Pulpitis is an inflammation of the dental pulp (pulp), the so-called nerve chamber of the tooth. The pulp is surrounded by dentin, which in turn is protected by the outer enamel. Because there is a tooth nerve in the pulp, inflammation can cause noticeable pressure and sometimes severe toothache. If pulpitis is treated in a timely manner, it often heals without any problems. Untreated, however, the inflammation can spread and effect as well as the root canals. Then usually only a root canal treatment or the removal of the diseased tooth remains.
How Does A Pulpitis Develop?
Infectious pulpitis is triggered by bacteria, which burden the pulp with their metabolic products and trigger an inflammatory reaction. If infectious pulpitis is not treated by a dentist, it may spread to the entire periodontium and cause periodontal disease. Conversely, untreated periodontitis can infect the pulp of a healthy tooth.
In the case of mechanical damage due to fractures along the tooth surface, pulpitis can be triggered mechanically. Due to the crack, bacteria can penetrate into the tooth interior and trigger the inflammation. Also, the strong force on the tooth, such as a blow, can subsequently damage the blood vessels that supply the tooth nerve, resulting in the death of the pulp.
Dental treatment may also result in pulpitis: grinding the tooth surface (in preparation for a conservative filling therapy) or inserting dentures may, under certain circumstances, cause a mechanical irritation that stresses the dental nerve and leads to pulpitis. Likewise, adhesives or acids, as well as certain filling materials, can trigger inflammation of the dental pulp.
What Symptoms Are Typical For Pulpitis?
A typical warning symptom is severe to very severe pain in the area of the affected tooth root. This pain is mainly due to the fact that a pressure builds up in the nerve canal, which acts on the tooth nerve and the surrounding tissue. In inflammatory processes, the surrounding tissue is perfused more strongly in response to the immune system, and this leads to a pressure build-up in the tissue. Because the pulp is not surrounded by soft tissue, this pressure cannot be dissipated but acts directly on the tooth nerve, which response to pain attacks.
The pain is particularly intense when eating or drinking hot or cold food and drinks perceived. An additional stimulus acts on the sensitive tooth nerve so that the affected person literally loses their appetite because they can no longer chew or drink without pain.
In severe cases of pulpitis, the tooth seems to throb. The level of pain thus swells and wanes and spreads increasingly to the surrounding tissue and to the adjacent teeth. If the affected tooth is still not treated by a dentist, a visible abscess forms in the further course, which can also be seen from the outside as a distinct swelling. This is not only particularly painful but also carries the risk that the tooth infection on the adjacent teeth or the entire jaw overlaps. In the final consequence, this can result in the loss of several and also healthy teeth.
Due to the inflammatory processes in the jaw, pus is increasingly formed, which in turn can trigger new infections. In addition, the entire organism and the immune system are increasingly burdened. This manifests itself in a deteriorating overall constitution – and in unpleasant, foul-mouthed bad breath.
However, all the symptoms described in acute pulpitis usually occur within a few days and quickly reach an unbearable level of pain. Therefore, an appointment with the dentist should be agreed at the latest in the case of prolonged, intense toothache in order to clarify and treat the exact pain causes.
How Is A Pulpitis Treated By The Dentist?
How exactly pulpitis is treated depends on how far the disease has progressed and what other effects it has. At an early stage, a simple restorative therapy may be enough to keep the tooth healthy and cure the inflammation. The filling therapy is always indicated when the damage to the pulp occurs only in the upper part of the tooth and the therapy was started early. The filling can be made with biocompatible plastic or amalgam. However, even under optimal conditions, there is no guarantee that the filling will actually heal the pulpitis.
In a more advanced inflammation or more severe damage to the enamel and dentin by caries, a filling therapy is not enough; rather, a root canal treatment must be undertaken. This will open the affected tooth and the dentist will manually remove the inflamed pulp and the tooth nerve. Then he cleans the root canals and introduces a final root filling, which prevents the penetration of new germs into the root canal.
If left untreated, progressive pulpitis may progress to periodontitis affecting the entire periodontium, including the gum and jawbone. If this is the case, the tooth can often be rescued by a Wurzelspitzenresektion. The root tip is removed with the drill over the open jaw. The treatment is performed under local anesthesia and is therefore painless for the patient. The wound in the jaw also heals without complications within a few days.
In particularly severe cases, even resection of the root tip can no longer stem the pulpitis. Here remains as a last resort, only the tooth extraction, so the removal of the entire tooth.
How Can A Pulpitis Be Prevented?
The most important preventive measure is thorough and regular oral hygiene. Regular brushing with a soft toothbrush protects teeth from harmful bacteria. In addition, regular flossing should be used as well as a mouthwash or mouthwash after brushing your teeth.
To be able to recognize and treat changes and damage to the teeth at an early stage, regular check-ups at the dentist are indispensable. Children and adolescents should be checked every six months, adults at least once a year.
It is also recommended to have a professional tooth cleaning at the dentist at least every 12 months. Here, plaque and calculus are thoroughly removed mechanically, so that even the hard to reach places between the teeth or at the jaw end are optimally cleaned and sealed. However, the costs may have to be paid privately by the patient, as not all statutory health insurance companies offer a subsidy or a reimbursement of costs.