Treatment of baby teeth with unformed roots. Symptoms and forms of the disease

Baby teeth are more susceptible to pulpitis than permanent teeth. This is due to the structural features of temporary children’s teeth:

due to the thin layer of dentin and enamel, the size of the pulp chamber is increased,
connective tissue is loose,
the apical and dentinal canals are wide.

These features create all the conditions for rapid penetration of infection into the pulp. Therefore, the treatment of pulpitis of primary teeth has its own characteristics.

Forms of pulpitis of milk teeth

Pulpitis of temporary teeth can occur in 2 forms: acute and. But the peculiarity of the course of the disease in childhood is that the acute form rapidly becomes chronic. Often this happens unnoticed by either the parents or the baby. That is why regular preventive examinations of the child at the dentist are extremely important for the health of children's teeth.

The structure of milk teeth has its own characteristics.

The acute form appears periodic pain in the tooth. Pulpitis is characterized by the appearance of pain without exposure to any irritants, and often the tooth begins to hurt precisely in evening time and at night. The acute form has the following peculiarities:

rapidly progressing stage of focal pulpitis,
the inflammatory process quickly moves from the coronal part of the pulp to the root area,
rapid transition to a chronic form,
inflammation quickly spreads to periodontal tissues,
the child's body often reacts elevated temperature, general intoxication of the body is noted.

The chronic form of the disease can rapidly develop from an acute one, but it can also occur initially. Develops predominantly in primary teeth fibrous form pulpitis, which gradually turns into gangrenous. As a rule, this process develops in a closed tooth cavity.

The main forms of pulpitis of primary teeth:

Acute form	Chronic form
Serous	Fibrous
Purulent	Gangrenous
Diffuse	Hypertrophic
Partial
Exacerbation of the chronic form

How the disease manifests itself: symptoms

Since the acute form of the pathology rapidly becomes chronic, the symptoms acute phase may be insignificant or absent altogether. Mild pain may appear in the area of the affected tooth. Chronic pulpitis is manifested by periodic aching pain, which may be accompanied by the following: symptoms:

Pulpitis can manifest itself as aching pain.

when tapping and biting,
the mucous membrane around the tooth may turn red and swell,
lymph nodes in the neck enlarge.

The gangrenous form is manifested by an unpleasant odor from the mouth, and a fistula may form in the area of the diseased tooth. With hypertrophic pulpitis the following is observed:

destruction of the crown of the tooth,
pulp growth,
pain while chewing.

The fibrous form of the disease can be asymptomatic, sometimes accompanied by pain when chewing. Because of this, children often chew on one side, avoiding the diseased tooth. As a result, plaque accumulates in an unused area and an inflammatory process of the mucous membrane can develop.

Diagnostic features

Expert opinion. Dentist Vernik R.O.: “Regular preventive examinations by a pediatric dentist will help identify pulpitis in early stage and save the baby tooth until it falls out. This is very important, since premature loss of baby teeth negatively affects the formation of the dentition and maxillofacial apparatus child, often complicates teething permanent teeth. If a baby loses at least one baby tooth ahead of schedule, there may be problems with teeth, so adequate and timely treatment of all dental diseases plays a very important role."

Diagnosis of pulpitis in children consists of the following stages:

An important stage is the differentiation of pulpitis from diseases that have similar symptoms:

deep,
sinusitis,
periodontitis,
otitis.

How is pulpitis of baby teeth treated? There are two fundamentally different treatment methods diseases:

conservative (preserving pulp viability),
surgical (the pulp is removed).

Modern pediatric dentistry, thanks to innovative diagnostic and treatment methods, makes it possible to preserve baby teeth in children even in the most difficult cases to ensure that they are constantly replaced on time. Let's consider these two methods of treating pulpitis in children in more detail.

Conservative treatment method

The conservative method can be used for partial acute or fibrous chronic pulpitis, when complete destruction of the pulp and changes in its structure have not yet occurred. At correct diagnosis the dentist manages to keep the pulp viable. Relative contraindications The use of this technique includes multiple caries and some types of somatic pathologies.

Stages carrying out conservative therapy:

the doctor removes areas of tooth tissue affected by caries,
the cavity is washed antiseptic solution,
put into the cavity medicinal paste containing calcium hydroxide,
The tooth is covered with a filling.

Conservative treatment also involves the use of some physiotherapeutic procedures.

Surgical method

The surgical method of treating pulpitis of temporary teeth involves complete or partial removal nerve (pulp). The treatment method depends on the stage of pulpitis and its shape, as well as the degree of tooth destruction. The dentist’s work algorithm in all cases will be as follows:

anesthesia,
the tooth cavity is opened, all affected areas are removed with a bur,
the pulp is removed
the tooth is treated with an antiseptic drug,
the doctor puts medicinal paste into the cavity,
a filling is installed.

There are 3 methods surgical treatment pulpitis in children:

When using this technique, it is necessary to exclude the presence inflammatory process periodontal tissues. The method can be used for any form of pulpitis with a formed root system.

Devital amputation– the essence of the procedure is to use it on the affected part of the pulp medicines for necrotization. This is a special paste that is placed in the tooth for some time to kill the pulp. The paste is applied to teeth with one root for a day, and to teeth with multiple roots – for two days.

After this, the paste along with the pulp is removed, and a tampon soaked in resorcinol-formalin liquid is placed in the cavity for several days. During the third visit to the dentist, the child is given a permanent filling. The formed cavity is filled with a special substance that prevents further tissue breakdown. For the procedure, topical anesthesia is most often used.

Surprisingly, many parents are still convinced that a child’s baby (temporary) teeth do not need to be treated, unlike permanent ones. Irresponsible mothers and fathers claim that they do not treat caries in their children simply because these teeth will soon fall out anyway. There are often cases where pulpitis in baby teeth is not treated in a timely manner, even despite the child’s severe pain.

This idea of the optional treatment of baby teeth is absolutely wrong, moreover, it is very dangerous ignorance!

If an infection enters the pulp chamber from a carious cavity, pulpitis may develop, which should be treated immediately to avoid the development of complications that spread to the rudiment. permanent tooth.

A peculiarity of choosing a method of treating pulpitis in the case of unformed roots is the impossibility of using extirpation methods, that is, complete extraction of the pulp and treatment of canals along the entire length of the root. This is why pediatric dentists prefer biological and amputation treatment methods for such cases.

Let us first consider the biological method of treating pulpitis of a baby tooth (conservative). This method involves preserving the entire pulp in a viable state, however, it has many contraindications and requires adherence to ideal asepsis and antisepsis during work in order to avoid recurrent pain.

First, under anesthesia, the carious cavity is cleaned of necrotic tissue, and a medicinal paste (usually based on calcium hydroxide) is applied to the bottom of the cavity or directly onto the exposed pulp for several days. After termination pain is put permanent filling on a baby tooth.

Thanks to the biological treatment method, the tooth remains alive, that is, the preserved pulp allows it to supply its tissues nutrients, supporting high strength. But a tooth with a removed “nerve” becomes more and more fragile over the years and is prone to chipping of the filling-bearing walls.

Amputation methods for the treatment of pulpitis in primary teeth with unformed or absorbable roots are very popular among dentists. The essence of such methods follows from their name - the infected pulp is simply amputated, removing it from the pulp chamber.

In this case, both “ancient” methods of devital amputation using the resorcinol-formalin method, and modern vital (under anesthesia and without arsenic) amputation techniques with therapeutic coating of the root pulp with antibiotics, enzymes, calcium-containing drugs, etc. can be used. Preparations “Pulpotek” and “Pulpodent” » are also suitable for the treatment of pulpitis in primary teeth with uncovered root tips.

The photo shows an arsenic-containing temporary filling in a tooth:

This is interesting

Devital amputation is a method of treating pulpitis, which involves first “killing” the pulp, and then mummifying it with potent and often toxic pastes. To cure pulpitis with this “old” method, you need not one visit, but three or even more. Long-term results Taking into account many years of experience in using this method, they most often turn out to be negative.

Possible errors during treatment and how they threaten the child

During the treatment of pulpitis of primary teeth in children medical errors happen more often than in adult dentistry. This is due to the specifics children's reception when the child often prevents the doctor from carrying out all the necessary manipulations with due accuracy and in full. To minimize the severity of errors and for violent children, pediatric dentists can resort to devital amputation using the resorcinol-formalin method, since otherwise the child simply does not have the opportunity to save a baby tooth until its physiological replacement.

In pediatric dentistry, when treating pulpitis of a baby tooth, we encounter, for example, such an error as incorrectly applied paste for pulp devitalization. The most difficult result of such an error is tolerated if the paste is arsenic. If the child does not allow the tooth to be treated efficiently, then the doctor places it not on the exposed “nerve”, but on the soft bottom of the prepared cavity, which is why it often not only does not work, but also causes even more severe pain. Emergency help in this case, the paste is re-formulated.

There are cases of placing devitalizing paste next to or directly on the gum, since in children the carious cavity is often occupied by overgrown gums or located close to the gingival papilla. The consequence of this is severe pain, and upon the child’s arrival to the doctor, a burn caused by the components of the paste is discovered on the gum. Prevention similar complication is to follow the technique of applying the paste, and if you receive a burn, it is necessary to prescribe anti-inflammatory wound-healing gels or pastes.

During root canal treatment baby tooth With pulpitis, bleeding may occur due to the fact that the apexes of the roots may not be formed or may already be slightly resorbed, and the dentist can forcefully remove the files for canal treatment (special needles) beyond the root, injuring adjacent tissues. Stop bleeding even special drugs it can be difficult.

Sometimes an inexperienced doctor can make mistakes such as perforation of the root and breaking off the instrument in the tooth canal. Since the canals in baby teeth are almost always very wide, the percentage of such complications is very low, but the severity is the same as in the case of permanent teeth in an adult. As a result of perforation of the tooth root and breakage of the instrument in the canal, periodontitis or periostitis may subsequently develop due to inflammation of the tissues around the root.

To prevent these complications pediatric dentist removes a piece of instrument from the canal in an accessible way, and the perforations are covered with a special material, for example, “ProRoot MTA”. In some cases, for lack of necessary equipment and materials, the doctor simply mummifies the canals using the resorcinol-formalin method.

The photo shows an example of an instrument broken off in a tooth canal:

How to prepare your child for treatment

In order for the child not to be afraid to have his teeth treated (even with severe pain during pulpitis), it is necessary to make the first preventive visit to the pediatric dentist long before this. The success of the first visit depends equally on the dentist and the baby’s parents.

The visit should be for informational purposes only. During it, the child gets acquainted with the new environment of the office, tools, showing only curiosity and not fear, but even such a visit requires preparation.

Before going to the dentist, follow these recommendations:

talk to your child before the preventive visit 1-2 days before he hears “horror stories” from his peers;
tell your child only about positive experiences;
do not overemphasize the importance of the event, since taking care of health is a common procedure;
talk about your future visit to the dentist as if you were meeting a new friend;
play “dentist” with the whole family: set an example that you are not afraid of the doctor;
do not use scary dental words;
do not deceive the child that it will not hurt, it is better to say that it may be unpleasant at first, but then the tooth will not hurt;
do not experience fear and panic yourself, then this will not be passed on to the baby;
the best option for a visit to the dentist is in the morning, when the child has slept, eaten well and is active;
It’s better if you go to the dentist with your favorite toy so that your child constantly plays with something in his hands;
let the doctor find contact with your child without your help;
if a child resists and interferes with the reception, then he should not be intimidated, threatened, begged, etc.
You should try to gain the child’s trust, so if the situation gets out of control, it is better to postpone the appointment until next time.

If the child is initially uncontrollable and anxious, often falling into hysterics, then he should be prepared with medication, relieving him of the upcoming stress. The over-the-counter drug Tenoten for Children is ideal for this. 20 minutes before treatment of caries or pulpitis of baby teeth, the child should be given one tablet under the tongue for resorption.

With high or moderate stress, Tenoten relieves tension, causing inhibition mental processes. As a rule, after 20-30 minutes the child allows all the necessary manipulations to be carried out.

In order for a child to feel comfortable in the dental chair, it is necessary to start visiting the dentist for the purpose of prevention. With the proper level of hygiene, timely preventive examinations and quality control of teeth cleaning, you can avoid not only pulpitis, but also caries, and preserve your baby’s teeth until their physiological change.

Interesting video about the importance of treating pulpitis of baby teeth

A few more useful explanations from the doctor regarding pulpitis of baby teeth

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Pulpitis of milk teeth.

Lesson notes.

Classification:

Stage 1 Serous-purulent EDI 20-25 µA

Stage 2 Purulent-necrotic EDI 70 µA

Chronic:

Fibrous 25-30 EDI µA

Ulcerative-necrotic (gangrenous) EDI up to 70 µA

Hypertrophic EDI 30-50 µA

Exacerbation of chronic

Acute pulpitis.

Peculiarities:

1. Acute pulpitis in childhood is rare in the clinic, which is associated with reduced reactivity of the child’s body (becomes chronic), the difficulty of collecting anamnesis (the acute stage is missed).

Severe symptoms are observed only before the onset of involutive processes in the pulp. Pain in the evening, at night, spontaneous. At first, pain can also arise from cold and subside from hot, then over time it’s the other way around (that is, it arises from hot and decreases from cold). There is usually no irradiation.

Reaction to percussion: sensation of a “pushed tooth”, pain when pressing with a finger (when periodontal tissue is involved in the process or when the edematous pulp is shaken).

There may be a regional reaction lymph nodes, local tissue swelling.

2. The process quickly spreads from the crown to the root (the orifices are wide).

3. The clinical picture is variable – 3 periods:

The process of root formation is not yet complete. Wide canals and apical foramen, a lot of predentin. Since outflow from the pulp is possible due to this, the clinic will be erased.

The roots are formed. The clinic is like that of an adult.

The roots are resolving. There may be an outflow - again a blurred picture. When removing a tooth, the main thing is not to damage the permanent tooth germ and to accurately follow the topography of the roots of the baby tooth.

4. The process quickly passes from one stage to another (serous-purulent to purulent-necrotic pulpitis), due to the structural features and the absence of restrictions.

5. Intoxication symptoms (headache, tearfulness, general malaise, fever). This is especially true for children under 3 years of age.

Clinic:

Temporary teeth with unformed roots.

1. Serous-purulent stage

Good outflow (through the tooth cavity and through the root).

Reactivity is reduced (that is, this stage will practically not exist - it goes unnoticed).

One-time short-term pain (on its own or during food). Parents do not take their child to the doctor right away. Then the process becomes chronic, and slight pain may persist when chewing.

2. Purulent-necrotic

The pain is mild. Short during the day, significant at night. The pain decreases with cold, and with heat it intensifies.

With inflammation of the hyperergic type (with increased reactivity of the body, with sensitization, increased tissue looseness), a violent reaction of the body, regional lymphadenitis, acute periodontitis, periostitis. Intoxication. Swelling in the area of the peri-maxillary tissues does not exclude the possibility of preserving living pulp.

Temporary teeth with formed roots.

1. Serous-purulent. Spicy pain attack, short-term (1 min – 30 min), pain-free intervals of several hours. Accurately indicate the diseased tooth. Pain from temperature stimuli

Inspection: the cavity is of medium depth, softened dentin is removed in layers (preferably under anesthesia). Probing and excavation of the bottom is sharply painful. Percussion is negative.

2. Purulent-necrotic.

Clear symptoms, proceeds rapidly. In the foreground are perifocal phenomena - a long painful attack (more than the light intervals). There may be irradiation along the branches of the trigeminal nerve.

Inspection: carious cavity of medium, deep depth. The softened dentin is removed in layers. Probing and excavation are sharply painful. There is a reaction of the perimaxillary tissues and intoxication.

X-rays show no changes.

Temporary teeth with root resorption.

The acute phase is almost asymptomatic, as the pulp tissue gradually begins to be replaced by fibrous tissue. Percussion is painless. There is slight pain sensitivity to temperature stimuli.

Chronic pulpitis.

Peculiarities:

1. Causes: develop as an outcome of acute pulpitis; primary chronic pulpitis occurs in children with somatic pathology.

2. In 40-60%, chronic pulpitis is accompanied by chronic predominantly granulating periodontitis. When a carious cavity is located on the chewing surface, a vacuum center bone tissue will be located, as a rule, in the area of the interradicular septum, bifurcation. If the cavity of the lateral surface is located medially, then the focus of bone loss is also medial (distal means distal).

When treating such teeth, it is better to take an x-ray in order to detect the focus of destruction and characterize its position relative to the permanent tooth germ, and from here choose a treatment plan.

3. 40-60% of chronic pulpitis occurs when the tooth cavity is opened.

Clinic:

Chronic fibrous.

Pain when eating, lasting from minutes to hours. The child avoids using the sore side. On examination there is a deep cavity with a large number changed dentin. When it is excavated, the pulp is exposed. Pain on probing. Percussion is painless.

X-rays show an expansion of the periodontal gap up to 8-14%.

Ulcerative-necrotic.

Happens frequently. Develops from acute or chronic fibrous. Pain doesn't always happen. Usually heaviness and swelling in the tooth, pain while eating due to sudden (!!) temperature changes. Delayed pain (this is due to necrosis of the superficial areas of the pulp and degeneration of receptors in the pulp).

On examination: the cavity is deep, there is a lot of softened dentin. The tooth is discolored and there may be bad breath.

Probing is slightly painful.

Chronic hypertrophic.

It happens rarely. More often it develops from chronic fibrous, when the pulp is exposed and is subject to constant mechanical stress and infection. There may be loose and bleeding tissue of a bright red color, or vice versa - dense, epithelium-covered tissue that is slightly painful and non-bleeding.

X-ray shows a slight widening of the periodontal fissure. The apex may have granulomatous periodontitis.

Exacerbation of chronic pulpitis.

Complaints about constant aching pain when pressed (changes in the periodontium). Reaction of lymph nodes, local tissue swelling.

The pulp is less painful than with acute pulpitis.

Features of the treatment of pulpitis of primary teeth.

Biological treatment method.

Indications:

Chronic fibrous pulpitis

The very beginning of acute pulpitis (pain up to 1 day, the attack is shorter than the light interval and percussion is painless)

1-2 health group in a child

Compensated course of caries

Traumatic pulpitis without local tissue reaction

The central position of the cavity (this is important condition, since it is necessary that there is enough space to hold the pads and filling - there is not enough wall in the approximal cavity to hold a permanent filling).

It is better to treat baby teeth that are in the process of formation or stabilization of root growth using a biological method - incisors up to 5 years, molars up to 6 years, canines up to 7 years.

Ideally, the biological method should be used when the pulp horns are only visible, but the probe does not fall into the cavity (that is, when there is deep caries).

Two methods are used: direct (application of calcium preparations to the pulp horn, insulating lining and filling) and indirect (application of preparations with hormones, antibiotics, plasticizing preparations to the opened horn - for 10 days, then at the next visit calcium preparations and a filling).

Vital amputation.

(maintaining the viability of only the root pulp)

Indications are the same as for the biological method, but the location of the cavity is not necessarily central. It is better to use this method in multi-rooted teeth (the line between the root and coronal pulp is clearer). Another method is also indicated for general anesthesia.

Devital amputation followed by mummification.

Indications: chronic and acute pulpitis. Contraindications: acute and exacerbation of chronic with severe reaction of periodontal tissues and lymph nodes.

Up to 7 years – treatment in 3 visits.

On the first visit, a devitalizing paste is applied, on the second visit, a tampon with resorcinol-formalin is applied under a temporary filling for 2-3 days, on the third visit, the mouth and bottom are closed - a permanent filling is applied.

After 7 years - in two visits. The application of a tampon with resorcinol-formalin falls out - in this case, the cavity is only impregnated with resorcinol-formalin for 1-2 minutes and a permanent filling is already placed.

Devitalizing drugs:

1.Arsenic anhydride is a cytoplasmic poison. Diffuses well into the peri-maxillary tissues (it is advisable not to use in hot climates).

Do not allow it to get on the gums. It also cannot be used again (that is, if after application the first time it had a weak effect and the pulp remained alive, then the second time it is necessary to use other preparations without arsenic).

Arsenic ensures the sterility of the cavity. But it is undesirable to use preparations containing arsenic in children.

2. Paraformaldehyde is an antiseptic and mummifier. It is useless to place the pulp on the horn (the cavity must be opened). You can bet twice. They are usually placed for 10-14 days. For example, Depulpin (Voco) can be used in childhood.

Resorcinol is a white crystalline powder (should not be pink!). Formalin 40% should be without sediment (if there are flakes, this means that the drug has already turned into paraform flakes and a solution of formic acid). Resorcinol crystals are added to formalin until saturation.

Vital extirpation.

The main condition is the formation of the roots. Indications: all forms of pulpitis, especially purulent-necrotic acute and ulcerative-necrotic chronic (since in these forms the periodontal tissues are already involved in the process, and when using devitalization they will be dealt an even greater blow).

X-ray – 3 pictures during the treatment process. Filling with dissolving pastes (without gutta-percha, without thermophil). There are special pastes for baby teeth, endomethasone (to fill loosely), eugenol with zinc oxide.

The good thing about this method is that the treatment occurs simultaneously, but it must be taken into account that not every child can withstand approximately 1 hour and 20 minutes for treatment and filling of a tooth (and it is easier to do it in several short visits using the devital amputation method). The method is recommended for use under general anesthesia, but use general anesthesia only when indicated.

Devital extirpation.

Also the main condition is formed roots. Indications: all pulpitis, but without reaction of the peri-maxillary tissues and lymph nodes (since in this situation it is impossible to use devitalizing agents due to their effect on the already “suffering” periodontium). In practice, in this case it is generally better to remove the tooth.

To summarize, the main method in practice should be considered devital amputation.

Pulpitis is a disease of dental tissues that differs inflammatory in nature. It usually develops against the background improper treatment. Not only adults, but also children have to deal with this pathology. From the materials in this article you will learn the causes of the disease, as well as its forms and the main methods of treatment.

Tooth pulpitis - what is it?

The pulp is the neurovascular bundle of the tooth. As a result of the penetration of pathogenic microorganisms into this area, an inflammatory process develops. The disease often occurs as a complication of caries or is a consequence of improper treatment ( low quality fillings, periodontal surgery, tooth grinding).

Pulpitis is one of the most frequent complaints patients dental clinics and at the same time it is considered a fairly common disease of primary teeth. In this article we will dwell in more detail on the manifestations of this disease in young patients, we will talk about the most effective methods treatment.

How is pulpitis different in children?

Pulpitis of primary teeth in children is a fairly common pathology. Its timely treatment helps prevent the development of dangerous complications.

Children are several times more likely than adults. Experts explain this phenomenon by the characteristics of babies. They have connective tissues differ in friability, root canals wider, and the dentin itself is less mineralized.

Imperfection leaves its mark immune system. The likelihood of catching a cold as a child is several times higher than as an adult. Nature has managed to balance this nuisance by the fact that the disease in 65% of cases is practically asymptomatic. This is what is hidden main danger illness.

If your child often complains about toothache, the enamel has become overly sensitive to hot/cold food, you should visit your dentist. You should not postpone your visit, because the consequences of this disease are unpredictable. Some note that after pulpitis the tooth hurts even more, while others experience severe swelling and a cyst forms.

Main causes of pathology

The disease usually develops under the influence negative factors How of a singular nature, and in total:

Exposure to toxins released pathogenic microorganisms in a carious cavity.
Mechanical damage to the tooth, careless treatment of the oral cavity, nerve damage during surgical procedures.
Previously rescheduled acute illness accompanied by decreased immunity.
Treatment of teeth with antiseptics with an aggressive formula.

Choice effective therapy directly depends on the reasons that caused tooth pulpitis in a child. Treatment in most cases allows you to save the molars.

The complexity of therapy for this disease comes down to the fact that the doctor can only eliminate that fragment of the pulp that is located directly in the crown. Its root part is subject to mandatory deletion only in fully formed dental roots. This is very difficult in young patients due to high risk traumatization of soft tissues and rudiments of permanent incisors.

What are the symptoms of pulpitis?

The clinical picture of the pathology is striking in its diversity. There are patients with no complaints and cases where symptoms of the disease are clearly manifested (painful discomfort, intoxication of the body, periostitis).

It is very difficult to diagnose pulpitis in a timely manner, because young patients cannot always accurately state their complaints. Therefore, parents often miss the onset of the disease and bring the child to the doctor with an acute form.

Among the main symptoms that occur with pulpitis are the following:

paroxysmal pain;
lymphadenitis;
swelling of the tissues around the tooth;
general deterioration of the child's condition.

The manifestation of specific signs of the disease depends on its form. Next, we will talk about each variant of pulpitis in more detail.

Hypertrophic pulpitis of the tooth

What is it? This form of the disease is extremely rare in children. It is characterized complete destruction tooth crown and the growth of pulp tissue. When probing the affected area, bleeding appears. The child usually does not feel pain. Minor discomfort occurs only when chewing food.

Gangrenous pulpitis

This form of the disease develops against the background of diffuse pulpitis. Little patient practically no discomfort in oral cavity, but upon examination, darkening of the tooth enamel is observed. A clear sign The pathological process is a peculiar smell from the mouth associated with the destruction of the pulp and its interaction with pathogenic microflora. Lymph nodes may be enlarged, but remain painless.

in the acute stage

The exacerbation of the disease is caused by problematic outflow of exudate and weakened immunity. The child complains of constant toothache. Lymph nodes enlarge as the disease progresses, and the tissues of the affected area swell. The disease can only be detected using an x-ray, which usually shows destructive changes at the apex of the root.

Chronic pulpitis

When protective forces the body weakens, and chronic tooth pulpitis usually worsens. What is this, what kind of pathology? Symptoms of the disease are the child’s complaints about nagging pain, which intensifies during meals. In addition, the tissues surrounding the tooth become inflamed and swollen, and the lymph nodes increase in size. Sometimes chronic form accompanied by fever and deterioration general condition child.

Acute partial pulpitis

In children with baby teeth this form the disease is very rare. It is not possible to detect the disease in a timely manner.

Diagnosis of the disease

Modern medicine offers several options for identifying dental disease. Pulpitis can be detected during a dental examination. During the examination it is necessary special attention pay attention to tooth mobility and sensitivity. To determine accurate diagnosis X-rays are taken and the teeth are checked for sensitivity to cold/hot temperatures. Based on the examination results, the doctor confirms pulpitis in children’s primary teeth. Treatment of the disease is selected on an individual basis.

What should the therapy be like?

Treatment should be aimed at eliminating inflammation, preventing the development of periodontitis, creating the maximum favorable conditions for the growth of permanent teeth. In pediatric dentistry, it is extremely important that all manipulations are simple and at the same time painless.

How is tooth pulpitis treated? Therapy can be either conservative (biological method) or surgical. The choice of a specific treatment option depends on the severity of the pathology and its form.

Biological method

This method of treatment is used for chronic fibrous pulpitis of primary teeth. Initially, the doctor opens the inflamed cavity. He applies a paste made from a mixture of artificial dentin and Shostakovsky balsam to its bottom and the pulp itself. The affected area is then dried and a phosphate cement filling is placed.

Opinions about use biological method treatments differ. On the one hand, saving the pulp allows the root tips to fully form in the future. On the other hand, after treatment of pulpitis, the tooth often aches and hurts.

Surgical method

The surgical treatment option involves complete or partial removal of the inflamed pulp. Manipulations can be carried out in two ways:

Vital method. During the procedure, the doctor removes the coronal part of the pulp, while the root part is preserved. When, as a result of improper treatment, an infected fragment remains, the likelihood of complications increases (the tooth after pulpitis may hurt, and the surrounding tissues may swell). The root pulp does not allow pathogenic flora penetrate the periapical tissue. To avoid opening the cavity, it is necessary to change burs as often as possible. At the final stage, the affected area is washed with an antiseptic solution. The pulp is cut off at the mouth of the canal, and the bleeding is stopped with a regular solution of adrenaline.
Devital method involves the use of arsenic paste, which is applied immediately after pulp removal. During manipulations, the doctor usually uses arsenic and leaves it for 1-2 days. Long-term use pastes can destroy periodontal tissue. At the next consultation, the pulp is removed, and a tampon soaked in a special liquid is placed into the cavity. During the third visit, the doctor installs a filling.

The devital method of treatment today is most often used for acute or chronic course diseases. In this case, it is strictly contraindicated.

Let's sum it up

In this article we talked about why tooth pulpitis develops, what it is and what its symptoms are. primary symptoms. Treating this disease is not an easy task, especially for pediatrician. The specialist must not only eliminate pathological process, but also maintain the opportunity for the full development of permanent teeth in the future. Pediatric dentistry has a number of features and differs significantly from adult dentistry.

For those children and their parents who regularly visit the dentist’s office together, it is not difficult to detect pulpitis in a timely manner and take action. necessary measures for his treatment. If you notice a damaged or discolored tooth, you should immediately visit the dentist. Otherwise, the likelihood of developing a complicated infectious process increases.

As a preventative measure, it is recommended to visit the dentist twice a year. Caries detected in time can prevent pulpitis in children's primary teeth. Treatment of this disease is best started at initial stages development. Be healthy!