Children's pulpitis of milk teeth treatment. Tooth pulpitis - what is it? Pulpitis in children of milk teeth: causes, symptoms and treatment. Features of the treatment of pulpitis of milk teeth

Milk teeth are more prone to pulpitis than permanent teeth. This is due to the structural features of temporary children's teeth:

due to the thin layer of dentin and enamel, the size of the pulp chamber is increased,
loose connective tissue
apical and dentinal canals wide.

These features create all the conditions for the rapid penetration of infection to the pulp. Therefore, the treatment of pulpitis of milk teeth has its own characteristics.

Forms of pulpitis of milk teeth

Pulpitis temporary teeth can occur in 2 forms: acute and. But the peculiarity of the course of the disease in childhood is that the acute form is rapidly turning into a chronic one. Often this happens unnoticed by either the parents or the baby. That is why regular preventive examinations child at the dentist are extremely important for the health of children's teeth.

The structure of milk teeth has its own characteristics.

The acute form is manifested by periodic pain in the tooth. Pulpitis is characterized by the appearance of pain without exposure to any irritants, and often the tooth begins to hurt precisely in evening time and at night. The acute form has the following peculiarities:

rapidly flowing stage of focal pulpitis,
inflammatory process quickly passes from the coronal part of the pulp to the root region,
rapid transition to a chronic form,
inflammation spreads rapidly to periodontal tissues,
the children's body often reacts with elevated temperature, there is a general intoxication of the body.

The chronic form of the disease can rapidly develop from the acute form, but may occur initially. In milk teeth, the fibrous form of pulpitis mainly develops, which gradually turns into gangrenous. As a rule, such a process develops in a closed cavity of the tooth.

The main forms of pulpitis of milk teeth:

acute form	Chronic form
Serous	Fibrous
Purulent	Gangrenous
diffuse	hypertrophic
Partial
Exacerbation of the chronic form

How the disease manifests itself: symptoms

Since the acute form of the pathology rapidly becomes chronic, the symptoms of the acute phase may be minor or absent altogether. There may be mild pain in the area of the affected tooth. Chronic pulpitis is manifested by periodic aching pain, which can be joined by the following symptoms:

Pulpitis can be manifested by aching pain.

when tapping and biting,
the mucous around the tooth may turn red and swell,
lymph nodes in the neck are enlarged.

The gangrenous form is manifested by an unpleasant odor from the mouth, a fistula may form in the area of \u200b\u200bthe diseased tooth. At hypertrophic pulpitis observed:

destruction of the crown of the tooth,
pulp growth,
pain during chewing.

The fibrous form of the disease can be asymptomatic, sometimes accompanied by pain when chewing. Because of this, children often chew on one side, avoiding the diseased tooth. As a result, plaque accumulates in an unused area and an inflammatory process of the mucosa can develop.

Features of diagnostics

Expert opinion. Dentist Vernik R.O.: "Regular preventive examinations at a pediatric dentist will reveal pulpitis on early stage and save baby tooth hic until it drops. This is very important, since the premature loss of milk teeth negatively affects the formation of the dentition and the maxillofacial apparatus of the child, and often complicates eruption. permanent teeth. If the baby loses at least one milk tooth ahead of time, there may be problems with it, so adequate and timely treatment of all dental diseases plays a very important role.

Diagnosis of pulpitis in children consists of the following steps:

An important stage is the differentiation of pulpitis with diseases that have similar symptoms:

deep,
sinusitis,
periodontitis,
otitis.

How is pulpitis of milk teeth treated? There are two fundamentally different treatment methods diseases:

conservative (with preservation of pulp viability),
surgical (the pulp is removed).

Modern pediatric dentistry thanks to innovative methods diagnostics and treatment makes it possible to keep milk teeth in children even in the most difficult cases, in order to ensure their change is permanent in due time. Consider these two methods of treating pulpitis in children in more detail.

Conservative treatment method

A conservative method can be used for partial acute or fibrous chronic pulpitis, when the pulp has not yet been completely destroyed and changes in its structure. At correct diagnosis the dentist manages to keep the pulp viable. Relative contraindications to the use of this technique are multiple caries and some types of somatic pathologies.

Stages conservative therapy:

the doctor removes areas of tooth tissue affected by caries,
the cavity is washed with an antiseptic solution,
a medical paste containing calcium hydroxide is placed in the cavity,
the tooth is covered with a filling.

A conservative treatment method also involves the use of some physiotherapy procedures.

Surgical method

Surgical treatment of pulpitis of temporary teeth involves complete or partial removal nerve (pulp). The method of treatment depends on the stage of pulpitis and its form, as well as the degree of tooth decay. The algorithm of work of the dentist in all cases will be as follows:

anesthesia,
the tooth cavity is opened, all affected areas are removed with a burr,
the pulp is removed
the tooth is treated with an antiseptic preparation,
the doctor puts a medical paste into the cavity,
seal is installed.

There are 3 methods surgical treatment pulpitis in children:

When using this technique, it is necessary to exclude the presence of an inflammatory process of periodontal tissues. The method can be used for any form of pulpitis with a formed root system.

Devital amputation- the essence of the procedure is to use medicines for necrotization for the affected part of the pulp. This is a special paste that is placed in the tooth for a while to kill the pulp. In teeth with one root, the paste is placed for a day, in multi-rooted teeth - for two days.

After that, the paste together with the pulp is removed, a swab soaked in resorcinol-formalin liquid is placed in the cavity for several days. During the third visit to the dentist, the child is given a permanent filling. Formed cavity filled with a special substance that prevents further tissue breakdown. For the procedure, application anesthesia is most often used.

Caries is a fairly common problem with children's teeth, and many parents believe that its treatment is not so important, since the teeth are milk teeth and they will soon fall out on their own. However, such irresponsibility often leads to complications, one of which is pulpitis.

What is pulpitis?

This is the name of the inflammation of the dental pulp, which is a connective tissue deeply located inside the teeth with nerves, blood and lymphatic vessels. In folklore, the pulp is often simply called the dental nerve. The disease mainly affects milk molars, while the lower teeth become inflamed more often, although pulpitis of the front milk teeth also occurs. It is important to note that in childhood, due to the low strength of dentin and thin enamel, pulpitis develops faster than in adults.

Pulpitis is an inflammation of the dental nerve

The reasons

The most common cause of pulpitis is the lack of treatment for caries. The infection first affects the enamel, then spreads to the dentin and, as a result, enters the pulp. Much less often, the development of pulpitis is provoked by trauma to the tooth, including accidental exposure of the nerve caused by the dentist during the treatment of caries.

Symptoms

Depending on the course, pulpitis can be both acute and chronic. Acute is less common, but its symptoms are more pronounced. The process goes through two stages:

Serous, during which the pulp becomes inflamed with the filling of the channels serous fluid. The child begins to complain of very severe pain in the tooth, which usually appears at night or during chewing. Pain is usually one-time, and the lesion is often observed in teeth with absorbable or incompletely formed roots. After 4-6 hours, the process proceeds to the next stage.
Purulent, during which purulent contents begin to form in the channels. The severity of this form is affected different factors such as the immunity of the child, the activity of bacteria or the condition of the roots of the tooth. Painful sensations may not be expressed if the immune system the child works well, the microorganisms in the tooth are weakened, and the pus comes out through the carious cavity. But much more often the pain syndrome is pronounced strongly. The pain is very long, sometimes given to other teeth, and appear when chewing, and when the temperature of the food consumed fluctuates. The child refuses to eat and often cannot even touch the tooth. General state the baby may worsen with the appearance of fever and swollen lymph nodes.

Pulpitis of a milk tooth is accompanied by pain

Chronic pulpitis often occurs without symptoms, and it can develop both in deeply carious teeth and under fillings. The tooth can hurt from food getting into the hole or from a cold drink, which is why the child usually does not eat on the “sore” side. In the gangrenous form of the disease, pain in the tooth appears after hot food after a while, an unpleasant odor spreads from the tooth, the child may feel fullness and heaviness in the tooth.

How to recognize the problem in time?

Since the sensitivity of the pulp in children is reduced, the disease often develops without pain syndrome. For the timely detection of pulpitis, it is important to visit the dentist regularly with the child, as well as to treat all teeth affected by caries at an early stage.

Signs of serious dental damage

The following symptoms will tell you that it is important to show your child to a pediatric dentist as soon as possible:

Severe pain in the tooth.
The appearance of pain when eating hot food or cold drinks.
Bad smell from a discolored tooth.
Inflammation of tissues around the tooth.
Increase in body temperature.

With pulpitis, an increase in body temperature is possible

Is it worth treating milk teeth for pulpitis?

The question of the need for treatment of pulpitis should not arise at all. If a child has this disease, it should be treated immediately. It is unacceptable to give a child painkillers and wait for a diseased baby tooth to fall out. Without treatment, such a problem with the teeth can result in serious complications, such as periostitis or periodontitis.

The consequences of untreated pulpitis can be very serious.

There were also deaths when an infection from an infected pulp entered the child's blood and provoked severe swelling faces.

In the next video pediatric dentist He will tell you why it is so important to treat milk teeth and how to do it.

Stages and methods of treatment

Sometimes pulpitis is so severe and threatens the life of the child that the easiest way is to remove the tooth completely. However, in most cases, the doctor tries to save the milk tooth in order to prevent malocclusion. At the same time, dental treatment in budgetary organizations and private clinics is different.

Traditional

Most pediatric dentistry public institutions pulpitis is treated in a way called "devital amputation". It includes several visits to the dentist:

On the first visit, the nerve is opened and a paste with devitalizing properties is applied to it (it “kills” the pulp). If it contains arsenic, then the paste is kept in the tooth for 24-48 hours. Paste without arsenic is laid for a period of up to 7 days.
In the next two visits, a special mixture is “pumped” into the canals of the tooth to mummify the infected pulp. Usually it is a resorcinol-formalin mixture.
On the next visit, a permanent filling is placed.

Most often, in the treatment of pulpitis, a filling is installed.

Modern

If the child is calm and can withstand a long stay at the dentist, as well as in the case of formed tooth roots, a treatment method called extirpation is used. It is vital, when the nerve is removed from the tooth at the first visit to the doctor, as well as devital, in which the pulp is opened and treated with a paste for killing.

When the canals of the tooth are carefully processed, the infected tissues are removed and sterile conditions are created, an anti-inflammatory paste is used for filling them, which will dissolve along with the roots during the period of teeth change. The most commonly used zinc-eugenol paste. The method is effective, but in order for the infection not to become active again, the cleaning of the channels must be very thorough.

Another modern method called vital amputation, the essence of which is to remove the upper part of the nerve and install it on the remaining pulp medicinal product with antiseptic and anti-inflammatory action (Pulpodent and Pulpotek materials are often used). The medicine is hermetically sealed lower part pulp, while maintaining its viability.

The specifics of the treatment of a tooth with unformed roots

Roots of milk teeth are formed long time after eruption, therefore, situations are possible when a tooth becomes infected with caries, at the roots of which the top has not yet closed. The difficulties of treating such a tooth are due to such factors:

The roots in the teeth are short, and their canals are wide.
Top part The root zone is a "growth" zone, trauma to which will prevent root formation.
There is enough high risk germ infection permanent tooth.
All manipulations are important to perform as accurately as possible.
The filling material and instruments must not be allowed to leave the area in which the expansion of the apical foramen begins.
Completely remove the pulp and process all the channels will not work.
the best way out there will be an amputation method of treatment. It consists in removing the infected pulp from the tooth in any way (with or without arsenic).
Often, a biological method is also used, the essence of which is to clean the tooth from dead tissues and lay it in it for several days. medical paste with calcium hydroxide, after which a permanent seal is installed.

Preparation for treatment

So that the baby is not afraid of dentists, the first visit should be preventive. It is carried out only to familiarize yourself with the environment of the doctor's office and the tools used. Before you go to treat your teeth, you should:

Talk to your child about doctors who treat teeth.
Tell the baby about positive effects treatment.
Emphasize that this is a procedure familiar to all people to take care of their health, and not something very important and exceptional.
Play "dentistry" with toys and family members.
Do not scare the child with scary terms.
Do not lie that there will be no pain. It is better to say that unpleasant sensations are possible, but as a result toothache stop.
Do not panic and do not be afraid of the parents themselves, so that the excitement is not transmitted to the child.
Visit the doctor in the morning when the child is active, not hungry or sleepy.
Take your favorite toy with you so that it remains in the hands of the child during the visit.
Give the doctor the opportunity to communicate with the child without parental participation, so that the doctor can find contact.
Do not intimidate or beg the child if he is not allowed to be examined.
If you lose control of the situation, reschedule the appointment for another time.

Pulpitis is a complication that occurs with caries. The disease strikes nerve endings and blood vessels of the pulp chamber and root canals.

Milk teeth have a specific structure, therefore, during caries, the pulp undergoes rapid infection.

If the disease is not treated, it causes damage to all tissues of the oral cavity and leads to problems with permanent teeth in the future.

Pathology occurs for the following reasons:

tooth injury, disease-causing, occurs when improper treatment or accidental opening of the nerve;
tissue exposure to toxins, which are secreted by microorganisms in the carious cavity;
Availability infectious disease against the background of a decrease in immunity;
overheating of the tissues of the tooth during his treatment. This can happen in the absence or poor quality of water cooling;
usage improperly selected filling material;
using too strong an oral solution, for example, alcohol.

Forms

Pulpitis is acute and chronic. Only a dentist can accurately determine the form of the disease. After examination, the doctor recommends treatment and suggests preventive measures to prevent re-infection.

Acute

The acute form is characterized by pain that can occur intermittently or be constant and manifest itself without visible reasons. Subdivided into focal and diffuse form, each of which has its own symptoms.

Focal pulpitis is the initial process of tooth decay, in which inflammation occurs around the carious cavity. In fragile children's immunity, inflammation quickly spreads to the entire pulp. Pain in this form of the disease occurs most often at night.

Diffuse pulpitis of acute form arises from focal and is an inflammation of the entire pulp. Main symptoms: fever body, pain from eating hot food or drinks and when biting. The cold is somewhat calming.

Adults may experience pain in the ear, jaw, and even in the temple from the side of the inflamed tooth. pain attacks intensify and increase in duration. In children, due to the lack of a root system, it quickly becomes chronic.

The acute form is characterized by certain features:

Fast development.
The inflammatory process for a short time penetrates into other dental tissues.
With absence timely treatment caries becomes chronic.
tissue inflammation causes fever and malaise.
The blood test gives high rate ESR.

On children's teeth, the disease proceeds without bright severe symptoms, Besides aching pain. Young children are not able to indicate where the pain is localized. This is due to the absence of the root system of the teeth. It is the inflammation of the root that is the source of the sharp pain.

The disease is accompanied by inflammation of the tissues of the oral cavity and can cause intoxication of the body.

Serous form acute pulpitis is one of the most dangerous. It is characterized oxygen starvation pulp. As a result, the channels are filled with serous fluid. On milk teeth, it instantly turns into purulent form.

Chronic

Acute pulpitis gives rise to the development of a chronic form. However, structural features of children's teeth (thin enamel and porous dentin), as well as weaker body resistance, often allow the chronic form to develop independently. Another good reason is prolonged absence caries treatment.

Occurs more frequently in milk teeth fibrous pulpitis. The lack of timely and qualified treatment of this form can cause the development gangrenous pulpitis.

It is characterized by the presence bad smell, pain while taking hot drinks or food, as well as a feeling of pulsation (soreness from the inside).

Chronic pulpitis is accompanied by inflammation of the periodontal tissues, a feeling of pain during probing, as well as the presence of swelling of the face.

Characterizes the presence of tooth decay with softened dentin. The carious area does not necessarily have a large size, often it is a small lesion.

After the treatment of caries, periodic pain or discomfort from cold and hot food immediately disappears.

From the video you will learn about the causes, symptoms and definition of pulpitis.

Therapy

Feature of the disease- the inability to determine it at the very beginning of development. Moreover, children do not tolerate both dental treatment and simple examinations.

If a initial stage caries was not detected, then it will be required competent treatment pulpitis. For this, various methods are used.

conservative method

The main advantage of using the biological (conservative) method is the ability to preserve and restore the pulp.

when the disease is began to develop and not yet affected most pulp tissues;
if chronic does not cause acute pain or others unpleasant symptoms(no need to use more serious methods treatment);
if during treatment deep caries the pulp was opened by accident.

When choosing a biological method of treatment, the dentist conducts:

Anesthesia of the inflamed area.
Caries treatment.
The tooth is isolated from saliva with a rubber dam.
The oral cavity is treated with a special solution.
A calcium pad is placed at the bottom of the tooth cavity. Calcipulp, Calcicur, Life and other drugs are used.
Laying overlay.
Installing a temporary filling.

Taking antibiotics for pulpitis is rarely prescribed due to low efficiency. However, if it is not possible to cope with the infection, antibiotics of the penicillin group are prescribed.

Second visit includes:

Removal of temporary filling.
Using a rubber dam to isolate a tooth from saliva.
Installing a permanent filling. It is recommended to use special filling materials for milk teeth.

Devital amputation

An effective method of treating children's milk teeth is devital amputation. This method is not recommended for gangrenous pulpitis.. Arsenic-based medications are used as a devitalizing agent.

To treat the chronic form, the pulp is first removed, and only then arsenic paste is used.

For the treatment of fibrous pulpitis, the use of arsenic is ineffective. It is recommended to apply a swab that is moistened with formalin or phenol.

The procedure involves the use of anesthesia. It can be anestezin powder or dicaine solution. The paste is applied for 1 - 2 days. However, there are drugs that are recommended to be applied for 1-2 weeks.

On the second visit to the doctor, the pulp is removed. Then a swab is placed in the tooth cavity, which is moistened with resorcinol-formalin liquid. The solution penetrates the pulp by a few millimeters.

The use of devital amputation avoids damage to the growth zone. Therefore, the roots of permanent teeth will develop normally.

A third visit will be required to apply a resorcinol-formalin paste, an insulating gasket and a seal to the mouth. When treating young children, it is recommended to use a phenol solution instead of arsenic to reduce toxicity.

After the end of therapy, the dentist additionally recommends anti-inflammatory and calcium-containing drugs, as well as the use of a large number liquids.

Judging by the reviews, the technique is quite effective if carried out by a highly qualified specialist.

vital

It is used in the event that without removing the infected part it is impossible to stop the spread of infection and further complications. Before starting the procedure, the area to be treated is anesthetized.

In some cases, a vital amputation requires more than one visit. After opening the infected cavity, it is required permanent replacement hog. This will prevent the spread of infections into the deep layers of the dentin.

The infected cavity should be carefully treated with an antiseptic and cut off the pulp in the area of the canal mouth.

Cutting off the pulp can cause bleeding. To stop it, you need to inject adrenaline.

If the bleeding does not stop, then the cause may be the presence of inflammation in the root pulp. In this case, it is recommended to remove it completely. This procedure is called a pulpectomy.

Before the procedure, the dentist must exclude the presence of periodontal damage. It is recommended to use this method for already formed teeth.

For milk teeth, vital amputation is unsafe, since the removal is carried out using a sufficiently strong anesthesia, which can harm the health of a fragile organism.

Due to the high labor intensity and duration of the procedure, vital amputation is practically not used in pediatric dentistry.

You will learn more about the treatment of pulpitis of milk teeth from the video.

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There are a lot of questions that constantly worry parents, and one of them is “Can baby teeth hurt in children?” Unfortunately, they can. Dental diseases not bypass the kids. In childhood, acute pulpitis is not as common as chronic, but it proceeds much more painfully and aggressively than in adults.

The intensity of pain, the overall clinical picture of the course of the disease is determined by the form of pulpitis, which can be:

acute serous;
purulent.

The serous form is very similar to acute focal pulpitis in adults: the first signs of the disease usually appear at night, and during the day there may be discomfort while eating and drinking. Acute serous pulpitis of milk teeth in children is accompanied by inflammation of the periodontal tissues, which leads to a lack of oxygen supply to the pulp. This provokes the filling of the root canals with a special fluid called exudate. Pain in this case can be intermittent, or even occur once. However, in most cases, the serous stage turns into a purulent one after 4-7 hours. And that's when the search for a dentist begins.

Formation of pulpitis in milk teeth

On the severity of the flow purulent form are influenced by the following factors:

performance of the immune system;
the level of formation of milk teeth;
activity of pathogenic bacteria.

If a immune defense the baby is very strong, then the pulpitis of the milk tooth can proceed almost painlessly, since the activity of bacteria is restrained by the body and there is an exit for pus from the pulp. But most often the disease proceeds in a very expressive form.

The purulent stage of pulpitis in childhood often resembles not a similar disease in adults, but periodontitis: fever begins, fluid accumulates in the channels, and strong pain when pressing on the affected teeth.

The nature of the pain is paroxysmal, each episode can last quite a long time, interspersed with short respite, these sensations often occur during meals, especially hot or cold foods. It is far from always possible for children to indicate the exact localization: the pain can respond not only in the affected tooth, but also in neighboring molars, in the jaw.

Treatment of pulpitis in a child is not as painful as in adults

If, when such signs appear, you do not consult a doctor and do not start treatment for pulpitis of milk teeth, in children, other unpleasant symptoms join the pronounced pain:

fever;
reduced activity;
refusal to eat and drink;
sleep disturbance and regimen;
sore gums.

Delay is fraught not only with aggravation of the baby’s condition, but also with the occurrence of complications that do not take long to wait: lymphadenitis, periodontitis, periostitis (“flux” among the people). This is all extremely dangerous states not only for health, but even for the life of the child, therefore, appeal for medical assistance at the first symptoms of inflammation in oral cavity must be urgent. On the background general intoxication and accessions bacterial complication the consequences can be unpredictable.

Traditional methods of treatment of acute childhood pulpitis

Due to the likelihood of complications and danger severe conditions, which can provoke pulpitis in children of milk teeth, treatment is primarily aimed at eliminating such risks. Of course, the easiest way is to simply pull out the affected tooth, but such manipulation can not only affect the child's psyche, but also affect the formation of bite.

Pulpitis in a child - what to do?

In public clinics and dental offices, and even in some commercial centers, the method of devital amputation is most often used. The method has long been known, tested many times, quite sparing in terms of experiences for the child, since direct impact on the root systems of the tooth is not found. It happens like this:

First, a special paste with arsenic for 1-2 days or a devitalizing composition without arsenic for a week is placed on the exposed area of the nerve (yes, the question “Are there nerves in milk teeth?” The answer is also yes).
At a subsequent visit, the tubules are laid special pastes, which provide antimicrobial action on the pulp and, as it were, “mummify” it, thereby preventing further development purulent process.
The last visit ends with a filling.

Modern approach to the therapy of pulpitis in children

For babies who can sit quietly for a long time, and who have already formed the root system of their teeth, there are two methods of modern therapy:

vital;
devital.

The first thing that involves the vital treatment of milk teeth in children is the removal of the nerve. And devital therapy consists in a gradual effect on the pulp in several steps. The method consists in scrupulous processing of root canals with mechanical and medical methods to create complete sterility inside the tooth and subsequent laying in root canals special formulations. These pastes have an anti-inflammatory and absorbable effect, which does not have any effect on the replacement of temporary teeth in the future.

Domestic dentists prefer zinc-eugenol paste for filling roots, and foreign experts respect the composition of Magipex, which has also proven itself well. But not only momentary help with pulpitis, but also the further life of the tooth depends on these materials. Because the possibility of re-infection depends on whether there is a nerve in the milk tooth, and on how carefully the treatment was carried out during treatment.

Damaged teeth in a child - what is it fraught with

Despite the sparing "mode" of the devital technique in the treatment of acute pulpitis, there are no fewer fans of the opposite method - the vital one. It involves not a complete removal, but a partial one: in this case, the top of the nerve is removed, and the roots are filled with special medicines.

Modern medicines, used in pediatric dentistry, have a pronounced anti-inflammatory and antiseptic effect of a long-term nature, while the sealing of the tooth roots is excellent. The previously widely used formulations with eugenol and calcium hydroxide have successfully changed to preparations of Swiss production (Pulpotek) and domestic production (PulpoDent). These drugs not only significantly prolong the "life" of the pulp, but also help to reduce pain during treatment and recovery.

Unlike previous preparations, modern pastes do not contain dyes, do not have a toxic effect on the children's body and can reduce the number of visits to the dentist, making the treatment of pulpitis in children more effective.

Features of the treatment of acute forms of pulpitis with an unformed root system

When, with the appearance of milk teeth, the tops of the roots remain uncovered, they say not unformed roots. Their full development usually takes several years. That is why the specifics of the therapy of such teeth is quite different from similar methods of influencing the formed system.

With an immature root system of temporary teeth, the vital and devital methods described above are not suitable, since there is no opportunity to fully influence the pulp. It is also difficult to process the canals of the tooth. Therefore, as best way in pediatric dentistry, amputation or biological treatment is used.

What to do if a child has pulpitis in a tooth?

Biological technique is conservative option allowing complete preservation of the pulp. However, the method is very complex, has a wide range of contraindications and requires absolute sterility during treatment, since whether milk teeth in children will ache after such an intervention depends largely on the quality of aseptic and antiseptic treatment. First of all, a thorough cleansing of the carious cavity from dead and affected tissues is carried out, and then medicines are applied either to the bottom or to the exposed nerve.

After a few days, when the soreness is gone completely, the tooth is closed permanent filling. With this treatment option acute forms children's pulpitis, the tooth continues to receive good nutrition due to the preserved pulp, while the amputation method deprives the molars of this opportunity.

However, due to the large number of contraindications and the sufficient complexity of biological treatment, simple amputation is used much more often. It can be performed both by the traditional devital method using arsenic-based formulations, and by the modern vital method using local anesthesia and non-arsenic pastes, as well as options that involve the participation of antibacterial drugs and various remineralizing agents.

And parents should remember that when a baby tooth hurts, the question “what to do” should not arise, it is necessary to seek help from a pediatric dentist as soon as possible.

Treatment of pulpitis of milk teeth in children

Pulpitis is an inflammation of the pulp, which is the most common complication of dental caries. One should be able to assess the state of the dental pulp, taking into account a number of factors: age, and therefore the degree of formation of the roots of the teeth, constitution, common diseases child.

It is possible to minimize the number of pulpitis during planned sanitation of the oral cavity, provided that the examination of children with a compensated form of caries is carried out at least every 12-13 months, children with a subcompensated form - at least every 6-7 months and who have decompensated form - after 3-4 months.

Pulpitis in children is diagnosed in both temporary and permanent teeth. The frequency and variety of clinical forms of pulpitis depend on many reasons, and most importantly on the structural features of the pulp tissue in the crown and root parts of it in different age periods.

The dental pulp is formed from the dental papilla and is located in the cavity of the tooth. In single-rooted teeth, the coronal pulp without sharp boundaries passes into the root. In multi-rooted teeth, there is a clear boundary between the coronal and root pulp - the mouths of the root canals. The pulp is a loose connective tissue consisting of the ground substance, cellular and fibrous elements, vessels and nerves.

Despite the common origin, there are a number of differences in the structure of the root and crown pulp, which makes the root pulp more resistant to various injuries. So, in the coronal part more cellular elements, and in the root - fibrous. The coronal pulp has fewer main vessels and nerve trunks. The root part of the pulp receives an additional amount of nutrients from the periodontal vessels. This is the theoretical basis of amputation treatments.

The dental pulp undergoes functional and morphological changes throughout a person's life. It develops in parallel with the formation of the tooth root. As the child grows older, there is a slight decrease in the size of the tooth cavity due to the work of odontoblasts, the number of cells decreases and the number of fibrous elements increases.

Thus, we can say that the pulp is one of the connective tissue formations that have functional autonomy. High vital activity, reactive ability, plastic function and pulp stability are proved. Only the pulp with its full-fledged functions ensures the trophism of all tooth tissues and protects the periodontium from odontogenic infection and the development of a focus of chroniosepsis. The pulp has a whole complex of protective and adaptive mechanisms that ensure its high viability.

The inflammatory process in the pulp is the result of the reaction of tissues to various stimuli. The occurrence of inflammation and its intensity are significantly influenced by the protective factors of the body as a whole and in the pulp itself in particular, as well as the strength and duration of exposure to the stimulus.

Most common cause pulpitis are biological agents (microbes, most often streptococci and staphylococci, their toxins) that penetrate into the tooth cavity from the carious cavity through the dentin layer located between the cavity and the pulp. The second most common cause of pulpitis is a mechanical injury that occurs when a part of the crown is broken off or during the preparation of a carious cavity. Less commonly, pulpitis occurs from excessive thermal and chemical effects in the treatment of caries.

Infection of the pulp can also occur by the hematogenous route during the period of an acute infectious disease of a child, especially with significant bacteremia.

Classification of pulpitis in children of the Moscow State University of Medicine and Dentistry based on the classification of E.E. Platonov:

I. Acute pulpitis:

a) focal (partial) - Pulpitis acuta localis (partialis);

b) diffuse (general) - Pulpitis acuta diffusa (totalis).

II. Chronic pulpitis:

a) fibrous - Pulpitis chronica fibrosa;

b) gangrenous - Pulpitis chronica gangraenosa;

c) hypertrophic - Pulpitis chronica hypertrophica.

III. Chronic pulpitis in the acute stage - Pulpitis chronica exacerbata.

Classification of pulpitis in children according to T.F. Vinogradova:

1. Acute pulpitis of temporary teeth

Acute serous pulpitis

Acute purulent pulpitis

Acute pulpitis with involvement in the periodontal process or regional lymph nodes

2. Acute pulpitis of permanent teeth

Acute serous partial pulpitis (possible in zy6ax with formed roots)

Acute serous general pulpitis

Acute purulent partial pulpitis

Acute purulent general pulpitis

3. Chronic pulpitis of temporary and permanent teeth

Simple chronic pulpitis

Chronic proliferative pulpitis

Chronic proliferative hypertrophic pulpitis

Chronic gangrenous pulpitis

Chronic exacerbated pulpitis of temporary and permanent teeth

The development of inflammation in the pulp and the clinical picture of pulpitis have a number of features:

inflammation of the dental pulp in a child can occur with a shallow carious cavity. This is due to the fact that in milk and permanent teeth with unformed roots, the dentin layer is thin, it is poorly mineralized and has wide tubules through which microorganisms quickly penetrate into the tooth cavity;

inflammation, having arisen, quickly spreads to the entire coronal and root pulp. This is due to the presence in children in the cavity of the tooth more than in adults, the number of cellular elements and the main substance, a developed network blood vessels, which leads to rapid development exudative process. The involvement of the root pulp in the inflammatory process is facilitated by the wide orifices of the canals of immature teeth;

in childhood, chronic forms of pulpitis predominate, which are not only the outcome of acute inflammation, but also as a primary chronic process. This is due to good conditions for the outflow of inflammatory exudate through the wide root canal into the periodontium and through the wide dentinal tubules into the carious cavity;

the same form of pulpitis can occur with different clinical manifestations in different periods tooth development, which is associated with age-related features of the structure of the tooth and pulp and entails various conditions occurrence and outflow of exudate;

all forms of pulpitis in the morphological study of the pulp are characterized by the presence of elements of purulent inflammation. Sensitization of the pulp by staphylococci, which are predominantly found in the carious cavity, leads to rapid suppuration of the pulp;

acute pulpitis and exacerbation of chronic pulpitis of milk teeth and teeth with unformed roots often occur with symptoms of periodontal inflammation. This is due to the infection in the periodontium, which also has structural features in childhood;

due to the reactivity of the child's body, acute and aggravated forms of pulpitis are sometimes hyperergic in nature.

Inflammation of the pulp occurs in children of any age. Pulpitis of molars of both milk and permanent teeth is observed 5 times more often than incisors and canines. Moreover, inflammation of the pulp of the molars of the lower jaw occurs more often than the teeth of the same name. upper jaw. This coincides with the frequency of tooth decay by a carious process. Significantly more often than in adults, in childhood with pulpitis (acute and exacerbated chronic) there is a reaction from the periodontium. This is due to the entry of a virulent infection, toxins and metabolic products of the inflamed pulp into the periodontium, especially with pulpitis in immature milk and permanent teeth, when the apical opening is wide and exudate penetrates from the pulp into the periodontium. Of particular importance are the features of the structure of periodontium in childhood: a large number of cellular elements, blood and lymphatic vessels, looser connective tissue. All this makes it more reactive when exposed to adverse factors in comparison with the periodontium of permanently formed teeth. The bone tissue limiting the periodontium has a small thickness of the cortical plate; thin bone beams, large medullary spaces, which also affects the development of inflammation in the surrounding tissues.

clinical picture.

Acute partial pulpitis of milk teeth is very rare, since in the presence of a virulent infection and reduced resistance of the child's body, this form quickly turns into diffuse inflammation. A mild pain reaction in milk and permanent teeth with unformed roots is due to a good outflow of exudate through a wide root canal and wide dentinal tubules. As a result, this form of pulpitis in younger age goes unnoticed by the child and his parents, and the short-term phase of acute partial inflammation after 2 hours passes into the general one. In histological studies of the pulp of milk teeth with a diagnosis of acute partial pulpitis, the diagnosis was not confirmed in any case [Chuprynina N.M., 1985].

In older children, the clinical picture of acute partial pulpitis consists of short-term pain attacks, alternating with long-term remission, which resembles the course of pulpitis in adults.

Acute focal pulpitis should be differentiated from acute general and chronic fibrous pulpitis. The diagnosis of acute partial pulpitis can be made when the pulp is accidentally opened during the preparation of a carious cavity or when a crown is broken at the level of the pulp, if dental care is provided no later than 1-2 hours. With this form of pulpitis, the prognosis for preserving the pulp is favorable due to its high ability to regenerate.

Particular attention should be paid to acute pulpitis resulting from trauma and fracture of the crown with exposure of the pulp. It is this situation that is the main cause of acute pulpitis of the frontal group of teeth in children aged 7 to 11 years. In the first hours after injury, changes in the pulp are regarded as acute focal pulpitis, but there are some features clinical picture this state. The child complains of pain in the tooth when inhaling cold air and eating, i.e. from mechanical and thermal stimuli. There are no nocturnal and paroxysmal pains characteristic of acute pulpitis. If the parents of the child do not go to the doctor, then due to infection of the pulp, the process develops as chronic fibrous or gangrenous pulpitis.

With an unformed tooth root, in the event of a crown fracture, the apical part of the pulp and the growth zone can remain viable for about 1 month after the injury.

Acute diffuse (general) pulpitis.

The clinical manifestations of this form of pulpitis are varied and depend on the age of the child, his reactivity and resistance to infection, as well as on the group of the tooth and the degree of its formation. In weakened children early age acute general inflammation of the pulp may be accompanied by reactive periodontal inflammation and rarefaction bone tissue jaws. Clinically, this is expressed by painful percussion, hyperemia of the mucous membrane alveolar process, pain and thickening of the periosteum, soft tissue edema, enlargement and soreness of regional lymph nodes. With this form of pulpitis, the general condition of the child suffers: the body temperature rises to 38-39 ° C, sleep and appetite are disturbed, the child becomes capricious and restless. Such a course of acute general pulpitis should be differentiated primarily from exacerbations of chronic periodontitis, chronic gangrenous pulpitis in the acute stage, periostitis of the jaw. Given a number of similar symptoms in these diseases, the only reliable diagnostic sign is the state of the pulp after its exposure.

The next clinical variant is the development of acute general pulpitis with formed tooth roots in older children. In this case, the symptoms are clearly expressed and are characterized by a sharp pulsating spontaneous pain of a paroxysmal nature that occurs without exposure to external stimuli. The pains are radiating remission, short, worse in the evening, especially at night. During the period of formation or resorption of roots, the clinical picture of general acute pulpitis of milk teeth may be mild due to a good outflow of inflammatory exudate through wide dentinal tubules and through a wide apical opening of unformed and absorbable roots. The same conditions contribute to the rapid transition of the acute stage of inflammation to the chronic one. Acute general pulpitis does not last long and becomes chronic or ends with the death of the pulp. The younger the child, the more often the pulp necrotic. The prognosis for the pulp in acute general pulpitis is favorable if the treatment is carried out in a timely manner; the root pulp can sometimes be saved, and in the coronal changes are irreversible. Diagnosis of pulpitis in children is much more difficult than in adults: there are difficulties in examining a child, collecting an anamnesis, subjective data are unreliable and often impossible to collect, in most cases it is necessary to focus only on objective information. Diagnosis based on clinical examination alone often leads to errors.

Chronic forms of pulpitis are much more common than acute ones in children of any age, both milk and permanent teeth. The most common chronic fibrous, then chronic gangrenous and most rarely chronic hypertrophic pulpitis. The development of chronic pulpitis of milk teeth occurs more often as a primary chronic process, less often as an acute outcome. In the early stages of chronic pulpitis, pain is more pronounced, and as inflammatory changes increase, they weaken. N.M. Chuprynina (1985) noted that pain in chronic pulpitis was detected only in 44% of children.

Chronic fibrous pulpitis is detected during routine preventive examinations and sanitation of the oral cavity. On examination, a carious cavity is found, often of a small size, with light softened dentin. The cavity of the tooth is usually not opened. Probing is painful, with the removal of softened dentin, a slight bleeding of the pulp occurs. Pain from temperature irritants quickly pass.

Chronic fibrous pulpitis of milk and permanent immature teeth occurs with minor pain or asymptomatically. In the anamnesis, pain in the past is sometimes noted. Differentiate chronic fibrous pulpitis follows from chronic gangrenous pulpitis and deep caries.

Difficulties in the differential diagnosis of these diseases arise in cases where the tooth cavity is not opened.

Chronic hypertrophic pulpitis is rare. Long-acting chronic irritations promote proliferation connective tissue in the pulp. The crown is significantly destroyed, under the influence of constant injury, the pulp tissue grows in the form of a polyp on a wide pedicle. The exposed pulp is insensitive to superficial probing, deep probing is painful. The size of the overgrown pulp is different. Sometimes it slightly rises above the level of the roof of the tooth cavity, and sometimes it fills the entire carious cavity. The overgrown hypertrophied pulp bleeds on probing and appears as a red tissue. From the survey it turns out that the tooth once hurt, but then the pain disappeared and only a slight soreness remained while eating.

Chronic hypertrophic pulpitis should be differentiated from the gingival papilla that has grown into the carious cavity, and from the granulation tissue formed during periodontitis and grown into the tooth cavity through a perforation in the bottom or wall of the tooth or through the orifices of the canals of resorbed roots in chronic granulating periodontitis.

Chronic gangrenous pulpitis. The second most common form of chronic pulpitis in children develops after acute diffuse or chronic fibrous pulpitis. Complaints are minor, sometimes they are not; from the survey it is possible to reveal that once the tooth hurt, the color of the tooth can be changed (darker). The carious cavity can be of various depths, but more often shallow. Sometimes there is a putrid smell from the mouth, which is associated with the decay of the pulp under the influence of microbes. Chronic gangrenous pulpitis can occur with a shallow carious cavity, in typical cases, communication with the tooth cavity is detected. Probing is painful in the depth of the tooth cavity or at the mouths of the canals. The preparation of the carious cavity is painless, at autopsy a gray mass with a characteristic putrid odor is visible. In multi-rooted teeth, the state of the root pulp in different canals is not always the same: in some, probing is painful at the mouth, in others, in the depths of the canal. On the gum, according to the projection of the root apex, there may be a fistula. Regional lymph nodes are enlarged and slightly painful.

Differentiate chronic gangrenous pulpitis follows from chronic fibrous pulpitis, chronic periodontitis. In the absence of complaints and a shallow carious cavity, the clinical picture of chronic gangrenous pulpitis is differentiated from the picture of medium caries; with an exacerbation of the process, it is differentiated from acute general pulpitis, acute periodontitis, exacerbations of chronic periodontitis. A significant difficulty is the differential diagnosis of gangrenous pulpitis from chronic granulating periodontitis of teeth with formed roots. In this case granulation tissue can grow into root canals, filling a significant part of them. It should be borne in mind that in chronic gangrenous pulpitis, a healthy growth zone of the tooth root is clearly projected on the radiograph in the form of a rounded area of enlightenment with clear, even boundaries.

Unfortunately, with this form of pulpitis, it is not possible to save either the coronal or root pulp, therefore, in the treatment, the method of its complete removal is more often used. Only in permanent teeth with incomplete root formation should one strive to preserve the apical part of the pulp and the zone of tooth growth.

An exacerbation of chronic pulpitis can develop in any of its forms due to an increase in the virulence of microorganisms in the pulp, deterioration of conditions for the outflow of exudate, and a weakening of the child's body's defenses.

Complaints are the same as with pulpitis, constant aching pain is possible, aggravated by pressure on the tooth; swelling of the surrounding soft tissues, acute inflammation of the regional lymph nodes. Sometimes the general condition of the child worsens. Past history of toothache. carious cavity may vary in depth. When the cavity of the tooth is closed, it is opened, but the pulp is less painful than in acute pulpitis.

Differential diagnosis is carried out with acute general pulpitis (especially with the reaction of surrounding soft tissues in young children), acute periodontitis, exacerbation of chronic periodontitis. The radiograph shows destructive changes in the area of the root apex and in the bifurcation of the primary molars.

Intrapulpal granuloma is detected in milk and permanent teeth, mainly in the incisors. This is a variant of chronic rare inflammation of the pulp, characterized by the transformation of the pulp into granulation tissue. When an intrapulpal granuloma is localized in the coronal pulp, as it grows, it approaches the dentin, resorbs it and the root cement from the side of the pulp cavity, resulting in a root fracture.

Usually, an intrapulpal granuloma is discovered by chance during an X-ray examination for another disease. Treatment is carried out immediately after the discovery of a granuloma, otherwise, growing, granulations can lead to perforation of the canal wall and root fracture. Filling of permanent teeth is carried out with a pin. The canals of milk teeth are filled with paste. At chronic forms pulpitis-fibrous and especially gangrenous - X-ray reveals changes in the periodontium and bone, as well as at the root apex and in the area of bifurcation of the molars. At fibrous form in chronic pulpitis of milk teeth, changes on the radiograph are found in 50-57%, and in the gangrenous form up to 80-100% of cases [Kolesov A. A., Zhilina V. V., 1987; Chernukhina T.M. et al., 1999]. Between the clinical picture of pulpitis and the state of the periapical tissues, there is often a discrepancy with the diagnosis, especially in chronic gangrenous pulpitis.

The decision on the advisability of treating chronic pulpitis of a milk tooth should be made after an X-ray examination, comparing both the clinical and radiological manifestations of the disease. In the fibrous form of chronic pulpitis of milk teeth, changes in the bifurcation on the radiograph are detected in 30-50% of the affected teeth, and in the gangrenous form - up to 80%.

In pediatric dental practice, contact and extraoral radiography in the lateral projection, as well as an orthopantomogram, are traditionally used, but they are informative mainly for diseases of the molars of the lower jaw; in diseases upper molars methods such as panoramic radiography are not acceptable, since destructive changes in the periapical tissues of milk teeth are closed by the rudiments of permanent ones. More promising is the method of extraoral contact radiography in an oblique projection, which allows you to get an image of not only the lower dentition, but also the upper one. The image of the lateral sections of the jaws in full size is possible without projection distortion. The tissue and effective equivalent dose is 28-30 times lower than when examining the same number of teeth using intraoral contact radiography. The study in identical projections allows you to monitor the dynamics of destructive changes or the reparative process in the jaw [Kovylina O.S. et al., 2001]. The method of extraoral contact radiography in a tangential (or oblique) projection is performed using the 5D-2 X-ray apparatus and does not require such special expensive equipment as, for example, an orthopantomograph.

Pulpitis treatment

Anxiety before visiting the dentist is experienced by 80% of children. The greatest fear is the drill. Dental interventions are more than others associated with pain and other unpleasant sensations Therefore, the problem of premedication is especially relevant in pediatric dental practice. Psychological and pharmacotherapeutic techniques in restless children with increased emotional reaction relieve excessive stress.

Small tranquilizers are used for sedation. In the treatment of pulpitis, various methods of anesthesia are used to anesthetize the pulp: infiltration, conduction, application, itralligamentary anesthesia, reflex analgesia, electrical anesthesia, as well as mask and intravenous anesthesia. Traditional methods of anesthesia - conduction and infiltration - in children cause a negative reaction in the form of fear of a syringe with a needle. In this situation, the most acceptable is intraligamentary anesthesia, which in last years increasingly began to be used in dental practice, although it was proposed in 1929. There are only single works on the use of this method of anesthesia in children [Shugailov I.A. et al., 1992; Rzaeva T.A. et al., 2001]. Treatment of pulpitis under general anesthesia is carried out in children who cannot tolerate anesthetics, with an unbalanced psycho-emotional state, accompanied by fear, fainting, increased gag reflex, as well as in children with epilepsy, cerebral palsy, mental retardation, etc.

The problem of dental caries and its complications, in particular inflammation of the dental pulp, is one of the most urgent problems of pediatric dentistry. A large amount of damage, untimely or insufficiently effective treatment of pulp inflammation often leads to severe complications in the periapical tissues and the whole body, so the clinical picture and treatment of pulpitis are constantly the subject of careful study and research.

Insufficient knowledge of the anatomy and biology of the pulp in the past led to the fact that, as a rule, little attention was paid to inflammation of the pulp in both adults and children, believing that it would inevitably die. Meanwhile, the pulp is a tissue with a high biological potency, capable of reparative and plastic processes.

The treatment of pulpitis in children has a number of difficulties, which are due to the behavior of the child and age-related anatomical and physiological features of the structure of the teeth. The main goal of treatment is to eliminate inflammatory focus and thereby pain, as well as the prevention of periodontitis and other odontogenic inflammatory processes, restoration of the function and shape of the tooth. In addition, in pediatric dental practice it is very important to create conditions for the correct formation of both milk and permanent teeth, timely physiological resorption of the roots of milk teeth.