Temporary filling of root canals in an endodontic treatment scheme. Composition and principle of action of arsenic pastes

Now a visit to the dentist has ceased to resemble a sophisticated execution, as it was a couple of decades ago. Particularly indescribable impressions were received by those unfortunate patients who had to depulpate a tooth (kill the nerve in the tooth). The word “arsenic” was familiar to almost every patient, and it inspired nothing but horror. New generation anesthetics quickly and effectively relieve toothache and allow treatment of any complexity without suffering for the patient. Why is arsenic in teeth still used by many dentists today as an old favorite? Let's look at the advantages and disadvantages of modern arsenic-based paste, and decide whether it is worth using.

How does arsenic work in a tooth?

The element arsenic is included in Dmitri Mendeleev's periodic table. This substance is toxic to humans, and in the past it was often used to kill rodents. A dose of the substance from 5 mg is considered toxic to humans. In dentistry, a paste containing arsenic anhydride components is used.

Dental arsenic paste contains:

arsenic anhydride;
antiseptic components (camphor, thymol) to destroy microbes and disinfect the pulp;
anesthetics (lidocaine hydrochloride, dicaine or novocaine, as well as tannin and filler);
astringents for prolonged action of the paste;
fillers to obtain the desired volume.

With pulpitis or periodontitis, the dental nerve reacts acutely to any thermal or mechanical influences. The cytotoxic effect of arsenic is used by dentists to necrosis the nerve endings and blood vessels of the pulp. In this case, the pulp ceases to be supplied with blood and dies. Broadcast nerve impulses in the nerve endings of the tooth core is blocked.

In simple words, modern dentistry has a lot of tools that make it possible, with the help of reliable anesthesia, to quickly remove the “nerve” of a tooth from its canal. However, the method of applying a “nerve-killing” arsenic paste still works great. Many doctors still consider this method of nerve removal to be the best. When used correctly, this toxic agent is quite reliable, allowing you to anesthetize the process of tooth depulpation without using additional funds and causing pain to the patient.

How arsenic is used for pulpitis

When visiting a dentist before using arsenic, the patient will have to go through the following steps:

First, the dentist prepares dental cavity for applying arsenic paste. To do this, the pulp is opened under local anesthesia. Then the tooth tissue destroyed by caries along with the softened dentin is removed.
After this, a small amount of arsenic paste is applied to the opened dental canal. The paste is coated with camphor or phenol on top. The tooth is then closed with a “temporary filling” (a special composition of hermetic paste), which allows the arsenic paste to be fixed in the tooth and prevent it from falling out during eating, drinking or salivation. After applying the paste, the dental nerve gradually becomes necrotic, accompanied by slight pain (sometimes for several hours).
The next stage of treatment will be a visit to the dentist to remove the destroyed nerve and fill the cleaned dental canals.

Patient behavior after arsenic application

For a patient who has arsenic in a tooth, it is important to follow some recommendations:

He cannot eat or drink for 2 hours. This time will allow the filling to harden thoroughly and give the arsenic paste an opportunity to “work” with the nerve. If you start eating and drinking immediately after a visit to the dentist, the filling will crumble and toxic substances will end up in your mouth.
Components in the form of arsenic in dentistry are completely safe for human health. This method of killing the nerve was previously calmly used even in pediatrics for very young children. And even if it gets into the mouth, arsenic does not pose a clear threat to human life or health, since we're talking about about the use of arsenic components, and not the toxic element in its pure form.
If, nevertheless, the arsenic paste has fallen out, then you can feel it in your mouth. sour taste. It is recommended to rinse your mouth soda solution. This simple remedy neutralizes the effects of the paste components and protects the oral mucosa from burns.
After the arsenic compound falls out of the tooth cavity, it is useful for the patient to drink 1-2 glasses of milk. This proven remedy to bind toxic compounds and remove them from the body.
You should not walk with arsenic for more than the period indicated by the dentist. Typically, arsenic paste is used for a period of 1 to 2 days. On single-rooted teeth, the period of application of arsenic is usually limited to one day, and on teeth with several roots, the period of use of the paste is increased to two days.
A temporary filling can last up to six months. If you miss this deadline, the arsenic in the tooth and the toxic substance from the diseased canal will begin to destroy the neighboring ones. healthy teeth. The extreme critical retention period for arsenic is up to 7 days.

After applying arsenic, it is important to strictly adhere to the deadline for the next visit to the doctor. The tooth will soon stop hurting, but under no circumstances should you reschedule a visit to the doctor on your own.

How to get rid of arsenic yourself

If suddenly the arsenic paste has expired and you can’t visit the dentist, you can remove it yourself. To do this, you need to ensure the cleanliness of your hands (wash) and teeth (brush). Next, you need to disinfect the sewing (or medical) needle or tweezers. To do this, the instruments need to be boiled and disinfected with vodka or manganese solution.
You can easily get rid of a soft filling in front of a mirror. Here it is important not to touch the gum with the needle and not to dig deeper into the dental cavity.
The grayish paste under the filling is arsenic. It must be carefully removed in one go, avoiding swallowing.
Then the mouth is rinsed “conscientiously” with a soda solution or chamomile solution. Carefully place a cotton swab into the tooth cavity.

After removing the filling, you should visit a doctor as soon as possible. Otherwise, the decomposition of the dead nerve can provoke inflammation.

If the paste is left in the tooth for too long, it can cause undesirable effects of arsenic compounds on the periapical tissue surrounding the pulp and lead to the development of periodontitis. Under no circumstances should arsenic paste be kept in the dental canal for more than 3 days. Otherwise, it may lead to blackening and destruction.

About the toxicity of arsenic

And yet arsenic has strong toxic properties and many dentists prefer to use it only in rare cases.

It is especially bad that some patients take their health lightly and often “overexpose” arsenic to their teeth. And such liberties can cause such unpleasant complications:

change in dentin color (blackening);
periodontitis due to toxic effect arsenic;
inflammatory swelling of the pulp;
death of bone and periosteal tissue;
intoxication of the body.

But unlike the old days, modern dentistry has many methods that allow you to kill the pulp using other, less toxic means.

Why does a tooth hurt with arsenic?

Typically, patients hope that applying arsenic paste will immediately stop their suffering from toothache. However, this is not always the case. Sometimes it takes 2-3 days for complete pain relief with arsenic. It often happens that arsenic paste is already inside the tooth, but the pain does not subside. After applying the medicine, the pain in the tooth continues for several hours. And that's completely normal. In such situations, it is quite permissible to take an anesthetic drug to relieve toothache (Nurofen, Ketorol, Nimesil, Ketanov).

If there is pain in the tooth during the action of arsenic, it is not recommended:

drink uncontrollably large doses painkillers;
apply heat to the cheek;
chew food on the side of the diseased tooth.

If toothache after the introduction of arsenic it does not subside for a long time, this is a dangerous signal. This condition can lead to the development serious complications, up to the development of sepsis.

Let's figure out what is the reason for tooth pain after using arsenic. After all, it is unacceptable to endure toothache in this situation, since the consequences of such patience are difficult to predict. Similar painful manifestations may indicate:

incorrectly chosen dosage of medication (below normal);
incorrect application of the substance or too tight a filling;
the patient turned to the doctor late and arsenic is not able to help with acute conditions that extend beyond the pulp (periodontitis, periodontitis, periostitis, phlegmon, abscess);
dangerous reaction of the body to the components of the paste (allergies up to anaphylactic shock occur);
the appearance of drug-induced periodontitis (its symptoms include swelling of the gums, pain in the tooth area, temperature);
necrosis (necrosis) bone tissue or periosteum;
swelling of the gums around the tooth;
violations in the technology of applying medication;
irritating effect of paste on tooth tissue;
about the transition of inflammation from the pulp to surrounding tissues.

Obviously, a specialist can determine the cause of persistent toothache after adding arsenic. And you shouldn’t delay your visit to him.

Indications

Let's figure out when the use of arsenic is permissible and justified. Most often, arsenic paste is used when it is not possible to use other analgesics. This substance is used to kill nerve endings and blood vessels in the pulp. Arsenic paste can be used in the following situations:

It is impossible to use another type of anesthesia due to the patient’s health condition ( high blood pressure, alcohol intoxication);
urgent emergency treatment and absence of other anesthetics;
allergy to other painkillers;
lack of effectiveness of other anesthetic drugs due to high pain threshold patient;
when treating baby teeth in children, when it is impossible to perform local anesthesia(the baby is afraid of injections).

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How do dentists treat the disease?

It is advisable to start treatment of pulpitis in a timely manner, as this can lead to negative consequences and certain complications, such as periodontitis. Dentists immediately try to relieve the patient of pain, inflammation, eliminate the infection and gradually restore the functionality of the pulp, if possible.

As soon as a patient with acute pulpitis sees a specialist, an anesthetic is injected into the carious cavity, and an analgesic is taken orally. After thorough examination In the oral cavity, a treatment method is selected - conservative or surgical.

Conservative treatment helps to get rid of pain, inflammation with medications and physiological methods therapies that are aimed at preserving the pulp. In such a situation it is used biological method. Sometimes the patient undergoes partial removal pulp, but at the same time maintaining its viability.

Conservative treatment is considered a one-session treatment in most cases, but it may take several days to resolve the problem. There are such indications for biological method therapy, such as focal pulpitis in acute stage, exposure of the pulp when a dental crown is broken, fibrous pulpitis chronic form, the patient’s age is no more than 29 years, there are no changes in the area of the apical foramen, there is no possibility of prosthetics, etc.

Conservative therapy includes the following steps:

Anesthesia.
Treatment of carious cavity with instruments and medications.
Degreasing procedures, drying the cavity.
Applying an insulating gasket to the bottom of the pulp and installing a filling.

Treat tooth pulpitis operationally possible and desirable only if it is impossible to carry out conservative treatment. It involves removing the pulp completely, then filling the canals and, accordingly, the dental crown. This method therapy is considered the most reliable and is carried out in several visits to a specialist:

Use of anesthesia.
Removal of carious tissue from the cavity.
Protecting the tooth from moisture using a rubber dam.
Removing pulp from the crown and canals.
Measuring the length of canals, their processing, expansion and filling.
Rinsing the canals with antiseptics, applying an antiseptic, then placing a temporary filling.
Removal of temporary filling and preparation from the canals.
Rinsing the canals and drying them.
Filling canals with gutta-percha.
X-ray examination, which helps to track the correctness of the canal filling.
Installation of a permanent filling.

How long does it take for treatment?

How long does it take to treat tooth pulpitis to get positive result from therapy? In this situation, everything will depend on many factors. First of all, attention is paid to the stage of the disease and inflammatory process. It is also necessary to take into account general condition patient and other severe symptoms. Do not forget about the destructive process and the possibility of restoring a damaged tooth.

If it is possible to leave the pulp and not remove the tooth, then use conservative method treatment, which includes several visits dental office. If a patient is diagnosed with an advanced stage of pulpitis, it is recommended to surgical treatment, which also involves several visits to a specialist.

Why do they place a temporary filling for pulpitis?

Temporary filling is recommended for conservative treatment pulpitis and caries. It is installed in order to prevent the leakage of the anti-inflammatory drug from the root canal, as well as to prevent the entry of pathogenic microflora and pieces of food.

What medicine is put into the tooth for pulpitis?

It is impossible to treat tooth pulpitis without using various drugs. The medicine is placed under the filling to eliminate the infection and inflammatory process. Various anti-inflammatory drugs may be used. Very often, arsenic is placed in the tooth to kill the nerve and numb the problem area.

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During pregnancy and breastfeeding

People often ask whether it is possible to agree to dental treatment during pregnancy using this remedy, and why this drug is dangerous for the woman and the fetus.

During such a crucial period as pregnancy or breastfeeding, it is prohibited to use arsenic-based devitalizing drugs. Despite small dose drug introduced into the tooth cavity, exclude toxic effects exposure to the fetus or absorption of arsenic into breast milk is prohibited.

When treating a tooth, be sure to notify the dentist about your pregnancy.

IN present moment exists sufficient quantity means that promote pulp death and do not contain arsenic. Their use is safe for both the health of the child and the mother.

Use of the drug in pediatric dentistry

Arsenic-based drugs for pulp necrosis in children are used only in cases where it is not possible to use modern anesthetic drugs (for example, an allergic reaction to anesthetics).

The use of devitalizing pastes in pediatric dentistry is also indicated if the child is afraid of any injections. Then arsenic is a necessary measure to spare the child’s psyche.

But whatever the reasons for applying devital paste, it is worth keeping in mind that arsenic-containing preparations are used only when the roots are formed. If this rule is not followed, there is a high probability of developing periodontitis.

Video: treatment of pulpitis in children

How many days can arsenic be kept in a child’s tooth?

The length of time that a drug containing arsenic can remain in a child is significantly shortened compared to the period for adults.

If the devitalizing paste is applied to the exposed pulp, then a repeat visit to the dentist should be no later than 16 hours after the first treatment.

When using indirect method(arsenic is in the carious cavity, but the pulp chamber is not opened), the period of exposure to the drug increases to 24 hours.

Photo

Arsenic can be in the form of a white or colored mass (for example, blue) - some manufacturers add a special dye so that the doctor can better see the location of the medicine and can completely remove it.

Frequently Asked Questions

Are alcohol and this drug compatible?

It is better not to combine alcohol with medications at all.

Due to the fact that arsenic-containing pastes are complex in composition, alcohol enhances the effects of each substance and negatively affects vital important functions body.

And although the dose of arsenic put into the tooth is insignificant, it is not worth the risk. Moreover, the abstinence time is only a few days.

Why does my tooth hurt?

This situation often happens when arsenic is added, and the tooth hurts.

This happens most often for the following reasons:

Arsenic has a multifaceted effect on the tooth, and in addition to the death of the nerve, it leads to swelling of the tissues, disruption of blood circulation in them, and dilation of blood vessels, both in the tooth and in the periodontium. As a result, a painful reaction may occur.
Most arsenic-based drugs contain an anesthetic, such as lidocaine, but the analgesic effect may be weak due to the body's low sensitivity to this type of painkiller.
Another cause of tooth pain can be an incorrectly selected dose of the drug. With pulpitis, there is already inflammation of the neurovascular bundle, and an insufficient dose of devitalizing paste does not help to reduce inflammation, but, on the contrary, to intensify it.
Prolonged stay of arsenic in the tooth also leads to pain. This is due to toxic effect the drug on the surrounding tissues and the development of inflammation at the apexes of the roots.
Rare, but possible option- intolerance to arsenic and its components.
Sometimes a tooth with arsenic may hurt not at all because of the medicine, but because of an incorrectly placed temporary filling. It puts pressure on the gums, and the body responds to such harsh pressure with pain. Also, a temporary filling placed on arsenic that is too compact can cause significant discomfort in the tooth.

Whatever the cause of tooth pain, you need to see a doctor immediately. Only he can adequately assess the situation and find the real reason such a reaction.

Is it possible to get poisoned by the drug during treatment?

With proper installation of the devitalizing paste and temporary filling, poisoning of the body is impossible.

However, it is extremely important to observe the time frame and not walk with the drug in the tooth for longer than the prescribed time.

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Composition and principle of action of arsenic pastes

The mechanism of action of drugs containing arsenic (Caustitsin, Kaustinerv, Septodont, etc.) is based on the suppression of the vital processes of dental pulp cells - metabolic disorders, blocking the flow of blood, denaturation of proteins, which leads to their death and cessation of the transmission of nerve impulses by neurons. Medicinal substance dosed by manufacturers in the form of small pellets, approximately the size of a pinhead, containing 0.0004–0.0008 g of arsenic.

The composition of devitalizing pastes includes the following ingredients:

arsenic anhydride, which kills the nerve in the tooth, makes up approximately 35% of the total mass;
one of the types of anesthetic drugs that reduces pain sensitivity before death nerve tissue- lidocaine hydrochloride, dicaine or novocaine - about 30%;
substances having antiseptic properties, which relieve inflammation by suppressing the activity of infection that has penetrated into the pulp - thymol, carbolic acid - 5%;
tannin, the astringent ability of which prevents the penetration of the toxic component into the tissue surrounding the tooth and allows you to increase the period of stay of the paste in the dental cavity - 1%;
filler.

Since arsenic is toxic substance, doctors take into account whether there are indications for its use. In some cases, it is impossible to use drugs that contain it. Pastes with arsenic are applied to the tooth if there are the following indications:

if the patient's body is insensitive to anesthetic drugs or reacts to their use with an allergic reaction;
with a time limit that does not allow full treatment tooth when a patient visits a dental clinic;
the health condition of a sick person does not allow the use of an anesthetic, for example, with a significant increase in A/D, serious illness, in a state of intoxication;
if the child's teeth have fully formed roots, but do local anesthesia not possible;
when severe pain at night, when assistance can only be provided by the doctor on duty.

if the body reacts allergic manifestations on the components included in the drug;
children under the age of 1.5 years and with insufficiently formed tooth roots;
in case of significant curvature of the dental canals, blocking of their lumen with denticles (calcareous deposits) and other obstacles that do not allow cleaning and expansion of the canal along the entire length to the apex of the root;
presence of high eye pressure threatening the development of glaucoma;
if there is a through hole in the roots or they are disconnected;
for diseases of the genitourinary system.

How is the treatment carried out?

When a tooth is damaged by pulpitis, treatment is carried out in two stages. During the first visit, an x-ray of the diseased tooth is taken, its cavity is opened and cleaned of damaged tissue. Then an arsenic paste is placed with a cotton swab soaked in an anesthetic. After installing a temporary filling on the tooth, the dentist sets a date for the next visit.

Depending on the condition of the pulp tissue and the drug used, the duration of the paste’s presence in the dental cavity can be 1–7 days. When removing the dental nerve in children, this period is reduced to 16–24 hours.

After installing a temporary filling, you may experience toothache, which usually goes away within 2–3 hours. If pain persists for a long time, you should visit a doctor earlier than scheduled to identify the cause of the pain and eliminate it. At a second visit, the temporary filling, arsenic paste and dental pulp are removed. Since arsenic kills the nerve, the procedure is painless. The doctor thoroughly cleans the tooth root canals, treats them with an antiseptic and installs a permanent filling.

Why does pain occur after installing a filling with arsenic?

The painkillers included in the paste prevent the transmission of impulses by nerve endings, reducing the severity of pain. Then arsenic begins to act and the sensitivity of the nerve is completely eliminated. But in some cases this does not happen.

Increased pain can be caused by a number of reasons:

an insufficient dose of arsenic was used;
high sensitivity threshold to the drug used;
expansion of pulp blood vessels;
the filling adheres too tightly to the arsenic paste;
adding arsenic to the closed pulp;
interaction with medications caused inflammation of the periodontal tissue, symptomatically this can be manifested by an increase in temperature, swelling of the gums, and the appearance of a purulent infiltrate;
the development of a dangerous, rare complication - necrosis of the periosteum or jaw bone;
an allergic reaction to the components of the arsenic paste; if severe swelling of the mucous membrane surrounding the tooth appears, the temporary filling and the preparation with arsenic should be removed.

The purpose of drugs containing arsenic is to cause the death of dental nerve tissue. But for the safety of their use, it is necessary to exclude contact of the paste with the gums and other parts of the oral cavity outside the diseased tooth. When the filling is installed properly, its integrity is not compromised and the toxic substance does not enter the oral mucosa. It is equally important that the dose of the drug does not exceed the maximum permissible values (arsenic is dangerous for human health in amounts of 0.005–0.05 g). One more an important condition the use of arsenic pastes is to strictly observe the residence period of the toxic component in the tooth cavity and complete removal its remains at the end of the validity period.

Overexposure to arsenic can cause the following complications:

tissue necrosis of the periosteum, alveolar bone;
burn of the gums with arsenic acid (treating the gums with iodine helps to prevent it; rinsing with hydrogen peroxide will improve the condition of the burned surface);
darkening of dentin, pulp swelling;
If the drug is not removed in a timely manner, periodontitis often occurs - inflammation of the tissues adjacent to the tooth root;
if there is increased sensitivity of the body, intoxication can adversely affect the condition of the liver and other gastrointestinal organs.

Self-removal of arsenic from a tooth

The dentist must remove the temporary filling and paste, but sometimes situations arise in which the patient has to do it himself. For example, in case of prolonged, incessant pain in a tooth or in case of destruction of a filling, which happens quite often, since less materials are used for its preparation. hard materials. For these purposes, you can use a toothpick, thin tweezers or a needle (be careful that it does not slip out of your hands and injure the gum), disinfecting them with alcohol.

After removing the paste (it is often colored blue, which makes it easier to detect), you should rinse your mouth with a soda solution, adding a few drops of iodine to it. Then you need to insert a piece of cotton wool into the hole in the tooth cavity.

If you accidentally swallowed the paste, do not worry - the dosage of arsenic in the paste is minimal and does not pose a serious danger to the body. To neutralize it, it is enough to drink 250 ml of milk. Do not put off visiting your doctor for too long and further treatment diseased tooth to prevent the development of complications.

Use of arsenic during pregnancy and breastfeeding

During pregnancy and breastfeeding breast milk the use of arsenic pastes is not allowed to eliminate the risk negative influence drug for the development of the baby. Medicine does not yet have accurate information about the effect on the fetus of toxic components of pastes that kill the nerve.

When visiting a dentist, you must inform him that you are expecting a baby or are a nursing mother. In such cases, when treating a tooth, drugs that do not contain arsenic are used.

The danger of intoxication of the body of a woman and child increases due to the fact that there is a possibility of the filling falling out and ingestion with food. In addition, arsenic pastes have a bad effect on dentin, leading to its gradual destruction.

In pediatric dentistry, devitalizing pastes are rarely used. They are used for allergic reactions of the body to other types of medications or when panic fear baby for injections. Before installing arsenic paste, the degree of formation of tooth roots is determined, since their insufficient formation increases the likelihood of periodontitis.

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Why do you need a temporary filling?

Dentists use this type of filling to diagnose teeth (which is why it is also called diagnostic). For example, often the doctor cannot say for sure whether the nerve is damaged. In this case, the dentist places a temporary filling in the tooth. If after a few days the patient does not complain of pain, the filling is replaced with a permanent one. If necessary, dental treatment continues.

It is also often used by doctors to seal medications that are placed in the tooth cavity.

For the treatment of pulpitis

Very often, a temporary filling is placed to treat pulpitis. A typical case is when a special medicinal paste. This drug is used to necrotize the pulp, more precisely the vessels and nerves contained in it.

This manipulation is necessary to ensure that further tooth treatment is painless. The doctor will be sure that there are no remnants of nerves in all canals that could become inflamed. The drugs used to necrotize the pulp are different.

They differ in validity period: from several days to 2 weeks. How long does it take to wear a temporary filling? It is the period for which the doctor prescribes the medicine that determines how long you need to walk with it.

It is very important in such cases to comply with the deadlines, because if you do not remove the medicine on time, it will begin to act like poison. If you have been given a temporary filling, you should definitely check with your doctor about how long you can wear the temporary filling with the medication, otherwise the drug will begin to destroy the periodontal tissues and hard tissues tooth

If the doctor removed the nerve during the first visit, he may put an anti-inflammatory drug into the tooth. Usually you need to walk with this drug for about a week, after which the doctor will fill the canals. But if there is no opportunity to visit a doctor within 7 days, you can walk without harm for 2-3 weeks with such a temporary filling.

For the treatment of periodontitis

Treatment of periodontitis is always carried out in several visits to the dentist, so there is no way to do it without installing temporary fillings. The type of medicine that the doctor will place under the filling depends on the stage of the disease. The doctor may use medication to help stop the inflammation.

You may also need a drug that can restore bone tissue. The doctor will monitor the condition of the tissues and decide when to replace them. There are cases when a dentist places a temporary filling on already filled canals. This happens when a specialist is going to install a pin in a tooth or use it to support removable design. And if the doctor is afraid that the tooth may hurt again. You can walk with such a filling for quite a long time, but be sure to come to the appointment on the appointed day.

Tooth hurts after installation

Very often, after installing the medicine, the tooth under the filling hurts. The drug will not be able to quickly relieve toothache, so you need to be prepared for this. Especially if you come to the doctor with an already advanced version of the disease, the tooth will most likely make itself felt until your next visit to the dentist.

If you have a temporary filling, your tooth will hurt for several days afterward. This is considered the norm. Nerve endings The pulps are still alive, so they react to the action of the medicine, causing pain.

Main reasons

If a tooth begins to hurt at night and when pressing on it, the pulp that has not yet completely dissolved under the influence of the medicine is to blame.
If the pain is constant, you may simply be allergic to the cementitious substance. In this case, it is better to consult a dentist as soon as possible, otherwise there is a risk of unpleasant complications.
A tooth under a filling may still hurt if you do not follow the dentist’s recommendations (rinses, baths, avoiding certain foods, etc.).
If the temporary filling just fell out. It can fly out while eating or while brushing your teeth. This can cause an infection to get into the tooth, which causes pain.

How to relieve pain?

You should try to avoid getting food and drinks on the sore tooth.
It is necessary to regularly rinse your mouth with decoctions of sage, chamomile, or a solution of soda and salt.
It is imperative to examine the gums of the diseased tooth. If redness or swelling appears, you should see a doctor as soon as possible.
You can moisten a cotton swab in the tincture of mata and lemon balm and apply it to the sore tooth. This will help relieve the pain for a while.
You can also take a pain reliever after consulting your doctor.

Video:

Features of temporary filling

A temporary filling allows the dentist to effectively treat many diseases. It perfectly seals the diseased tooth, protecting it from infection, and is easily removed if necessary. Such a filling must be strong enough so as not to break during chewing.

Requirements for temporary filling material:

Tightness and reliable fixation of the medicine and the tooth cavity.
Easy to install and remove.
Fast hardening of the filling mass.
The material should not cause allergic reactions.

Most often, dentists use one-component filling materials:

Aqueous or artificial dentin.
Dentis paste or oil dentin.
Cements.
Polymer materials.

Temporary filling of root canals - filling the root canals with plastic non-hardening paste for a period from several days to several months. Some time after achieving the desired result or after the end of the therapeutic effect, the paste is removed from the canal.

Temporary non-hardening pastes: Pastes based on antibiotics and corticosteroids. Metronidazole-based pastes. Pastes based on antiseptics long acting. Pastes based on calcium hydroxide. Pastes based on antibiotics and corticosteroids. Metronidazole-based pastes. Pastes based on long-acting antiseptics. Pastes based on calcium hydroxide.

Indications for use Treatment acute forms periodontitis and exacerbation of chronic periodontitis When destructive forms chronic periodontitis Treatment of “arsenic” periodontitis In destructive forms of periodontitis, it is recommended to remove the paste from the apex.

Positive: Bacteriostatic effect. Anti-inflammatory effect. Harmless to periapical tissues Negatives: Contains strong antibiotics, therefore not used in pediatric dentistry. The paste has a strong but short-lived effect (applied into the canal for 3-7 days) Properties:

Pastes based on metronidazole Properties: Suppress anaerobic microflora Stops catabolic destruction of tissues Blocks inflammatory phenomena at the biochemical level Absence of allergic reactions and addiction phenomena this drug. Secondary infection of the periodontium by oral microflora is prevented and the prognosis of the disease is improved.

Metronidazole-based pastes are intended for heavily infected tooth root canals (with gangrenous pulpitis, acute and chronic periodontitis). These pastes are intended for active treatment, therefore, the paste in the canal is changed daily until all symptoms of the disease completely disappear.

Properties: Slowly dissolve in the canals Radiopaque Have a disinfectant and deodorizing effect Stimulate protective properties periodontal tissues Do not interfere with the development of the bud permanent tooth Allows you to avoid painful phenomena after tooth filling

Indications for use: 1. Periapical foci of bone tissue destruction. 2. Lysis of the apex of the tooth root. 3. Wet root canals. 4. Internal root resorption. 5. Transverse root fracture. 6. Perforation of the root wall. 7. Endodontic treatment of baby teeth and teeth with immature roots.
Temporary bandage. After the root canals were processed and dried, they were tightly filled with calcium hydroxide. Long lasting effect can only be obtained if the antibacterial dressing is in contact with the walls of the canal. Antibacterial effect. After 3 months clinical symptoms the abscess disappeared. The temporary filling was intact and protected the tooth cavity from re-infection. Root canal filling. The root canals are filled with gutta-percha and sealer using the lateral condensation method. There is a decrease in the size of the periapical rarefaction area.

Endodontic treatment in many cases requires several visits to the doctor, which involves sealing the cavity for a short period of time until the next visit. For this purpose, a variety of materials are widely used for temporary filling. The main requirements that they must meet are the following:

bioinertness;
possibility of retention medicines and normal interaction with them;
ease of filling and removal of material;
tightness of cavity closure;
relative strength that lasts for the required period of time.

Materials for temporary filling of teeth are one- and two-component. The hardening reaction is based on chemical processes, which are provoked by the influence of certain factors: heat and water, light.

Types of materials

Depending on the period of application, the dentist uses temporary fillings and bandages. The latter are applied for a period of 1 day to 2 weeks. For this purpose, dentin paste, water dentin, some types of cement, etc. can be used.

A temporary filling is installed for a period of several weeks to 6 months. This requires the use of cements.

Both types of materials are used to provide a hermetically sealed closure of the tooth area and should not be destroyed due to chewing load.

Materials are divided according to chemical composition and structure:

Aqueous dentin. It is a powder (zinc oxide and sulfate, koalin) and liquid (water). Cement is prepared immediately before filling.
Dentine paste. She has similar composition, but is released in finished form with the addition of additional components.
Cements. They are used in cases where it is necessary to fill teeth with a high chewing load.
Polymer materials. As a rule, they are light-curing one-component pastes, characterized by ease of use, high adhesive properties and elasticity.

Filling materials for temporary filling of root canals are pastes based on:

calcium hydroxide;
antibiotics (metronidazole, etc.);
mixtures of long-acting antiseptics.

Each of them is intended for specific indications. For the most part, materials for temporary filling of root canals allow eliminating or minimizing inflammatory phenomena and stimulating recovery processes and improve the condition of tissues.

Compromise prices are not the only opportunity to save money; the store also offers special promotions and there is a bonus program. Delivery is carried out in short terms, and payment can be made in any convenient way.

Practical lesson No. 2

Subject. Endodontic filling materials. Classification and preparations for temporary filling of root canals – plastic non-hardening materials (sealers).

Target. To study the classification, composition, properties, requirements for endodontic materials and indications for the use of plastic non-hardening sealers.

Method of implementation. Group lesson.

Venue. Training, phantom and treatment rooms.

Security.

Technical equipment: multimedia systems, tool sets, universal dental units.

Teaching aids: multimedia presentations, videos, stands, endodontic filling materials, phantoms of the head and jaws. Means of control: control questions and tasks, questions for testing knowledge control, homework.

Lesson plan

Checking progress homework. Input test control. Theoretical part. Classification of endodontic filling materials. Requirements for these materials. Preparations for temporary filling of root canals – plastic non-hardening materials (sealers). Properties, indications for use. Interview for control questions and control tasks, solving situational problems. Clinical part. Demonstration by the teacher of the method and technique of filling the root canals of teeth in a patient with chronic apical periodontitis with a plastic non-hardening sealer “Biodent”. Laboratory part. Demonstration by an assistant of the technique of mixing and filling root canals with the plastic non-hardening material “Biodent” on a phantom. Independent work of students. Students master the technique of mixing plastic non-hardening materials. Analysis of the results independent work students. Test control knowledge. Assignment for the next lesson.

Annotation

An important stage in the treatment of complicated caries is root canal filling. How correctly the endodontic filling material is chosen in a particular clinical situation and how well and completely the filling is carried out depends on the reliability and long-term results treatment. In this regard, certain requirements are imposed on materials for filling root canals.

Endodontic materials must be:

Non-toxic to the body; devoid of carcinogenic and mutagenic properties; easy to insert into the root canal; be flexible to ensure filling of the channel throughout its entire length; do not decrease in volume during hardening; do not dissolve into root canal, dissolve when removed beyond the apical foramen; be impermeable to root fluid; do not irritate periodontal tissue; promote the regeneration of pathologically altered periapical tissues; possess and maintain anti-inflammatory properties long time; do not stain tooth tissue; be radiopaque; if necessary, it is easy to remove from the root canal; have a slow hardening; do not disturb the adhesion, marginal seal and hardening process of permanent filling materials.

According to modern classification, endodontic filling materials are divided into the following groups. (, 2001)

1. Plastic:

1.1. Plastic non-hardening materials (for temporary filling)

a) antiseptic pastes in which zinc oxide is used as a filler, white clay or water dentin, which are mixed on or aromatic oils;

b) “Biodent” – eugenol + medicinal component – immunocorrector (to stimulate regeneration processes in the periodontium);

c) Septomixin Forte paste – antifungal and antiseptic effect;

d) “Grinazol” paste – based on metronidazole.

1.2. Plastic hardening. and depending on the composition (1984) the following groups are distinguished:

a) pastes based on zinc oxide and eugenol: zinc oxide + eugenol, eugedent, furatsilin immobilized on polysorb, and hydroxyapatite (Russia), endomethasone, merpozan, propylor (France), endoflas (Colombia), Eston;

b) zinc oxide eugenol cements: Cariosan, Kalzinol (England), Endosolv (France), Endobtur (“Septodont”);

c) pastes based on resorcinol-formalin resin: resorcinol-formalin paste (Germany, Russia), forfenan, bioplast, preparation “Z” (France), foredent, cresopasta (“Septodont”);

d) zinc phosphate and polycarboxylate cements: phosphate cement (Russia), adhesor, argyr, hydrophosphate cement (Japan, USA);

e) pastes based on epoxy resins: intradont (Russia), AH-26, AH plus (England), epoxycal (Bulgaria), Thermaseal;

f) pastes with calcium hydroxide: biocalex (France), paste containing calcium and phosphorus ions immobilized on polysorb (Russia), Sealapex (Kerr), Apexit (Vivadent);

g) others: bakelite paste, etoniya paste (Russia), diaket, palavit (Russia);

h) glass ionomer cements: “Ketak-Endo” (Espe), “Endo-Jen” (Jen dental), “Endion” (Voco);

i) pastes with tricalcium phosphate and iodoform.

2. Primary hard (pins):

a) paper;

b) plastic;

c) gutta-percha;

d) silver.

There is another classification of materials for obturation of the lumen of root canals.

1. Sealers (endo-sealers - from the English “to seal” - to seal, seal) - clogging, sealing substances. These include plastic hardening materials or endosealants.

2. Fillers (from the English “to fill” - to fill, to fill) - solid fillers that fill the lumen of the canal.

Temporary filling of canals with medicinal non-hardening pastes is an effective and convenient technique that allows for more effective treatment of forms of periodontitis, cystogranulomas, radicular cysts and medicinal periodontitis.

Temporary obturation of the root canals of teeth is filling them with a plastic, non-hardening material that has certain healing properties, for a period of time from several days to several months, followed by replacement with a permanent obturation material. For obturation, it is advisable to use paste-like materials that fill the canal well and ensure that the concentration of the drug substance is maintained at a sufficient level throughout the obturation.

The main purposes of temporary filling are:

1) antiseptic and cleansing effect on the system of root canals and dentinal tubules;

2) anti-inflammatory effect on the focus of inflammation in the periodontium;

3) stimulation of the regenerative activity of periodontal tissues and the surrounding bone of the alveolar process;

4) channel isolation if it is impossible to complete processing in one visit.

The disadvantage of all plastic non-hardening materials is their permeability to tissue fluid and gradual resorption in the root canal. It should be borne in mind that drugs introduced into pastes are quickly inactivated, and some of them can cause reactions. IN lately soft antiseptic pastes are used more often for filling baby teeth, in which the resorption of the root and filling material should proceed in parallel.

The first group of plastic non-hardening materials consists of antiseptic pastes, in which zinc oxide, white clay or aqueous dentin are used as a filler, which are mixed with petroleum jelly or aromatic oils (clove, peach, sea buckthorn, camphor, castor, eucalyptus, rosehip oil, carotoline).

To give the pastes antiseptic and anti-inflammatory properties, various biologically active additives are introduced into them: thymol, formalin, sulfonamides, iodoform, enzymes, glucocorticoid drugs, agents that stimulate bone tissue regeneration and others.

Non-hardening pastes are prepared, as a rule, immediately before filling. Choice and ratio individual components for preparing the paste is determined in each specific case by the attending physician. The pastes are mixed on the rough surface of a glass plate. WITH right side(for ease of mixing) add zinc oxide, on the left - a few drops of the selected oil base. Mixing is done with a metal spatula, gradually adding powder to the liquid until it reaches the consistency of a paste.

The paste is injected into the canal manually (using a root needle) or machine (canal filler). It is left under a temporary filling for some time, followed by filling with plastic hardening pastes.

The next type of non-hardening paste is “Biodent”, which is available ready-made in tubes. This is a plastic, non-hardening paste containing eugenol and a special therapeutic component - an immunocorrector, which stimulates regeneration processes in the periodontium and restores impaired reactivity.

The material is produced in tubes equipped with a special tip, which ensures the required dosing of the paste. After taking the required portion, the tube with the tip must be tightly closed to prevent the material from drying out.

The canal is processed and dried according to generally accepted methods. Filling is done with a root needle or canal filler. In order to reduce the adhesion of the material to the tool, it is recommended to pre-treat the tool ethyl alcohol. If it is necessary to make the consistency of the paste thicker, the use of cement powders “Uniface” and “Dioxyvisfat” is allowed. After filling the canal, excess paste is removed with a swab with alcohol.

"Biodent" is intended for filling the root canals of teeth of adults and children in the treatment of all forms of complicated caries, including filling the root canals of teeth with an unformed apical foramen.

The next representative of non-hardening materials is Septomixin Forte paste. It is produced by Septodont and is a non-hardening, absorbable antibacterial paste wide range actions. The composition includes two antibiotics with antibacterial and antifungal effect. Another component of the paste is the corticosteroid dexamethasone, which in the dosage used reduces inflammatory and allergic phenomena without affecting defensive reactions body. Important property"Septomyxin Forte" is that it is absolutely harmless to periapical tissues, and the body is able to respond quickly and effectively to therapeutic effect drug. Septomixin Forte also contains a radiopaque filler.

"Septomixin Forte" is used in the treatment of granulating and granulomatous periodontitis, "arsenic" periodontitis. In this case, the canal, carefully processed mechanically and medicinally, is filled with “Septomyxin” using a canal filler. For destructive forms of periodontitis, it is recommended to remove the paste beyond the apex. The tooth is covered with an airtight bandage.

During repeated visits at intervals of two to ten days, the paste is removed from the canals and replaced with a new portion of Septomixin. With positive dynamics pathological process(disappearance of pain and inflammation, cessation of exudation) the canal is cleaned and sealed with hardening material.

The drug "Grinazol" from Septodont is a paste containing 10% metronidazole. Metronidazole actively suppresses the anaerobic microflora of root canals, blocking inflammatory phenomena at the level.

The method of using “Grinazol” has some features. Firstly, "Grinazol", providing a strong bactericidal effect on the microflora of the canals, allows you to postpone full instrumental treatment of the canal until subsequent visits, when acute inflammatory phenomena subside and this procedure becomes less painful for the patient.

Secondly, “Grinazol” allows even acute and aggravated chronic periodontitis treat with a hermetically sealed tooth cavity, i.e. do not “leave the tooth open.” This prevents secondary infection of the periodontal microflora of the dental cavity and improves the prognosis of the disease.

Thirdly, “Grinazol” is intended for active treatment; the paste in the canal should be changed daily until all symptoms of the disease completely disappear (pain on percussion, suppuration from the canal, upon palpation along the transitional fold in the area of the projection of the root apex, etc.)

Fourthly, “Grinazol”, by changing the environment in the canal and periodontal tissues, allows one to avoid painful phenomena after filling a tooth (“reaction to filling”).

Fifthly, in some cases (the presence common symptoms inflammation, severe general condition of the patient), along with local application"Grinazol" shown general treatment antibiotics.

Security questions

Classification of endodontic filling materials. Requirements for materials for filling root canals. Preparations for temporary filling of root canals – plastic non-hardening materials (sealers). Properties, indications for use. Composition, properties, indications for use, preparation method for Biodent. "Septomixin - forte." Composition, properties, preparation method. Composition, properties, indications for use, preparation method for “Grinazol”.

Situational tasks

The root canal of the tooth was filled with plastic non-hardening paste "Biodent", permanent filling. Are the doctor's actions correct? To prepare the Biodent paste, the doctor opened the tube with the material, placed it on a glass plate and added Silidont cement powder. What's wrong? The Septomixin Forte paste contains two antibiotics with antibacterial and antifungal effects. The third component of the paste is the corticosteroid drug hydrocortisone. Is this true? Plastic non-hardening paste "Grinazol" from Septodont is a preparation containing 25% metronidazole. Is the composition correct? To prepare a plastic, non-hardening paste, the doctor mixed clove oil and zinc oxide. Are the doctor's actions correct?

Test knowledge control

For permanent filling of root canals in adults, the following pastes are used:

a) hardening;

b) non-hardening.

2. Representatives of sealers:

a) Vinoxol;

b) gutta-percha pins;

c) artificial dentin;

d) silver pins;

d) "Grinazol";

e) titanium pins;

g) "Biodent".

3. Choose plastic non-hardening materials:

a) “Silidont”;

b) “Biodent”;

c) "Grinazol";

d) “Septomixin - forte”;

e) glass ionomer cement.

4. Biodent includes:

a) eugenol;

b) resorcinol;

c) immunocorrector;

d) calcium hydroxide.

5. The composition of "Septomixin - Forte" includes:

a) antibiotic;

b) resorcinol-formalin resin;

c) hydrocortisone;

d) zinc oxide.

Homework:

a) write a classification of endodontic filling materials.

b) list the basic requirements for root fillings;

c) list plastic non-hardening sealers and their properties.

Literature

Main

Popkov materials science: Tutorial. / , // M.: MEDpress-inform, 2009. Methodological developments departments.

Additional

Tsepov therapeutic dentistry. – St. Petersburg: St. Petersburg Institute of Dentistry, 2001. – P. 291-305. Propaedeutic dentistry: A textbook for medical universities/ ed. . – M.: GEOTAR-Media, 20008. – P. 95-99, 216-224. , Bidenko endodontics: tools, materials and methods. – M.: “Book Plus”, 1999. – P. 87-108.