Tooth pulpitis: how to diagnose and treat the disease?


Diagnosing the problem at home

Sometimes, to understand which tooth hurts, it is enough to look into your mouth. You need to go to the mirror and conduct a visual inspection. The diseased element may be damaged, with dark spots and depressions. There are also signs that indicate a problem: chipped, worn, cracked or transparent enamel, the presence of pustules and seals on the mucous membrane, inflamed, swollen or bleeding gums.

It also happens that a visual inspection reveals nothing. For example, when the problem develops under an artificial crown or filling. In this case, light pressure on the crowns or gently tapping them with the tip of a teaspoon will help determine the source of the pain.

How else can you find out which tooth hurts? During eating, pieces of food can become lodged in an element destroyed by dental diseases; it is difficult not to feel it. Hard tissues in the area of ​​the pathological process can react to food temperature and mechanical stress during hygiene procedures.

On a note! If you want to understand which tooth hurts, then take the diagnostic question seriously. Before examination, remove soft plaque and food debris from your mouth. The room where the inspection is being carried out should have good lighting. Carefully examine every visible surface of the tooth using a mirror, and also check your gums for inflammation.

Chronic pulpitis

  • Fibrous

The symptoms are not pronounced, so the patient may not pay attention to such pulpitis for years;

  • Gangrenous

Acute untreated pulpitis, which has passed into the chronic stage, accompanied by suppuration, tissue necrosis, discoloration of enamel and bad breath.

  • Hypertrophic

Pulpitis, in which a bleeding polyp is already visible in the tooth cavity, causing pain when chewing.

We determine the cause of pain by the nature of the sensations and accompanying symptoms

In most cases, checking which tooth hurts on your own is not difficult. It is more difficult to establish why the discomfort and discomfort appeared. It all depends on the accompanying symptoms.

Possible reasonAssociated symptoms
Increased sensitivity of enamelThin, transparent enamel, with cracks and chips. Reaction to cold and hot, sour, sweet. Discomfort due to mechanical impact. Often pain occurs not in one, but in several teeth at once or along an entire row
CariesReaction to food temperature and mechanical stress. The discomfort goes away almost immediately after the irritating factor is eliminated, but as the disease progresses, the pain persists longer. First, white chalky spots appear on the enamel, then black dots, depressions and pits into which food easily gets clogged.
PulpitisThe pain is acute and prolonged, persists for a long time after the removal of the stimulus, can occur involuntarily, and “spread” to all parts of the face and head. Unpleasant sensations intensify at night. With pulpitis, the enamel of the diseased tooth may darken
PeriodontitisMay occur under a filling or crown. Sharp pain appears when pressing or chewing solid food. With this disease, there is a feeling of fullness and pressure in the inflamed area. The root of the diseased unit may begin to wobble
Flux, abscess, cystThe gums around the diseased element become inflamed, and ulcers, pimples, and lumps may appear on the mucous membrane. In acute and advanced stages, swelling of the soft tissues of the face occurs. Unpleasant sensations intensify during tapping and pressure on the sore area
FistulaAn ulcer or pimple on the gum that may ooze fluid or pus. Unpleasant taste and odor in the mouth
Root fracture, crack, traumaSharp and acute pain, the tooth becomes mobile, it is impossible to chew food on it
Periodontal inflammationIf it is not clear which tooth hurts, then it may not be about the tooth at all, but about the periodontal tissues. So, with gingivitis or periodontitis, the mucous membrane itches and becomes inflamed, and also bleeds, and this process is most often generalized (applies to the entire jaw). At advanced stages of periodontitis, the roots become exposed and the teeth become mobile and begin to respond to thermal and mechanical stress.
Previously performed poor-quality treatmentIf you just recently visited the dentist, and after that the treated tooth began to ache, then in the first 2-4 days this situation can be considered normal. In most cases, this indicates a tissue reaction to various medications and surgical intervention. With each subsequent day, the discomfort should decrease, but if it becomes stronger, this may indicate medical errors made during treatment.

“I don’t advise anyone to guess on the coffee grounds and independently identify various diseases. In general, I never know which tooth hurts me, because the sensations are always ambiguous. The other day, there was a situation: my upper jaw was aching, and I was sure that the problem was there, although visually everything was normal everywhere. Even when I went to the doctor, I indicated a specific area, but the dentist looked and said that this was not so. As a result, the lower filled molar turned out to be problematic, under which secondary caries developed, and it was treated.”

Katerina, review from the dental portal gidpozubam.ru

How does the mechanism of tooth pain sensitivity work?

The nerves connected to each tooth and to the gum tissue are part of one of the segments of the peripheral nervous system, namely the facial one. There is one nerve plexus for each jaw, formed by many nerve endings extending from each of the teeth. Greatly simplifying the innervation scheme of the teeth, we can say that they are all ultimately connected to the branches of the facial trigeminal nerve.

And if inflammation occurs anywhere along the innervation, pain signaling this can be felt in all tissues penetrated by nerve endings from this plexus. Therefore, patients who need treatment for caries of several teeth often come to the doctor with a complaint of pain in the entire dentition. The pain spreading throughout all the nerves of the plexus does not allow one to clearly indicate the location of its localization.

The whole jaw aches: what does this mean?

Many patients, when visiting a doctor, complain that their entire jaw ache, but after examination it turns out that one tooth is to blame. Why is this happening? With some pathologies, pain can radiate (give) to different parts of the face and head: jaw, temple, ear, eyes. This often happens with pulpitis, eruption of wisdom teeth, the presence of impacted and dystopic elements in the jawbone that grow in the wrong direction, put pressure on their neighbors or do not break out at all. Pain can radiate to different areas if the disease is in an acute stage or the patient has advanced pathology.

On a note! Does your entire jaw ache after tooth extraction? This situation is also not uncommon, especially if the extraction was difficult and traumatic, or occurred against the background of a cyst or abscess. To ensure that the discomfort quickly disappears, strictly follow all the doctor’s recommendations. If improvements do not occur after 5-7 days, and alarming signs intensify, then contact your dentist immediately.

The entire jaw may ache if the patient has a malocclusion, since against the background of this problem the maxillofacial apparatus or its individual areas are overloaded, and teeth wear out, wear out and are destroyed ahead of schedule. Discomfortable sensations radiating throughout the entire jaw can also occur during bite correction with orthodontic devices, but many patients admit that these are temporary difficulties, because after a period of adaptation to braces or trainers, the situation normalizes.

Signs of illness

Typically, pulpitis manifests itself as a pain syndrome, which can have varying severity.

Depending on the manifestations of the disease, pulpitis is distinguished:

  • acute - accompanied by severe paroxysmal pain (they intensify at night), occurring both spontaneously and as a result of exposure to cold or heat, the pain often radiates to the neck, ears, temples and does not go away even when taking analgesics;
  • chronic – the pain is aching, almost imperceptible, and appears quite rarely.

Acute pulpitis can be serous and purulent. If a purulent process develops, the pain becomes constant and acquires a shooting and pulsating character.

If teeth have nothing to do with it

Sometimes it is not clear which tooth hurts. It may even seem like everything hurts at once. But dental disease is not always the cause. Similar symptoms may indicate other problems:

  • inflammation of the trigeminal nerve,
  • cancerous tumors in the oral cavity,
  • ENT diseases: sinusitis, sinusitis, otitis media,
  • hypothermia,
  • salivary stone disease,
  • dysfunction of the temporal mandibular joint,
  • pathologies of the cardiovascular system: for example, angina pectoris,
  • intervertebral hernia, pinched cervical nerve,
  • psychosomatic state of a person: it may simply seem to you that your teeth are aching, especially if you have recently suffered stress,
  • Jaw Fracture: Discomfort may occur even years after you have been treated. Some people note that in this way the body and the bones that have grown together after injury react to changing weather.

It is important to understand that internal diseases of the body can aggravate dental problems or contribute to their occurrence, just as, conversely, diseased teeth can cause other pathologies, such as sinusitis. This occurs due to the fact that infections from the source of inflammation can freely penetrate into all adjacent areas.

Why does inflammation develop?

The main reason for the development of inflammatory processes in the pulp is infection due to advanced caries. Usually (in 90% of cases) the infection enters the pulp through a carious cavity. But sometimes a retrograde route is possible (the penetration of bacteria through a hole in the root or periodontal pockets). It is extremely rare (with osteomyelitis, acute respiratory infections, rubella, chickenpox, sinusitis) the infection is introduced through the blood - the hematogenous route.

Other factors can cause pulpitis:

  • poor-quality treatment of a carious cavity or accidental damage to the pulp chamber during the treatment of caries;
  • improper filling of the canal;
  • pulp burn when grinding a dental crown before prosthetics;
  • gum diseases leading to the formation of periodontal pockets;
  • tooth injury.

Depending on the etiology, there are 4 types of pulpitis:

  • infectious

    – develops due to the penetration of pathogenic bacteria into the pulp;

  • traumatic

    – the cause is a violation of the sterility of the pulp due to traumatic damage to the tooth, due to which opportunistic bacteria are directed into the pulp chamber and provoke inflammation;

  • iatrogenic, or medical

    – occurs due to the fault of the dentist due to improper treatment of the carious cavity;

  • calculiform

    – the result of a metabolic disorder in the neurovascular bundle, accompanied by the formation of stones or denticles (replacement dentin).

Methods for diagnosing problems in dentistry

Regardless of whether it is clear or unclear to you which tooth hurts, the first thing to do when an alarming symptom occurs is, of course, to consult a doctor. The specialist will not only accurately diagnose, but also cure the disease that caused the problem. Otherwise, after a short period of time you will notice that not just one, but several nearby units are aching, as the infection has spread further.

Today in dentistry there are many diagnostic methods, one of the informative ones is x-ray examination. To determine the condition of the entire jaw system, roots, root canals and bone tissue, as well as to identify hidden problems, for example, fractures and cracks of the root, cysts and granulomas, the presence of dystopic and impacted teeth, doctors prescribe a two-dimensional panoramic image of the jaw or CT (computed tomography) . The second type of examination - computed tomography - is more accurate, as it allows you to obtain three-dimensional 3D images and examine all processes in great detail.

In addition to X-rays, the doctor will definitely conduct a visual examination using a mirror, percussion1 (tapping on the crown) and examination of the oral cavity using special instruments (dental probe). Additionally, electroodontodiagnosis may be prescribed to determine the viability of the pulp, color and thermal tests to identify various non-carious (hypoplasia, wedge-shaped defect) and carious pathologies.

Ways to eliminate pain

You need to visit a dentist as soon as possible to identify the specific cause of the discomfort. Self-medication will not be successful; such actions can only lead to the development of complications. At home, you can only reduce pain for a short time in order to wait for a trip to a specialist:

  • Painkillers. They will help reduce the manifestation of pain, regardless of what caused the symptom. You can take Nise or Ketarol according to the instructions. If there is nothing suitable, a Paracetamol tablet will do.
  • Infusion of chamomile. Pour boiling water over a tablespoon of dry raw materials. When the liquid has cooled, rinse your mouth.
  • Soda + salt. Dissolve a teaspoon of salt + baking soda in a glass of warm water. You need to rinse your teeth every two hours.

Recovery period

Once treatment for pulpitis is completed, the patient will need some more time to fully recover - from one week to a month. During this period, physical therapy is indicated, for example laser therapy using a helium-neon apparatus. This is necessary to speed up the healing process and consolidate the therapeutic effect.

Since pulpitis is an inflammatory disease, after treatment in the clinic it is necessary to take a course of non-steroidal anti-inflammatory drugs at home, such as: Ibuprofen, Ketanov, Naproxen-Acri. However, it should be remembered that all anti-inflammatory and painkillers have their contraindications, so the choice of a specific medication must be agreed with your doctor.

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