Pediatric dentistry

Pulpitis in children – treatment

Pulpitis in children - treatment

Pulpitis is an inflammatory disease of the tissues inside the tooth (pulp). It develops as a consequence of untreated dental caries (or errors during his treatment), or as a separate process, for example, after trauma to the tooth. Inflammation can be acute or chronic. In this article we will discuss pulpitis in primary teeth: causes, types, treatment.

Often develops pulpitis baby tooth as a result of the following factors:

— the action of toxins secreted by germs in cavities, their metabolic products and the decaying tissues of the tooth;

— tooth trauma (this includes careless rough machining of the cavity in the tooth decay, accidental opening of the nerve by a physician);

— an acute infectious disease of the child with the presence of bacteremia and low immunity;

— toxic effect of incorrectly selected filling material in the treatment of caries, treatment of oral strong irritating antiseptics (alcohol);

— overheating the tooth during preparation of carious cavity (in the absence of water cooling of such a procedure);

Incidence of pulpitis

Dairy in front teeth pulpitis develops most often in 2-year age, and in the molars (large teeth)- children from 3 to 7 years. Inflammation of the pulp in the milk-molars occurs 5 times more often than front teeth. The lower teeth are affected faster.

Classification of pulpitis

Acute pulpitis: serous, purulent, with involvement of the periodontal (surrounding tissues), and lymph nodes

Chronic pulpitis: fibrous, gangrenous, hypertrophic

Exacerbation of chronic pulpitis.

Symptoms of pulpitis

Inflammation tissue tooth developing faster and often “slips” classic stages of this process compared with the pulpitis of permanent teeth. Picture of pulp inflammation in children has some peculiarities:

– inflammation of the pulp develops in teeth with small carious cavity

– the process is distributed very quickly

– acute process through a small period of time becomes chronic, so children are more common chronic or exacerbation of the symptoms of pulpitis are highly dependent on the stage of formation of the tooth

– frequent inflammation of tissues surrounding the tooth

-General reaction (fever, drowsiness, headache, leukocytosis and increased erythrocyte sedimentation rate in blood)

Acute pulpitis of temporary teeth

This form is found only in teeth with fully formed prior to its root “resorption” (physiological resorption). Acute inflammation is an active response of tissues inside the tooth to stimuli which is capable of a healthy and strong body. Most often, the process develops at the age of 3-6 years. It should be noted that the final formation of deciduous teeth ends only after 1.5 to 2 years after their eruption (single rooted) and 2.5—3 years (for multirooted teeth). The main symptoms of acute inflammation:

the sudden emergence of a strong toothache, often in the evening or at night

– pain is worse from cold or warm (if in the tissue filled with pus, the pain becomes stronger from hot and cold calms down)

– pain during the clenching of the jaws, getting food on the tooth

– there may be mild soft tissue swelling and swollen lymph nodes

Acute pulpitis occurs in the tooth with a small carious cavity or in its absence. If the cavity is deep or the tooth is badly damaged, this is considered pulpitis exacerbation of chronic. With the development of acute purulent inflammation the pain is so strong that the child can not precisely specify a sick tooth, and sometimes the side of the jaw. To clarify you can watch the kid — he will go to the “sick” side.

Chronic pulpitis

Chronic pulpitisOften develops as an asymptomatic process. As often occurs in deep cavities, and tooth with a filling. In 40-60% of cases there is a hidden inflammatory reaction from the tissues surrounding the tooth, so it is recommended to Refine the treatment plan to make an x-ray. The pain at this form of pulpitis appears during the stimulus — getting food in a cavity, from cold drinks on the street. Of all the chronic form is most common fibrous pulpitis. Symptoms:

– pain during the meal, the children tried not to eat at the “sick” side (when viewed on that side will be more plaque)

– sometimes there is pain from the cold water, when you hit it on the tooth

In chronic gangrenous pulpitis pain is not always the case. Often tooth change in color (grey, dark) and different from others. The symptoms of gangrenous pulpitis:

– the pain is absent or occurs from hot

– the pain appears immediately, but after some time after the stimulus except

– pain may be a feeling of heaviness in the tooth, a feeling of fullness, tooth “not like”

– is an unpleasant smell from a tooth

It is noted that children in 62% of cases of chronic gangrenous pulpitis baby tooth ends periodontitis (inflammation of tissues around the tooth).

Chronic hypertrophic pulpitis is rare and is manifested in the form of overgrowth of pulp tissue in carious cavity, when opened the bare fabric is exposed to constant mechanical irritation, and the crown of the tooth is badly damaged.

Exacerbation of chronic pulpitis clinically similar to acute inflammation (sudden severe pain in the tooth that strengthens even from irritants, swelling, General body reaction). The differences boil down to basic:

– damaged tooth or a deep cavity in it

– pain in the past of varying intensity

Treatment of pulpitis of deciduous teeth

Treatment of pulpitis of deciduous teethTimely treatment of pulpitis allows in most cases to save the tooth. The principle of treatment is the inflammation of the tissue inside the tooth is removed. The complexity of the treatment is that the doctor to remove only the portion of the pulp, which is in the crown. The root part can only be deleted completely formed roots, but this is rarely done because of the risk to injure pubrelease fabric and the beginnings of permanent teeth.

If the child allows you to make injectable anesthesia, the doctor at the same visit removes carious lesions and tooth crown pulp, leaves at the bottom of the cavity and the mouths of the channels special pill, which disinfects the remaining tissue, causing the mummification. It prevents development of complications. Depending on drugs such medicinal “gasket” replace with time, or the leave under permanent seal. Some doctors still use the overlay technique of arsenic or its analogues to first “kill” the nerve and then clean out the cavity a few days later. If such tactics need to strictly adhere to the duration of medication, and its quantity, otherwise follow the toxic inflammation of the deeper tissues with the development of periodontitis. Then save the tooth would be difficult. About this doctor must warn parents.

Pulpitis of deciduous teeth is not an indication for their removal. But to treat this disease you need time. Incorrect treatment or in the absence of a tooth can be easy to lose, and in the worst case to cause failure of the permanent tooth germ. Therefore, the most correct and proper decision — time to take care of teeth, caries treatment and to monitor the state of hygiene of the child, to monitor the presence of seals in the already treated teeth, and regular checkups at the dentist.

Reviewed by the QSota Medical Advisory Board