Pulpitis: symptoms

Most patients seek dental care with complaints of jaw pain. It should be understood that toothache due to pulpitis is a subjective symptom, despite the fact that its intensity can be compared to renal colic. The perception of pain largely depends on the patient's personality, which complicates its objective assessment. Approximately 90% of patients complaining of pain in the maxillofacial area require a thorough examination for endodontic pathology. Endodontic symptoms may be associated with pathological changes in dentin or periapical tissues. Even if the diagnosis seems clear and obvious, it is always recommended to thoroughly examine the patient. The basis for establishing a diagnosis of pulpitis is the dentist's ability to navigate the symptom complex of the disease. The onset of acute pulpitis can deprive the patient of working capacity due to severe pain, headache, and sleep disturbance. An important role is played by neuroreflexive influences emanating from pathologically altered pulp. Since it contains only pain endings, when pulpitis is limited only to its tissue, the patient has difficulty determining the "causal" tooth. As soon as the inflammatory process moves to the periapical region and, in particular, the periodontal ligaments containing proprioceptive endings, the doctor and the patient can localize the diseased tooth, the percussion of which will be positive.

The term "acute pulpitis" is used in relation to a group of diseases differentiated on the basis of anamnesis and objective examination data (hyperemia, serous focal, serous diffuse, serous-purulent, focal, purulent diffuse pulpitis, and also inflammation that occurs due to accidental trauma - opening the pulp chamber with a drill or as a result of exposure to external factors). Acute serous-purulent pulpitis is most common. Acute serous pulpitis is almost never diffuse, the patient consults a doctor not in the first hours of the disease, but much later, when a purulent process develops in the coronal zone, and the symptoms of pulpitis become obvious.

Chronic pulpitis is most often the outcome of an acute process, however, an initial chronic course is possible, which can be explained by the short duration of the acute inflammation phase.

According to some authors, if the cause of acute pulpitis is infectious, chemical or thermal factors, then in the pathogenesis of chronic pulpitis the main role is played by changes in the reactivity of the organism. The leading symptoms are spontaneously occurring pain. In acute forms, the pain is characterized by a paroxysmal nature, occurring in the absence of an external irritant; with the aggravation of the inflammatory process, irradiation along the branches of the trigeminal nerve (for example, in the temporal region) is added. After the elimination of the irritant, the symptoms remain for some time, which is typical for the chronicity of the inflammatory process in the tooth.

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Symptoms of pulp hyperemia

This is the mildest form of initial pulpitis, characterized by general diffuse hyperemia, the layer of softened dentin covering the pulp is easily removed in the form of plates using a hand tool - an excavator. Clinically, a carious cavity is determined, most often deep; probing is uniformly painful. When a cold stimulus is applied to the tooth, a short-term pain reaction of the patient is observed. Patients, as a rule, note such symptoms as painful phenomena in the tooth when eating cold or sweet food, persisting for 1-15 minutes after the removal of the food irritant. Some patients note symptoms that are expressed by short-term ("lightning") pain attacks lasting up to 1 minute. The phenomena of discomfort may persist after odontopreparation (carried out for orthopedic or therapeutic indications), but spontaneous pain attacks may no longer recur.

Symptoms of acute pulpitis

There can be many forms of the disease.

Serous limited form

The pain is not very pronounced, paroxysmal, light intervals up to 6-8 hours. Duration of symptoms - 1 day. In practice, this form of pulpitis is rarely diagnosed due to the patient's late appeal. Objectively, against the background of the pigmented bottom of the carious cavity, a point area is visible through which the bright red pulp of the tooth shines through.

Serous diffuse form

In this form of the disease, serous inflammation spreads to the coronal and root portions of the pulp in just 24 hours. In clinical practice, this form of pulpitis is almost impossible to establish. Symptoms that are expressed by painful attacks of diffuse serous pulpitis last for 10-15 minutes. As the disease progresses, the duration of "light" intervals decreases, night pain appears, and the reaction to a cold stimulus is positive. Clinically, a deep carious cavity is determined, the bottom is pigmented, and there is uniform pain upon probing. Percussion is painless. Self-medication, taking painkillers changes the symptoms of pulpitis (aspirin blocks the production of prostaglandin E, which is responsible for the pain response).

Serous-purulent focal form

The nature of the pain changes as the inflammatory process progresses, it becomes cutting, shooting, radiating. The duration of symptoms is determined from the anamnesis. A deep carious cavity is objectively determined, the bottom is made of softened pigmented dentin, and when probing, pain is felt at one point. Percussion is painless, the reaction there is sharply positive. Electroodontodiagnostics shows a decrease in values in one area, although in others it may be normal

Purulent form

Purulent diffuse pulpitis is the most severe form of acute pulpitis, which is characterized by the appearance of symptoms such as sharp, unbearable pain (tearing, pulsating, increasing at night). The pain is so strong that the patient may lose the ability to work, and cannot indicate the causative tooth. The pain radiates to the eye socket, ear, and temporal region. Percussion of the tooth is sharply painful.

Under the influence of a hot stimulus, a sharp pain attack occurs, a cold stimulus does not cause a pain attack and sometimes even stops it.

Radiographic symptoms are usually not detected, but sometimes the compact bone plate limiting the periodontium is not clearly visible. Electroodontometry shows a decrease in the pulp excitability threshold values.

Symptoms of chronic pulpitis

Chronic fibrosis

The disease is characterized by a decrease in the severity of symptoms, it can be said that it is latent; sometimes the patient may note discomfort in the tooth or aching pain, even more rarely - painful sensations when eating hot and hard food. A deep carious cavity is objectively determined, there may be a connection with the tooth cavity; probing is painful. This form of pulpitis can develop in a tooth after treatment for uncomplicated caries. After removing the pulp, a bottom with weak sensitivity is found when probing in the projection of the pulp horn or a connection with the tooth cavity

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Chronic hypertrophic

Clinically, this form of pulpitis occurs with an open tooth cavity, the presence of a pulp "polyp" that apparently protrudes beyond its limits. Patients complain of symptoms such as pain and discomfort when eating solid food.

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Granulating

Early stage of the disease. The pulp chamber is always open, swollen bleeding granulation tissue "grows" from it. A later stage is accompanied by the formation of a pulp "polyp". The surface of the rounded formation is bluish-gray, the epithelial cover is tightly fused with the underlying tissue, which is confirmed by probing.

Chronic gangrenous

The disease develops as a result of prolonged damaging effect of the agent on the superficial parts of the pulp or the outcome of general purulent pulpitis. According to the anamnesis; intense pains arising spontaneously and from all types of irritants, then the pain becomes aching. This type of pulpitis is characterized by the course in the closed and open cavity of the tooth. The surface of the pulp is damaged, covered with a grayish-yellow coating, more or less firmly fused with the underlying tissue, the pulp bleeds under it. Pulpitis is benign, but is characterized by protracted symptoms and course.

During examination, probing of the bottom is asymptomatic, but painful reactions appear. Electrical excitability of the pulp is greatly reduced. In case of pulp necrosis, a putrid odor appears.

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Symptoms of exacerbation of chronic pulpitis

Symptoms of chronic pulpitis are often characterized by more or less severe exacerbations, which are mistakenly interpreted as acute forms of pulpitis. Patients complain of sharp pain attacks (paroxysms of pain), which appear after they have felt only discomfort in the tooth for a long time, sometimes a feeling of heaviness, tingling during meals. A more severe clinical course of this form of pulpitis occurs when periodontal changes are added. Percussion of such a tooth is sharply positive.

Pulp denticles

The symptoms of a concrement vary depending on its size, the length of time it has been in the pulp, and the reaction of the surrounding tissue. Usually, a denticle forms asymptomatically and is an accidental finding during depulpation of a tooth, X-ray examination of patients with malocclusion, periodontal disease, and metabolic disorders.

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