2) Night pain.
(3) Temperature stimulation exacerbates 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.
Chronic pulpitis generally does not have obvious spontaneous pain, but often has a long history of cold and heat stimulating pain and/or spontaneous pain history, and it is also certain that dental hard tissue diseases or other causes of pulpitis may be found. The tooth has an abnormal response to the temperature test, and percussion discomfort can be used as an important reference indicator.
Differential diagnosis
Chronic pulpitis, dry socket disease: patients with dry socket disease have a recent history of tooth extraction. Check that the alveolar fossa is empty, the bone surface is exposed, and an odor is present. Although the adjacent teeth of the extraction socket can also have cold and heat stimulation and pain, but there is no clear indication of pulp disease.
