Treatment of pulpitis in permanent teeth with incomplete root formation

Pulpitis is an inflammation of the internal structure of the tooth - the neurovascular bundle. In the vast majority of cases, this disease is caused by caries - many parents believe that it is not necessary to treat it, because baby teeth must be replaced quickly. However, this statement is incorrect, since caries, which is not addressed in time, causes tooth destruction and inflammation of the pulp.

Primary molars, especially the lower ones, are more susceptible to this. This is due to the relatively thinner enamel - the infectious process reaches the internal structures of the tooth faster. For the same reason, pulpitis in children develops much faster than in adults.

Among the causes of the disease are also injuries, including those associated with improper treatment of enamel caries, when the doctor accidentally exposes the pulp during tooth preparation.

Symptoms of pulpitis in children

Symptoms and treatment of pulpitis in children vary depending on the form and severity of the disease. Pulpitis has two forms - acute and chronic. The first is relatively less common, but the symptoms in this case are more pronounced. There are two stages of the inflammatory process:

1. Serous. The pulp becomes inflamed, and the tooth canals are filled with serous fluid. The child experiences severe pain in the tooth, which intensifies at night or with exertion—chewing on the side of the causative tooth. Often there is only one episode of pain. Within a few hours, the inflammation moves into the next stage.
2. Purulent. Purulent contents begin to form in the root canals of the tooth. The severity of this stage depends on several parameters: the state of the child’s immune system, the activity of microorganisms, the state of the root system of the tooth, and the age of the young patient. The pain can be tolerable if the child’s immunity functions normally, microorganisms multiply slowly, and pus escapes through the carious cavity of the tooth. However, more often there is quite pronounced pain, prolonged attacks, and the unpleasant sensations radiate to other teeth. They intensify with mechanical, temperature effects on the causative tooth; the child’s appetite worsens or he refuses food altogether. In rare cases, there is an increase in body temperature and enlarged lymph nodes.

It is worth noting that chronic pulpitis can be asymptomatic, and there are often cases of the development of an inflammatory process in a previously filled tooth. The fact is that it can be quite difficult to properly treat the carious cavity of a child’s tooth before filling it - this is due to the emotional state of the patient and the forced haste of the dentist. This leads to the fact that the filling is installed in a cavity that is not sterile or is not sufficiently dried from saliva - pathogenic microorganisms continue to multiply, penetrating deep into the tooth and causing pulpitis.

With chronic pulpitis, pain can only occur when food debris gets into the carious cavity. The gangrenous form of the disease is characterized by the appearance of pain some time after eating hot food, a feeling of fullness and heaviness in the tooth, and bad breath.

Causes of pulp inflammation

The main cause of pulpitis is the penetration of infection into the pulp cavity, in which a bundle of blood vessels and nerves is located.

The causative agents of the disease can be both pathogenic (Staphylococcus aureus) and conditionally pathogenic (lactobacillus) microorganisms. They can penetrate into the tooth in several ways:

• through the dentinal tubules in case of poor oral hygiene, accumulation of bacterial plaque and stone in the gum pockets;
• through cracks in the enamel caused by tooth trauma;
• through cracks due to a fracture of the dental crown;
• through the apical opening of the root canal against the background of periodontitis, osteitis and other chronic inflammatory processes of the oral cavity.
• Inflammation can also occur after treatment of deep caries

When should you visit a dentist?

The sensitivity of the neurovascular bundle of a tooth in a child is lower than in an adult, so the symptoms of its inflammation may be erased or absent altogether. It is important to contact a pediatric dentist when the first symptoms of caries appear - a dark spot on the tooth, or the child complains of pain. You should hurry up with your visit if:

• severe pain;
• increased pain when eating hot or cold food/drinks;
• bad breath;
• elevated body temperature;
• inflammation of the gums around the tooth;
• darkening of the enamel.

Possible consequences

If pulpitis is advanced and nerve removal is already required, then after 3-4 months the pathological process will make itself felt by darkening of the teeth. In addition, they will become brittle and dull. If the enamel has acquired a bluish tint, the dentist may have made a mistake when filling. This happens if there were traces of blood in the canal at that moment.

It is worth remembering that it is impossible in principle to cure pulpitis using traditional methods. Moreover, there is no single medicine that a doctor can prescribe to a patient for this diagnosis. Each case is individual, so treatment methods are selected taking into account the characteristics of the clinical picture: the degree of tooth damage, the presence of caries, purulent contents, diseases of the oral cavity, etc. Therefore, if signs of this disease occur, be sure to consult a doctor.

Pulpitis of a baby tooth: is it necessary to treat?

Treatment of pulpitis in children should be carried out in any case and as soon as possible. It is unacceptable to wait for a baby tooth to fall out, stopping only the symptoms. Failure to provide assistance to a child can result in serious complications - periostitis (in common parlance - gumboil), periodontitis - inflammation of the periodontal tissues. In addition, the infectious process in the neurovascular bundle of a baby tooth can spread to a permanent tooth when it erupts.

If a long time must pass before the eruption of a permanent tooth, premature destruction of a baby tooth due to pulpitis can lead to malocclusion - displacement of healthy teeth in a row, change in their position, which will require complex orthodontic treatment in the future.

If a baby tooth with pulpitis is soon to be replaced by a permanent one, the doctor may resort to extraction. In any case, this disease should not be ignored.

Treatment methods for pulpitis

The tactics of a pediatric dentist depend on the condition of the child’s tooth and dental system, the severity of his condition, and whether there are concomitant diseases of the oral cavity. If the pulpitis is very severe and there is a risk of a threat to its health, the tooth must be removed. However, in the vast majority of cases, it is possible to keep the tooth permanent until its natural replacement, since removal can lead to disruption of the bite or the position of the remaining healthy teeth in the row.

Traditional treatment of dental pulpitis in a child consists of devital amputation of the pulp and is carried out in several visits. The stages of treatment of pulpitis in children are presented as follows:

1. The doctor opens the tooth cavity, removes carious tissue, and applies a paste to devitalize the pulp. It is designed to “kill” the neurovascular bundle and eliminate pain. If the paste contains arsenic, it is used for a period of 1-2 days; if an arsenic-free product is used, it is used for at least 7 days.v
2. The second visit involves placing a special mixture into the canals for tissue mummification - a resorcinol-formalin mixture is used.
3. The third visit is to fill the diseased tooth.

This method is practiced much less frequently today, since there is a possibility that the infectious process will persist in unsealed tooth canals - mummification of the pulp involves its “drying out” and the formation of voids in which pathogenic bacteria continue to multiply.

The modern approach to the treatment of pulpitis of primary teeth in children is extirpation - complete removal of the inflamed pulp. This can be done with or without prior killing or devitalization of the pulp. In many cases, devitalization is more preferable, since it relieves the child of any unpleasant sensations during the removal of the neurovascular bundle.

After the tooth canals are freed from pulp and carefully processed, the doctor fills them with an anti-inflammatory paste - it tends to dissolve along with the roots during the natural change of teeth to permanent ones. For this purpose, zinc eugenol paste is often used. This method of treatment is comparatively more effective, and if the canals are treated with the utmost care, the infection will not reactivate. Other modern methods of treating pulpitis in children include vital amputation. It consists of preserving the viability of part of the pulp - the upper part of the nerve is removed under local anesthesia, and a medicine with an antibacterial and anti-inflammatory effect is applied to the remaining root pulp. The drug closes the lower part of the neurovascular bundle without affecting its viability, and the tooth is subsequently filled.

Clinical researches

ASEPTA products have clinically proven effectiveness.

• Repeated clinical studies have proven that using ASEPTA propolis gum gel for a week can reduce gum inflammation by 31%.
• Repeated clinical studies of the ASEPTA ACTIVE mouth rinse have proven that this two-component product effectively combats the causes of inflammation and bleeding in the mouth - it reduces inflammation by 41% and reduces bleeding gums by 43%.
• It has been clinically proven that regular use of ASEPTA SENSITIVE toothpaste for a month can reduce bleeding gums by 62%, reduce tooth and gum sensitivity by 48% and reduce inflammation by 66%.

According to the results of clinical use of the Asepta series of products: in the majority of patients examined, the level of hygiene according to Green-Vermillion was satisfactory.

Already at the first follow-up examination (1-2 days) after using the Asepta line products, a decrease in complaints of discomfort is noted. On the 7th day, complaints of gum bleeding persisted in a small proportion of patients, but upon examination, all of them noted a decrease in hyperemia and swelling of the gums, but persistence of bleeding upon probing. On day 14, 2 patients continued to complain of bleeding gums when brushing their teeth; upon examination, a significant decrease in hyperemia and swelling of the gums was noted.

Improved dynamics of indicators allows us to recommend the Asepta line of products for the local treatment of inflammatory periodontal diseases.

Sources:

1. The effectiveness of the use of Asept “adhesive balm” and Asept “gel with propolis” in the treatment of chronic generalized periodontitis and gingivitis in the acute stage (Municipal Dental Clinic No. 4, Bryansk, Kaminskaya T. M. Head of the therapeutic department Kaminskaya Tatyana Mikhailovna MUZ City Dental Clinic No. 4, Bryansk
2. The role of anti-inflammatory rinse in the treatment of periodontal diseases (L.Yu. Orekhova, A.A. Leontyev, S.B. Ulitovsky) L.Yu. OREKHOVA, Doctor of Medical Sciences, Prof., Head of Department; A.A. LEONTIEV, dentist; S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I. P. Pavlova
3. Clinical studies of antisensitive toothpaste “Asepta Sensitive” (A.A. Leontyev, O.V. Kalinina, S.B. Ulitovsky) A.A. LEONTIEV, dentist O.V. KALININA, dentist S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry, St. Petersburg State Medical University named after. acad. I.P. Pavlova
4. Clinical experience in using the Asepta series of products Fuchs Elena Ivanovna Assistant of the Department of Therapeutic and Pediatric Dentistry State Budgetary Educational Institution of Higher Professional Education Ryazan State Medical University named after Academician I.P. Pavlova of the Ministry of Health and Social Development of the Russian Federation (GBOU VPO RyazSMU Ministry of Health and Social Development of Russia)

Treatment of pulpitis of teeth with unformed roots

The root system of a baby tooth is formed over a long period of time after eruption, so there are often situations when caries begins to form on a tooth whose roots have not yet closed the apex. This leads to some treatment difficulties:

• short roots and wide channels;
• the upper part of the root is the “growth” zone, injury to which is an obstacle to root formation;
• the likelihood of infection of the permanent tooth germ;

Treatment of pulpitis of teeth with immature roots in children requires special care. The doctor must carefully monitor that the filling material is not carried beyond the expansion of the root apex. It is worth noting that complete removal of the pulp and treatment of the canals is impossible - the optimal solution here is vital and devital extirpation. Pulp amputation may also be used. The biological method, which consists in preserving a viable pulp and relieving inflammation, is also practiced quite often. Its essence is to prepare the tooth, apply a medicinal paste with calcium hydroxide, after which the tooth is filled with temporary material. A few days later, if there are no complications and the unpleasant symptoms disappear, the doctor installs a permanent filling.

How to prepare a child for treatment?

Treatment of pulpitis of primary teeth in children is a rather complex task, so it’s great if the child is already familiar with the dentist’s chair. The first visit should be preventative - to familiarize yourself with the office environment, the doctor, and the instruments.

Also, the task of parents is to psychologically prepare the child. Required:

• talk to your child about doctors in a positive way - tell them that the dentist treats teeth and makes sure they don’t hurt;
• play dentist with toys and other family members;
• avoid mentioning pain or unclear, scary terms;
• do not deceive the child - explain that dental treatment may not be very pleasant, but it will not last long and the tooth will no longer hurt;
• remain calm, act gently but confidently if the child resists treatment;
• choose a suitable time for visiting - it is better in the morning, when the baby is alert and active;
• take a toy with you to calm the child;
• give the doctor the opportunity to establish contact with the small patient - do not rush him;
• Do not scare the child under any circumstances, do not threaten, do not blackmail.

If the situation cannot be controlled completely, you will have to reschedule the appointment for another day. However, the disease should not be ignored - treatment of pulpitis of baby teeth in children must be carried out one way or another. In special cases, treatment under general anesthesia may be considered, but this should be discussed with your doctor.

Possible complications of treatment of pulpitis in children

Child anxiety is the main difficulty faced by pediatric dentists. Due to the emotional state of the patient, the specialist has to rush or fails to perform the manipulation carefully, which may result in the following complications:

• the paste is not applied to the nerve - this leads to the fact that the pain does not subside, and the procedure must be repeated again;
• burn of the gums by the paste due to its close location to the tooth;
• bleeding when processing unformed roots;
• perforation of the root of a baby tooth;
• breakage of instruments in the root canal.

You can avoid possible complications or minimize the likelihood of problems arising by normalizing the child’s psychological state and contacting an experienced, qualified doctor.

First visit:

• The doctor performs anesthesia. Thanks to painkillers, all manipulations performed by the dentist will be comfortable for the patient. Mandibular anesthesia is sometimes required for mandibular molars.
• Carious and partially healthy dental tissues are drilled out. The latter are used to open the mouth of the root canal and provide access to them for working with instruments.
• A rubber dam is placed to protect the canals from saliva, which may contain pathological microflora.
• A pulp extractor (a very thin barbed needle) is used to remove the nerve.
• A special devitalizing paste without arsenic is applied to the treatment site (it is not used in modern products due to toxicity).
• The doctor determines the length of the root canal using radiography with an apex locator. In cases where there are several canals, a K-file is inserted into them one by one, which, when penetrating deeper, indicates that the instrument has reached the apex of the tooth root. This is done with each channel separately, since their depth is not the same.
• The canals are widened for subsequent filling. At the same time, washing with antiseptic agents is carried out constantly.
• Placement of turundas into the canals and installation of a temporary filling.

Prevention of pulpitis in children

Treatment of pulpitis in permanent teeth in children, as well as their “predecessors” - baby teeth - is a rather complex procedure that may require several visits to the doctor. Preventing a disease is easier than treating it - all you need to do is pay attention to hygiene procedures and teach your child how to brush their teeth correctly from a very early age.

It is also important to monitor the child’s diet - strengthen the enamel with solid foods (carrots, apples, etc.), provide a balanced diet to saturate bone tissue with minerals. It is better to limit sweets and give only water at night. Prevention of caries is the basis for preventing its complications, including pulpitis.

Second visit:

• The doctor removes the temporary filling.
• The canal is washed with antiseptics and then dried.
• The canal is sealed. To do this, the dentist uses a gutta-percha point and paste. The pin is used to compact the filling compound.
• Finally, you need to take an x-ray to make sure that all actions were performed correctly and that the filling is tight to the top of the canal.
• A temporary filling is placed again. After this, painful sensations may persist for some time. To eliminate them, it is allowed to take ibuprofen, ketanov, nimesil and other drugs that the dentist should recommend.