Pulpitis, apical periodontitis, apical periodontitis, apical ostitis, apical inflammation
Under the term Tooth pulp inflammation is a disease that takes place inside the tooth and around the tip of the tooth.
In-depth carious defectsthat go untreated for a long time and get through the inside of the Dental crownWorking through the inflamed root canals to the tip of the root are the trigger for tooth pulp inflammation. Furthermore, those responsible bacteria Wander over deep gum pockets to the tip of the root and from there provoke tooth pulp inflammation.
In addition, in some cases strong thermal, mechanical and / or chemical stimuli are responsible for the development of dental pulp inflammation.
The presence of tooth pulp inflammation does not necessarily have to be accompanied by severe toothache.
Many affected patients report only slight to moderate pain, some were even completely pain-free until the start of treatment.
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A painful inflammation of the tooth pulp is called acute pulpitis in dentistry. Pulpitis does not always have to lead to an event that requires treatment; short-term pathogenic stimuli can completely subside through spontaneous healing.
In such cases, from a medical point of view, one speaks of so-called reversible pulpitis. As soon as the triggering stimulus acts on the pulp (pulp) acts, it comes to the development of a chronic inflammation of the tooth pulp (chronic pulpitis).
The tooth and the tissue around the tooth have several options to react to the pathogenic stimuli.
The formation of a substance called an irritant dentine is by far the most common way for a tooth to protect itself. Irritant dentine is formed on the inside of the dentin (Dentine), in the area of small dentinal tubules that have arisen in the course of tooth stress. Furthermore, a so-called blood vessel reaction can take place inside the tooth pulp. This defense mechanism leads to an effective increased blood flow and immigration of red and white blood cells (erythrocytes and leukocytes).
The immigrated white blood cells release specific inflammatory substances inside the tooth pulp, which increase the permeability of the small blood vessels in the tooth pulp.
In addition, many damaged teeth react with the formation of connective tissue fibers in the area of the tooth pulp. The collagen fibers are supposed to protect the attacked pulp and make it impermeable to the inflammatory stimulus.
Tooth pulp inflammation can be an uncomfortable, extremely painful condition with a variety of causes.
In most cases, inflammation of the tooth pulp is triggered by bacteria that invade the tooth root from a carious tooth defect. Often the pathogenic bacteria also get through deep gum pockets into the area of the tooth root.
Deep gingival pockets can result from long-term, untreated inflammation of the gums (gingiva) or from periodontal disease. To date, it is not clear why the inflammatory processes occur inside the tooth. However, it is assumed that a number of immunological processes lead to the development of inflammatory processes as a decisive reaction to a pathogenic stimulus.
In summary, the main cause of tooth pulp inflammation, as with most dental diseases, is poor and / or incorrectly performed oral hygiene.
In addition to these reasons for developing tooth pulp inflammation resulting from a lack of oral hygiene, traumatic influences can also be the cause.
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This means that violent effects, for example biting too hard, a violent blow on the jaw or severe grinding of teeth, can break through a tooth or rather its root.
Such a trauma to the tooth can have devastating effects on the pulp inside the tooth.
So-called iatrogenic causes are also possible in the presence of tooth pulp inflammation.
Iatrogenic causes are causes that are directly or indirectly caused by medical or dental treatment. The grinding in of fillings and the preparation of a tooth in the sense of prosthetic dentistry can attack the tooth substance and promote the development of tooth pulp inflammation.
You might also be interested in: Pulp necrosis
The onset of tooth pulp inflammation manifests itself in a large number of those affected by the occurrence of pain and / or hypersensitivity reactions to heat or cold stimuli.
If that Bite in an ice cream or that Drink a hot coffee leads to unpleasant reactions of the tooth, this can be a first indication of the presence of an inflammation of the tooth pulp.
However, such a phenomenon can also be triggered by exposed tooth necks and / or irritation of the gums. A dentist should be consulted as soon as possible to determine the exact cause. In the course of the disease, in most cases there is severe inflammation inside the affected tooth, which is accompanied by sudden, throbbing or stabbing pain.
Once the patient has this type of Toothache a dentist must be consulted immediately, because there is an acute risk that the inflammatory processes will no longer be limited to the affected tooth, but rather over the tip of the root into the Jawbone and the surrounding tissue. The result is usually painful abscesses that are difficult to treat, and the risk of losing the affected tooth.
In addition, the spread of inflammation within the jawbone often leads to extensive bone loss, which also endangers healthy teeth.
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The presence of inflammation of the tooth pulp does not necessarily have to be accompanied by severe pain. Many affected patients report only slight to moderate pain, some are completely painless until the start of treatment.
An existing one Tooth pulp inflammation can in the majority of cases of illness by a Root canal treatment be treated. The affected tooth is
Dentist first numb and then opened with drill. In the course of this, if available, Caries eliminated. In the next step, the treating dentist will have access to the Pulp and create the nerve fibers embedded in it. Not so long ago, before the actual treatment, it was essential to install a so-called coffer dam.
A metal clamp, around which a tension rubber is placed, was to be treated on tooth fixed. The cofferdam was used to shield the tooth, so that no saliva get into the tooth and lead to a spread of the bacteria.
However, since the attachment of a cofferdam is very uncomfortable, nowadays, as a rule, only a relative drying of the tooth to be treated is resorted to.
This means that the tooth is only protected from saliva by cotton rolls. Then the pulp and the nerve fibers in it are completely removed from the Tooth root remove. For this purpose, root files of different lengths and thicknesses (Reamer, Hedström or K files) are used. The inflamed tooth pulp is processed and dead and inflamed tissue is removed. A disinfecting alternating rinse must then be carried out.
As soon as the inflamed pulp has been completely removed and the root canals disinfected, they are filled with so-called gutta-percha points and a special density cement.
With the help of a X-ray follow-up it is then checked whether the inflammation of the tooth pulp has been completely removed and the root up to the tip (apex) is filled. Ultimately, the tooth comes with a suitable one Tooth filling locked. In the case of very pronounced inflammation of the tooth pulp and / or involvement of the bone, it may be necessary to carry out a so-called apectomy.
In this treatment, the tip of the root is separated from the rest of the tooth and removed from the bone. In order to get to the tooth root, the treating dentist must create an access through the jawbone (Osteotomy). It is no longer a purely dental therapy, rather a root tip resection should always be performed by a skilled oral or maxillofacial surgeon.
After the bone has been opened, the tooth roots are prepared and rinsed in the same way as a normal root treatment. In this case, however, this does not happen from the Dental crown, but from the Tooth root out (retrograde root canal treatment). This has the great advantage that the root filling begins exactly at the end of the tooth roots. Ultimately, the gums are closed with the help of 2-3 stitches. The dentist usually uses self-dissolving sutures which do not have to be removed. During apicectomy, there is a risk of nerve fiber damage.
Damage to a nerve manifests itself in the appearance of loss of sensitivity and numbness in the area of the lip and / or the cheeks.
In addition, as with any surgery, bleeding and / or Wound healing disorders come. The removal of the tooth root can also be necessary in the course of an inflammation of the tooth pulp if the attempt to preserve the tooth by means of root canal treatment has already failed.
The prospect of preserving the affected tooth through such an oral surgical measure is at least included 90 – 97%.
