Pulpitis: Symptoms

Most patients turn to the dentist with complaints about pain in the jaw area. It should be understood that toothache in pulpitis - symptoms that are subjective, despite the fact that in terms of intensity, they can be compared with renal colic. The perception of pain largely depends on the personality of the patient, which makes it difficult to assess objectively. Approximately 90% of patients with complaints 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 recommended that the patient be carefully inspected. The basis for the diagnosis of pulpitis - the ability of the dentist to orientate himself in the symptom complex of manifestations of the disease. The appearance of acute pulpitis can deprive the patient of the patient due to severe pain syndrome, headache, sleep disturbance. An important role is played by neural-reflex influences emanating from a pathologically altered pulp. Since it contains only painful endings, when the pulpitis is limited only by its tissue, the patient finds it difficult to determine the "causal" tooth. Once the inflammatory process passes into the periapical region and, in particular, the periodontal ligaments containing proprioceptive endings, the doctor and patient can localize the diseased tooth whose percussion will be positive.

The term "acute pulpitis" is used in relation to a group of diseases differentiated on the basis of anamnesis and objective research data (hyperemia, serous focal, serous diffuse, serous-purulent, focal, purulent diffuse pulpitis, and also inflammation that occurred when accidentally injured - autopsy pulp chamber boron or as a result of external factors). The most common acute serous-purulent pulpitis. Acute serous pulpitis is almost never diffuse, the patient does not consult the doctor in the first hours of the disease, but much later, when the purulent process develops in the coronary zone, and the symptoms of pulpitis become apparent.

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

According to observations of some authors, if the cause of acute pulpitis - 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. Leading symptoms are spontaneous pain. In acute forms, the pain is characterized by a paroxysmal character, the appearance in the absence of an external stimulus; with aggravation of the inflammatory process, irradiation along the branches of the trigeminal nerve (for example, in the temporal region) is added. After removal of the stimulus, the symptoms remain for a while, which is typical for chronic inflammation in the tooth.

[1], [2], [3], [4]

Symptoms of pulp hyperemia

This is the most easily flowing form of the initial pulpitis, characterized by a general diffuse hyperemia, covering the pulp layer of softened dentin easily removed in the form of plates using a hand tool - an excavator. Clinically, a carious cavity is defined, most often deep; sounding is evenly painful. When the cold stimulus is applied to the tooth, a short pain reaction of the patient is observed. Patients, as a rule, notice such symptoms as painful phenomena in the tooth with the use of cold or sweet food, which last for 1-15 minutes after elimination of the food irritant. Some patients notice symptoms that are expressed by short-term ("lightning") pain attacks lasting up to 1 min. Discomfort phenomena can persist after odontopreparation (performed on orthopedic or therapeutic indications), however, spontaneous pain attacks can no longer repeat.

Symptoms of acute pulpitis

Forms of the disease can be many.

Serous limited form

Pain is not pronounced, paroxysmal, light intervals up to 6-8 hours. Duration of symptoms is 1 day. In practice, this form of pulpitis is rarely diagnosed due to late treatment of the patient. Objectively, on the background of the pigmented bottom of the carious cavity, a dotted area is visible through which the bright red color of the tooth pulp appears.

Serous diffuse form

With this form of the disease, serous inflammation in just 1 day extends to the coronal and root part of the pulp. 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. With the progression of the disease, the duration of the "light" gaps is reduced, there is a night pain, the reaction to the cold stimulus is positive. Clinically define a deep carious cavity, the bottom is pigmented, with probing uniform pain. Percussion is painless. Self-medication, taking pain medications changes the symptoms of pulpitis (aspirin blocks the production of prostaglandin E, responsible for the pain reaction).

Serous-purulent focal form

The nature of pain changes with the progression of the inflammatory process, it becomes cutting, shooting, irradiating. The duration of the symptoms is clarified from an anamnesis. Objectively, a deep carious cavity is defined, the bottom is made with softened pigmented dentin, when sensing, soreness is felt at one point. Percussion is painless, there the reaction is dramatically positive. Electroodontodiagnosis demonstrates a decrease in values in one area, although on others it can be normal

Purulent form

Purulent diffuse pulpitis is the most severe form of acute pulpitis, which is characterized by the appearance of such symptoms as sharp, intolerable pain (tearing, pulsating, amplifying at night). The pain is so strong that the patient can lose work capacity, the causative tooth can not indicate any more. The pain radiates into the orbit, ear and temporal region. Percussion of the tooth is very painful.

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

X-ray symptoms are usually not detected, but sometimes there is no clarity of a compact bone plate that limits the periodontium. Electroodontometry shows a decrease in the threshold of excitability of the pulp.

Symptoms of chronic pulpitis

Chronic fibrous

The disease is characterized by a decrease in the severity of symptoms, we can say that it is latent; sometimes the patient can note discomfort in the tooth or aching pain, even less often - painful sensations when taking hot and solid food. Objectively define a deep carious cavity, there may be a communication with the cavity of the tooth; probing is painful. This form of pulpitis can develop in the tooth after treatment for uncomplicated caries. After removal of the pulp, a bottom with a weak sensitivity is detected when probing the horn of the pulp in the projection or a communication with the tooth cavity

[5], [6], [7], [8], [9]

Chronic hypertrophic

Clinically, this form of pulpitis flows with an open cavity of the tooth, the presence of a "polyp" of the pulp, apparently protruding beyond its limits. Patients complain of symptoms such as soreness and discomfort when eating solid foods.

[10], [11]

Granulating

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

Chronic gangrenous

The disease develops as a result of a prolonged damaging effect of the agent on the surface areas of the pulp or the outcome of a common purulent pulpitis. According to anamnesis; intense pain, arising spontaneously and from all kinds of irritants, then the pain becomes aching. The length of this pulpit firm is characterized by flow in the closed and open cavity of the tooth. The surface of the pulp is damaged, covered with a greyish-yellow coating, more or less firmly welded to the underlying tissue, the pulp under it bleeds. Pulpitis proceeds benignly, but differs in protracted symptoms and course.

At inspection - sounding of a bottom is asymptomatic, however there are painful reactions. Electroexcitability of pulp is greatly reduced. With necrosis of the pulp, a putrid smell appears.

[12], [13], [14], [15]

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 severe pain attacks (paroxysm of pain) that appear after a long time they felt in the tooth only discomfort, sometimes a feeling of heaviness, tingling with food. The more severe clinical course of this form of pulpitis occurs with the attachment of periodontal changes. The percussion of this tooth is dramatically positive.

Denticles of pulp

Symptoms of the calculus are varied depending on its size, the length of stay in the pulp and the reaction of the surrounding tissue. Usually the denticle is formed asymptomatically and is an accidental finding in the depulpation of the tooth, X-ray examination of patients with bite pathology, periodontal diseases, metabolic disorders.

[16], [17], [18]