CLINICAL STUDY OF PULPITIS: (ACUTE PULPITIS, CHRONIC PULPITIS)
- Acute pulpitis
Primary or secondary, these are closed pulpitis, or indirectly opened or closed fortuitously; there is no possible drainage other than by the root canals, main and accessory, or by the vascularization of another root on multi-rooted teeth. Hence the painful consequences and the tendency to necrosis.
I-symptomatology:
A- Physical signs:
- Due to the anatomical location of the pulp in the depth of the tooth, these physical signs are often non-existent:
- 1-the crown keeps its natural light yellow tint:
- 2-the possibility of seeing the pulp by transparency in the case of:
- Significant dentin destruction
- Major coronary fractures
- 3-the case where the pulp cavity is open the pulp appears as:
- a red dot (blood)
- a yellowish point (pus)
- gray-brown (necrosis)
B- Functional signs:
1-Spontaneous pain
- These are pains which are characterized by their intermittence in the form of attacks separated by periods of complete remissions.
- A- Intensity: it is variable; the pain can be subacute, acute or superacute (paroxysmal); the pain of pulpitis gives way to analgesics.
- B- Duration: it is variable (a few seconds, minutes, or even hours)
2-The pain caused:
- They are caused by contact, temperature variations, acids, sugar; pressure
- These pains continue for some time after the causal action and can trigger a new painful attack.
II-Means of diagnosis
A- Questioning the patient:
- It will be necessary to specify the existence of:
- Spontaneous pain (intensity-duration-location)
- Pain caused and its prolongation over time
B- The clinical examination:
- It consists of the inspection of the dental arches; which allows to observe: The existence of fractures, abrasions, caries, more or less voluminous fillings, dysplasia and polyps.
C-The search for pulp sensitivity and vitality:
- Temperature variation tests
- Electrical tests
- Very light percussion tests which allow the patient to recognize the tooth….
- D- Radiography : It is not used in the diagnosis of pulpitis.
III- clinical forms:
1-Pre-pulpit states:
- 1-Uncovered pulp: exposure of a clinically “healthy” pulp, with extremely acute sensitivity to contact, temperature variations and suction; absence of spontaneous pain, progression towards pulp inflammation.
- 2-Pulpal hyperemia:
- It is the congestion of the pulp; it is a pathological entity characterized by reversibility.
- It presents an exaggeration of the responses of the pulp to all excitations, especially thermal; which cause an acute and fleeting painful sensitivity which can propagate, after the excitation, within the limit of one minute only. There is no spontaneous pain.
- the evolution is towards subacute pulpitis, or, often, towards chronic pulpitis.
2-Acute pulpitis :
a. Acute superficial serous pulpitis:
- 1-Definition: it is an inflammation of the most superficial part of the cameral pulp.
- 2-Physical signs: they are non-existent.
- 3-Functional signs: they are characterized by provoked and spontaneous pain.
- pain caused by: external irritations (temperature variations, acid, sugars, etc.) and continuing for more than 3 minutes after the stimulus stops.
- The percussions are negative.
- spontaneous pain: it is mild, short-lived and does not radiate.
b. Acute partial serous pulpitis:
- 1-Definition: also called acute partial red pulpitis. The acute inflammation is localized to the cameral pulp.
- 2-Physical signs are non-existent.
- 3-Functional signs:
- Pain caused by irritation and continues for some time after the causal action and can trigger a new painful attack. Transverse percussion is positive.
- Spontaneous pains have three characteristics:
- Gnawing and throbbing.
- Intermittent.
- Irradiated.
c. Acute total serous pulpitis:
- 1-Definition: also called total acute red pulpitis. The acute inflammation is localized to the entire pulp organ.
- 2- physical signs are non-existent.
- 3-Functional signs are characterized by:
- Pain caused by: external irritations, with a rapidity of sensitivity to cold compared to acute partial serous pulpitis and continues for some time after the causal action can trigger a new painful attack. Transverse percussion is positive.
- Spontaneous pains: are of 3 characteristics:
-Gnawing and throbbing. Intermittent., Irradiated.
- The difference with partial acute serous pulpitis is that in total pulpitis the patient cannot locate the pain.
d. Acute purulent pulpitis:
- 1. Definition: It is an acute yellow pulpitis with intrapulpal abscess.
- 2-Physical signs: When the pulp cavity is opened, the pulp appears as a yellowish point (containing pus)
- 3-Functional signs:
- Pain caused : increased by heat and relieved by cold . Axial and transverse percussion are positive . Opening the pulp chamber relieves the patient.
- Spontaneous pains: are violent, pulsatile, lasting and radiating.
IV-Differential diagnosis of acute pulpitis
1-Dental diseases:
- A- Dentin syndrome:
- B- Desmodontic syndrome:
The alternation of crises and moments of total remission that characterizes pulp pain allows the difference with desmodontic syndrome, in which spontaneous pain is continuous, the lulls are rare and never total and the tooth has lost its vitality.
2-The septum lesion:
the symptomatology can be confused with pulp and desmodontic pain, it is necessary to go back to the source of the pain and differentiate what comes back to the septum, moreover the X-ray in this case confirms the diagnosis.
3-Accident of evolution of the wisdom tooth.
4-Extra dental diseases:
- Eye diseases (glaucoma; iritis, etc.).
- Inflammation of the salivary glands.
- True earache: tonsillitis or temporomandibular arthritis.
- False sinus odontalgia of nasal origin.
- essential facial neuralgia.
- Chronic pulpitis
1. Chronic closed pulpitis:
- 1-Definition: Responses to vitality tests vary little from normal (except in cases of severe degeneration where they are non-existent).
- 2-Physical signs: the only physical sign is the preservation of the usual shade of the tooth and its translucency.
- 3-Functional signs: There are no functional signs: clinical silence, except for the possible dentin syndrome in the event of denudation of the dentin.
- 4-radiological signs: the X-ray reveals a narrowing at the level of the pulp chamber with disappearance of a pulp horn
2. Chronic open pulpitis:
a- ulcerative pulpitis :
- 1-Definition: parenchymal necrosis very commonly affects the entire coronal pulp, which is therefore insensitive to contact. On the other hand, the root filaments are still sensitive to probe exploration.
- 2-Physical signs: the pulp does not bleed on contact and the area is gray where the pulp is open.
- 3-Functional signs: the sensation due to the different tests is less violent and the pains are more provoked than spontaneous. b- Hyperplastic pulpitis:
- 1-Definition: It is a chronic inflammation of the exposed pulp which presents as an exuberant proliferation of the pulp tissue.
- 2- Physical signs: the widely opened hypertrophied pulp insinuates itself into the orifice created by the caries. The pulp ceiling is destroyed.
- 3-Functional signs:
- The pain caused is almost non-existent except for slight pain when chewing, due to contact with the polyp.
- Spontaneous pain is almost non-existent.
- The pulp polyp may be soft, bleeding easily, dark pink, or lighter, firm, smooth and bleeding little.
- percussion is little or not sensitive.
- Internal Granuloma
- 1-Definition: it is a granulomatous hyperplastic process accompanied by progressive resorption of hard tissues to the point of causing perforation and then fracture of the tooth.
- 2-Physical signs: its location is variable, it can be:
- Coronary; otherwise called “pink spot” in this case causes resorption of the dentin.
- Or radicular resulting in a fracture of the root discovered on X-ray.
- 3-Functional signs:
- Before the stadium
- of externalization, the symptomatology is zero.
- After exteriorization, there are signs of acute pulpitis .
CLINICAL STUDY OF PULPITIS: (ACUTE PULPITIS, CHRONIC PULPITIS)
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.