Removal of the tooth nerve: methods, indications and contraindications -

Any manipulation of teeth is a traumatic process that involves interference with the tissue structure. After this, the person may sometimes feel pain and discomfort when chewing or drinking hot or cold drinks. Therefore, after visiting the dentist, the question often arises whether a tooth can hurt after nerve removal and how long it lasts. In the absence of complications, all discomfort disappears after a few days.

Increasing pain and the appearance of signs of inflammation require urgent medical attention. The dental clinic’s specialists will provide qualified assistance and help you quickly return to your normal lifestyle.

Indications for nerve removal

Caries has reached the pulp. Initially, caries appears on the enamel, then moves to dentin, then to the pulp. Inflammation increases: acute pain occurs. To eliminate the pain and save the tooth, you need to remove the nerve.
Injuries of various types: impact, fracture, chip. With such mechanical impact, traumatic pulpitis develops. The integrity of the tooth is damaged, the infection penetrates into the pulp. Inflammation occurs and pain appears. Treatment involves removing the nerve.
Retrograde infection. When inflammation occurs at the apex of the tooth root, it then spreads to the nerve.
Orthopedic treatment. Before placing a crown, in some clinical cases it is necessary to remove the nerves. To avoid complications, a severely damaged tooth is first treated: the nerves are removed.
Asymptomatic pulpitis (chronic). The patient does not have acute pain, but the nerve is infected. The patient's complaints may include mild pain in the past.

Pain in a tooth after a temporary filling is placed - normal or pathological?

If, after several days or a week of keeping a temporary filling with a medicinal drug under it, with the pulp preserved, intense pain continues, does not tend to decrease, increases with temperature and chemical stimuli, or signs of complications appear (sharp throbbing pain, swelling of the tissues surrounding the tooth, swelling of the cheek, signs of general intoxication, fever, enlargement, soreness of peripheral lymph nodes, etc.) – an urgent appointment is required to review treatment tactics.

It is concluded that there is severe inflammation of the pulp that is not amenable to biological treatment and that it must be removed. In this case, a devitalizing arsenic-containing or paraformaldehyde paste is placed for a period depending on its composition (from two days to a week), followed by depulpation and cleaning of the canals. After placing such pastes under a temporary filling, after the required time has passed, depending on the type of paste, the tooth should stop hurting due to the death of the nerve. If this does not happen, we can assume that the drug was poorly delivered and had a bad effect on the pulp, or the pulp is completely necrotic and the canals are filled with pus (in this case, swelling of the gums is added to the clinical symptoms), in such cases you should urgently consult a specialist.

In case of any progression of pain or the addition of other symptoms, urgent treatment is necessary with removal of the filling, re-cleaning of the canals and long-term step-by-step treatment, and in some cases even surgical treatment.

Features of pain under a temporary filling in various diseases

The different nature of pain is, to one degree or another, inherent in different inflammatory processes.

Thus, a characteristic sign of acute pulpitis is intense pain in the tooth, often manifesting itself in the form of attacks lasting up to half an hour, worsening at night, when eating food of contrasting temperature, radiating to neighboring areas.

Chronic pulpitis is manifested by mild, spontaneously occurring periodic pain, also associated with eating food of contrasting temperature.

Intense, acute, increasing twitching, paroxysmal pain is also characteristic of acute purulent periodontitis.

Gradually developing, aching, bursting pain with the sensation of an “overgrown tooth” is characteristic of chronic periodontitis.

Mild aching pain is characteristic of ongoing inflammation in the pulp and at the top of the tooth during the action of devitalizing pastes.

Of course, it is categorically impossible to completely rely on the nature of the pain and try to diagnose yourself; you should definitely consult a qualified dentist, who, based on examination data and objective research methods, will accurately diagnose and carry out appropriate treatment.

What are the methods for removing a nerve?

Amputation . This method is rarely used: mainly in pediatric dentistry. Its essence lies in the fact that the neurovascular bundle is partially removed. The pulp remains in the roots, and only the coronal part is removed. In adults, it is used in exceptional cases, when the doctor sees that the inflammation has affected only a small part of the nerve.
Extirpation . The pulp is completely removed from the tooth. After removing the nerve, the canals are cleaned, washed, and filled.

Doctors providing this service

Tooth extraction is an extremely painful undertaking that causes a great deal of stress for most people. When the operation has already been performed, you can breathe more freely - all that remains is to follow fairly simple recommendations during the recovery period. After tooth extraction, a swollen and sharply painful wound remains in the mouth for some time, which interferes with eating. The timing of its healing depends on the general condition of the body, but the average period is considered to be 2-3 weeks. If a single-rooted tooth was removed, the hole heals in about 16 days, and if it is multi-rooted, it takes about 22 days. In addition, the length of the postoperative period depends on several other factors, for example, a young body heals such damage faster.

Sequence of treatment

Diagnostics . After the doctor has examined you and collected your medical history, an X-ray is taken. This diagnosis allows you to evaluate the structure of the tooth and plan treatment. To see the full anatomy of the root canals, a computed tomography (CT) scan is performed - a 3D diagnostic that allows you to see all the structures of the tooth.
Pain relief . Local infiltration or conduction anesthesia is performed. Before the injection, the gums are lubricated with an anesthetic gel so that the injection is not felt.
Setting up insulation . Root canal work should be done in clean, dry conditions. For this purpose, rubber dam (insulation) is used. It is a latex plate that is placed on the tooth. Advantages of isolation: saliva and plaque do not enter the root canals. Medicines and solutions also do not flow into the patient’s mouth.
Preparation of hard dental tissues . The doctor uses a drill to remove the destroyed tissue. To prevent overheating of the tooth, water flows from the tip. The doctor creates direct access to the root canals.
Nerve removal . It is performed with thin sterile instruments similar to long needles. The doctor places an instrument into the root canal and removes the nerve. Machine rotary tools may also be used. This stage is completely painless, since anesthesia was previously performed.
Mechanical and medicinal treatment of canals . The canals are washed with special antiseptic solutions and passed through with instruments. This allows you to completely remove the diseased nerve and relieve inflammation.
Temporary filling . Root canal work is complex, so it is not always possible to treat a tooth in one visit. An anti-inflammatory paste is placed into the canals, a temporary filling is placed, and a further stage of treatment is planned.

For permanent restoration of the crown part of the tooth, ]esthetic dentistry[/anchor] will be required.

Oral care after tooth extraction

In the first two weeks, it is better not to brush your teeth at all, as this may resume bleeding and disrupt the entire healing process. Instead of brushing, you can rinse your mouth with hot water and clean your teeth with your finger until a characteristic squeak occurs. After this, be sure to rinse your mouth with special disinfectant solutions prescribed by your doctor. It should be borne in mind that frequent (more than three times a day) rinsing your mouth only slows down the healing process.

If the tooth was removed during the acute stage of the inflammatory process, then the healing of the hole takes longer and is much more painful. In this case, the doctor may prescribe oral or local use of anti-inflammatory drugs. Antibiotic mouth rinses should be alternated periodically to prevent bacteria from becoming accustomed to a particular drug. Lubricating the hole with the juice of the medicinal plant Kalanchoe works well - it gives a very strong analgesic and healing effect - often the wound heals within a few days. To increase biological activity, a plucked Kalanchoe leaf can be kept for 5 days on the bottom shelf of the refrigerator, preventing it from freezing.

Contraindications

Doctors at the SDent aesthetic dentistry center collect all data about the patient’s condition before starting treatment. In the health questionnaire, the patient notes the characteristics of his body, and the doctor conducts a survey. Planned nerve removal is not performed if:

high blood pressure, hypertensive crisis;
first, third trimester of pregnancy (provided there is no acute pain);
acute inflammatory diseases of the mucous membranes and facial skin;
acute respiratory and viral diseases, etc.

How long can your gums hurt after tooth extraction?

Severe pain that interferes with normal life activities lasts no more than 3 days after the surgical procedure. It will take up to 7 days for the discomfort to disappear completely. For complex removal, this period increases to 2 weeks.

If during the rehabilitation period you feel pulsation in the socket, bleeding, or bad breath, then you need to contact a surgeon at the Cerekon clinic as soon as possible, because all these signs signal the development of inflammation.

General recommendations after treatment

You can eat and drink immediately after treatment;
Until the anesthesia wears off, you should not eat rough food;
in the days following treatment on the side of the diseased tooth, do not chew rough, hard food;
in some cases, anti-inflammatory drugs, painkillers, and oral baths are prescribed;
If a temporary filling falls out, consult a doctor immediately;
If pain occurs after placing a temporary filling, also consult a doctor immediately.

After the anesthesia wears off, the patient may feel discomfort in the area of the treated tooth. If pain, throbbing, or swelling occurs, you should consult a dentist.

What ways to get rid of toothache are there?

Let's start with the fact that if you are experiencing severe throbbing pain, you should not endure the pain. The dentist will conduct a detailed diagnosis and be able to identify the cause; it could be damage to soft tissues or incompletely cleaned canals. Next, you will be prescribed effective treatment.
Under no circumstances should you search the Internet for methods to relieve pain at home and self-medicate. You need to identify the exact cause and undergo treatment. Otherwise, the disease will progress and inflammatory processes will spread to neighboring teeth.
If, in addition to pain, you experience any other unpleasant symptoms, for example, severe swelling, discharge, fever, etc., you should also consult a doctor immediately.

Long-term consequences after treatment

Patients often experience complications after nerve removal. This is due to many factors: lack of diagnosis, poor quality treatment, incorrect diagnosis, etc. Main consequences:

poor canal filling. A loose filling leads to the re-emergence of bacteria that extend beyond the tooth root. A cyst forms, due to which the tooth is often removed;
tool fragments. The complex anatomy of the canals and low-quality instruments can lead to its failure.
removal of material beyond the root apex. If the filling material is chosen incorrectly or there is too much of it, it extends beyond the root.
Tooth perforation occurs due to aggressive processing.

To avoid such complications, doctors at the SDent clinic recommend contacting us for medical help, as we have a staff of highly qualified doctors, an equipped X-ray room and advanced equipment!

Wisdom tooth removal

Wisdom teeth are considered full-fledged elements of the oral cavity. They are involved in chewing food (if they are located above each other and have contact), and can act as a support for bridges and removable dentures in the future. There are specific indications for extraction in their case. For this reason, the decision about whether wisdom teeth need to be removed is made only by the attending physician.

The most common problem with eighth teeth is their growth. Only some teeth form and grow completely without complications, but often these processes are accompanied by a number of difficulties:

semi-retinated or impacted elements that have formed in the bone tissue, but have not erupted or only partially erupted. Their position can be vertical, horizontal, or with their roots outward. Because of this, neighboring elements suffer, constant pain appears;
violation of position (dystopia). Since wisdom teeth erupt without predecessors (baby teeth), and the jaw bone is already formed and does not develop, the position of the elements is often incorrect. They injure the mucous membrane, overlap other crowns, and put pressure on neighbors. This leads to inflammation. The doctor will determine whether the position can be restored with orthodontic treatment or whether it is better to remove the wisdom tooth;
appearance of a gingival hood. When slowly cutting through the mucosa, an area is formed in which bacteria and food debris accumulate, which are difficult to clean. This leads to acute inflammation, which can provoke the appearance of pus;
destruction, caries. Elements may appear immediately underdeveloped with carious lesions.

The doctor determines whether wisdom teeth should be removed or not based on complaints and the clinical picture. Problems with even one or two teeth interfere with the normal functioning of the entire dental system. Pain appears when opening the mouth and chewing. The bite and position of the incisors may even change.

How a wisdom tooth is removed depends, as in the case of permanent elements, on the condition of the dental system. In the absence of contraindications, manipulation is carried out with ordinary forceps.

What should you not do during the healing period?

It happens that after a tooth is removed, the doctor puts sutures - under no circumstances should they be touched with a brush for the first week or even two after the operation.
Do not rinse your mouth on the first day after surgery.
It is strictly contraindicated to create increased pressure in the mouth - when sucking from tubes, sucking secretions from a wound, etc. This can quickly restart heavy bleeding.
After the first two weeks, you can brush your teeth with a soft brush without touching the socket.
In the first days, you can only eat soft or semi-liquid food, and later you cannot chew on the side where the tooth was removed.
Do not touch the hole with your tongue.
It is better to stop smoking for the first three days of healing, if possible. In addition, you should not use alcohol or alcohol-containing tinctures of medicinal plants for rinsing your mouth.

In what cases may depulpation be required?

Advanced caries, when the pathological process affects not only dentin, but also spreads to the pulp.
Preparation for upcoming prosthetics.
Various chronic gum diseases. If treatment is not treated in time, the inflammation progresses, affecting the roots and nerve endings, which requires radical measures.
An injury as a result of which a sufficiently large part of the tooth has broken off, and its restoration is impossible with conventional filling materials.

Sometimes depulpation has to be resorted to after unsuccessful caries therapy. Incorrect processing and violations of the filling process lead to softening of the dentin, but already under the installed filling. The patient does not notice this immediately, and turns to the dentist after the onset of acute pain. And in such situations one has to resort to radical methods of solving the problem.