Pulpitis is the inflammation of the pulp, the nerve chamber inside a tooth, causing pain and pressure. This nucleus of the tooth protects the nerve endings. If pulpitis is treated in time, it usually does not cause further problems.
What is pulpitis?
In pulpitis, pressure builds up in the pulp cavity and radiates to the tooth nerves and surrounding tissues. Unlike other parts of the body, the pressure in the pulp cannot be dissipated by the surrounding soft tissues. The tooth core is surrounded by dentin, a hard tissue, which makes pressure dissipation impossible. Thus, it is primarily the increased blood flow that causes the mild to extreme pain. If the teeth are denervated during treatment, this can lead to irreversible pulpitis, depending on the location, intensity of infection and size of the treated area. This usually leads to reduced sensitivity in the affected teeth and an increased rate of further tooth damage. Deciduous and permanent teeth can be equally affected by pulpitis.
Causes
Pulpitis is an inflammation caused by a bacterial infection resulting from tooth decay or dental decay. The affected pulp is the internal part of the tooth and consists of nerve endings, blood vessels, and connective tissue. The triggering caries is a lesion of the tooth enamel caused by acid erosion of the tooth surface due to bacterial plaque. If the decay is deep, the pulp becomes irritated and bacteria can invade, causing inflammation. This increases the pressure in the tissues and causes the pain. Apart from this, pulpitis can also be triggered by other factors: Injuries that have caused small cracks in the tooth, invasive procedures such as fillings or crowns, and by acidic food residues. If pulpitis is not too advanced, the pain may disappear once the cause is removed.
Symptoms, complaints and signs
Tooth root inflammation is primarily manifested by severe pain in the area of the tooth roots. The toothache increases with external stimuli such as heat, cold or pressure. In severe inflammation, the tooth appears to throb, and the pain radiates to the jawbone and surrounding tissues. Eventually, an abscess forms, which can be seen externally by swelling. If pulpitis is not treated, the discomfort increases in intensity. As a final consequence, one or more teeth may die. There is also a risk of developing blood poisoning. If the inflammation spreads to surrounding regions, inflammation of the teeth themselves as well as the jaw and mucous membranes may also occur. Pulpitis itself leads to suppuration, which can cause infections in addition to bad breath and a strong feeling of discomfort. In addition, painful cysts and bleeding can occur in the area of the mouth and jaw. The symptoms of dental root inflammation usually appear within a few days and rapidly increase in intensity. If the disease is treated early, the symptoms subside just as quickly. In isolated cases, looseness of the teeth persists.
Diagnosis and course
Pulpitis is often initially accompanied by symptoms such as increased sensitivity to stimuli (e.g., hot and cold). Persistent throbbing pain may also be associated with the condition. However, pulpitis can also occur without pain. In acute pulpitis, the pain is intense and may occur continuously at intervals. In purulent acute pulpitis, the pulp is completely inflamed. The extremely painful condition often worsens when lying down. In another form, the pulp begins to die. This form is less painful, but can lead to the formation of a granuloma or abscess. Chronic pulpitis is also characterized by less intense pain than in the acute form of the disease, but it can spread in the root canal. As a result of significant pressure on the dental nerves, locating the source of the pain is quite difficult, which is why confusion with adjacent teeth may occur.
Complications
Due to pulpitis, in most cases patients suffer from discomfort in the oral cavity and especially in the teeth. This results in severe toothache and likewise tooth decay.It is not uncommon for the toothache to spread to the head or ears, so that those affected suffer from impaired concentration and permanent pain. The teeth themselves are very sensitive to hot and cold foods, so that normal eating is usually no longer possible for the affected person. Patients suffer from weight loss and also depression. If pulpitis is not treated, it is not uncommon for the tooth roots to become inflamed. In this case, the tooth root usually has to be completely removed, as the pain does not disappear otherwise. The patient’s life expectancy is not affected due to pulpitis. As a rule, pulpitis can be treated relatively easily by a dentist. Complications do not occur. The patient may be dependent on painkillers. Furthermore, pulpitis can also occur in the further course of life in the patient.
When should one go to the doctor?
Since pulpitis is a serious condition, it should always be treated early. This can prevent further destruction of the tooth. As a rule, pulpitis can be treated relatively well so that it does not lead to further complications or other discomfort. A doctor should be consulted if the affected person suffers from severe pain in the tooth. In this case, the pain often spreads to the head or ears, so that very unpleasant feelings can occur in these areas as well. The affected tooth also reacts very sensitively to cold or heat, and eating with the tooth is hardly possible any more. A doctor should also be consulted if pulpitis is already causing the tooth to bleed. As a rule, the disease is treated by a dentist. In the process, a complete cure occurs.
Treatment and therapy
In principle, pulpitis should always be treated by a dentist. This usually involves root canal treatment or removal of the tooth core. One way to relieve the pain initially is to take over-the-counter pain relievers. The most effective medications are based on the active ingredients acetylsalicylic acid or aspirin, paracetamol and ibuprofen, do not contain cortisone and have anti-inflammatory as well as analgesic properties. If pulpitis is caused by caries, the lesion should be treated. The damaged area is cleaned and dried with sterile cotton. The cavity can be filled with additional cotton soaked with an analgesic disinfectant.
Prevention
The best way to prevent pulpitis is to maintain good oral hygiene. Teeth must be cleaned thoroughly at least three times a day. Each tooth, including its inner surface, requires thorough care. Careful brushing should be done, otherwise the delicate enamel could be damaged. Toothbrushes, which should be changed every two months, should have a medium hardness and rounded bristles. Toothpastes containing fluoride strengthen the enamel and prevent tooth decay. At the same time, the use of dental floss is recommended, as well as mouthwash to clean inaccessible tooth spaces.
Aftercare
For mild pulpitis, most patients can be treated with anti-inflammatory medications. If pulpitis is irreversibly chronic, root canal treatment or apicoectomy may be necessary. If surgical resection is successful, further X-rays will show whether the inflammation of the dental pulp has been completely cleared and the root tip cleaned or filled. After oral surgery, follow-up treatment supports the healing process. Regular check-ups serve to ensure the success of the treatment and help to detect renewed pulpitis in its early stages. In addition, dentists provide detailed information on what to do after an operation. Reduce swelling, for example, by cooling. In the first period, soft foods such as milk porridge or soups are best for consumption. The use of interdental space brushes, antibacterial mouth rinses and mouthwashes complements careful dental care. In the aftercare of pulpitis, professional dental cleaning (PZR) is recommended every six months. Despite sonic toothbrush, dental floss and fluoride toothpaste, bacterial plaque cannot be removed from hard-to-reach areas.Dentists or specially trained practice personnel use suitable instruments for thorough removal of pathogenic plaque as well as for polishing and fluoridation. Since caries is a frequent trigger for inflammatory changes in the pulp, intensive cleaning effectively protects against bacterial recolonization. In addition to early diagnosis and therapy, scheduled follow-up care, especially in cases of severe pulpitis, is an essential factor for a good prognosis.