Tooth Marrow Inflammation

Synonyms

Pulpitis, apical periodontitis, apical periodontitis, apical ostitis, inflammation of the root apex

Definition

Inflammation of the tooth pulp is a disease that occurs inside the tooth and around the root tip. Deep carious defects, which remain untreated for a long time and work their way through the inside of the crown of the tooth, through the inflamed root canals to the tip of the root are the trigger of tooth pulp inflammation. In addition, the bacteria responsible can migrate through deep gum pockets to the root tip and from there provoke a tooth pulp inflammation.

In addition, in some cases strong thermal, mechanical and/or chemical stimuli are responsible for the development of a tooth marrow inflammation. The presence of an inflammation of the tooth marrow does not necessarily have to be accompanied by the occurrence of severe toothache. Many affected patients report only mild to moderate pain, some of them were completely pain-free until the beginning of treatment.

A painful inflammation of the tooth marrow is called acute pulpitis in dentistry. Pulpitis does not always have to lead to an event requiring treatment; short-term pathogenic stimuli can be completely eliminated by spontaneous healing. In such cases, from a medical point of view, one speaks of a so-called reversible pulpitis.

As soon as the triggering stimulus acts on the tooth pulp over a longer period of time, a chronic inflammation of the tooth pulp (chronic pulpitis) develops. The tooth and the tissue around the tooth have several possibilities to react to the disease-causing stimuli. The formation of a substance called irritant dentine is by far the most common way for the tooth to protect itself.

Irritant dentine is formed on the inner side of the dentin, in the area of small dentine tubules that have been formed in the course of tooth wear. Furthermore, a so-called blood vessel reaction can take place inside the pulp. This defence mechanism leads to an effective increased blood circulation and immigration of red and white blood cells (erythrocytes and leukocytes).

The immigrated white blood cells release specific inflammatory substances inside the tooth pulp, which increase the permeability of the small blood vessels of the tooth pulp. In addition, many damaged teeth react with the formation of connective tissue fibers in the area of the pulp. The collagen fibers are supposed to protect the damaged pulp and make it impermeable to the inflammation-inducing stimulus.