Causes | Tooth Marrow Inflammation

Causes

The onset of pulp inflammation is manifested in many patients by pain and/or hypersensitivity reactions to heat or cold stimuli. If biting into an ice cream or drinking a hot coffee leads to unpleasant reactions of the tooth, this can be a first indication of the presence of dental pulp inflammation. However, such a phenomenon can also be caused by exposed tooth necks and/or irritation of the gums.

A dentist should be consulted as soon as possible to determine the exact cause. During the course of the disease, in most cases there is severe inflammation inside the affected tooth, which is accompanied by sudden, throbbing or stabbing pain. As soon as the patient notices this kind of toothache, a dentist must be consulted immediately, because there is an acute danger that the inflammatory processes are no longer limited to the affected tooth, but reach the jawbone and surrounding tissue via the root tip.

The consequences are then usually painful and difficult to treat abscesses, and the loss of the affected tooth is imminent. In addition, the spread of inflammation within the jawbone often leads to extensive bone loss, which also endangers healthy teeth. However, the presence of a dental pulp inflammation does not necessarily mean that severe pain is experienced. Many affected patients report only slight to moderate pain, some are even completely pain-free until the start of treatment.

Treatment

An existing tooth marrow inflammation can be treated by root canal treatment in the majority of cases. The affected tooth is first anaesthetized by the dentist and then opened with a drill. In the course of this, caries, if present, is removed.

In the next step, the dentist will create an access to the tooth pulp and the nerve fibers embedded in it. Not so long ago, it was essential to attach a so-called cofferdam before the actual treatment. A metal clamp, around which a tension rubber is placed, was fixed to the tooth to be treated.

The cofferdam served as a shield for the tooth, which prevented saliva from entering the tooth and causing the bacteria to spread. However, since the application of a cofferdam is very unpleasant, nowadays people usually only resort to a relative drying of the tooth to be treated. This means that the tooth is only protected from saliva by absorbent cotton rolls.

Afterwards the tooth pulp and the nerve fibers lying in it are completely removed from the tooth root. For this purpose, root files of different lengths and thicknesses (Reamer, Hedstrom or K-files) are used. The inflamed pulp is prepared and freed from dead and inflamed tissue.

A disinfecting alternating rinsing must then be performed. As soon as the inflamed pulp is completely removed and the root canals are disinfected, they are filled with so-called guttapercha points and a special sealing cement. An X-ray control image is then taken to check whether the pulp inflammation has been completely removed and the root is filled to the tip (apex).

Finally, the tooth is closed with a suitable filling. In the case of very pronounced inflammation of the pulp and/or bone involvement, it may be necessary to perform a so-called apicoectomy. In this treatment measure the tip of the root is separated from the rest of the tooth and removed from the bone.

In order to reach the root of the tooth, the dentist must create an access through the jawbone (osteotomy). This is no longer a purely dental therapy; instead, an apicoectomy should always be performed by a qualified oral or maxillofacial surgeon. After the bone has been opened, the roots of the teeth are prepared and rinsed in the same way as a normal root canal treatment.

However, in this case this is not done from the crown of the tooth, but from the root (retrograde root canal treatment). This offers the great advantage that the root filling starts exactly at the end of the tooth roots. Finally, the gums are closed with the help of 2 – 3 stitches.

The dentist usually uses self-dissolving suture material which does not need to be removed. During the apicoectomy there is a risk of damaging nerve fibres.Damage to a nerve manifests itself by the occurrence of loss of sensitivity and numbness in the area of the lip and/or cheeks. In addition, as with any operation, bleeding and/or wound healing disorders may occur.

The removal of the tooth root can also be necessary in the course of tooth pulp inflammation, if the attempt to preserve the tooth by means of root canal treatment has already failed. The chance of preserving the affected tooth by such an oral surgery measure is after all 90 – 97%.