Treatment options

Biological method of treatment is aimed at reducing the inflammation and renewing of pulp function. Surgical method of treatment envisage total or partly removal of pulp from previously anaesthetized tooth or extraction of pulp after using devitalized substances.

CONSERVATIVE (BIOLOGICAL) METHOD   A — indirect pulp capping; B — direct pulp capping; 1— calcium hydroxide lining; 2 — temporary dressing. Indication. Initial stages of acute pulpitis: pulp hyperemia, acute limited pulpitis, traumatic pulpitisт (accidently pulp exposure) and chronic fibrous pulpitis without clinical and Rtg signs of apical periodontitis. This method is preferable to use when: patient is younger than 30 years old; carious cavity has central location, patient don’t suffer any general diseases and there is no pathological changes in periodontium, short period of inflammation (not longer than 3 days).
SURGICAL METHOD
VITAL AMPUTATION Indication: pulp hyperemia, acute limited pulpitis, chronic fibrous and hypertrophic pulpitis, acute and chronic forms of pulpitis of temporary teeth in the period of roots resorption and in permanent teeth in the stage of root formation. Pulp amputation is indicated to old-aged patients with sclerosed and obliterated root canals and when roots are severely curved. Anaesthetised tooth cariously exposed     Roof of pulp chamber is removed Coronal pulp is removed using slowly rotating large rose-head bur A pledget of cotton wool moistened with hydrogen peroxide is applied to the radicular pulp for 4 minutes.   The cotton with hemostatic liquid is removed and the cavity is dried and lined with zinc oxide eugenol (calcium hydroxide) and the tooth is subsequently restored with temporary dressing.	VITAL EXTIRPATION Indication: traumatic pulpitis (acute trauma with fracture of tooth crown), acute diffuse pulpitis, acute purulent pulpitis, chronic hypertrophic pulpitis (pulp polyp), chronic gangrenous pulpitis, chronic calcified pulpitis (pulp stone). Schematic diagram representing stages of vital extirpation: 1 — before treatment (carious lesion on the proximal surface, tooth previously anaesthetized); 2 — carious cavity preparation; 3 — tooth cavity disclosure; 4 — pulp amputation; 5 — enlargement of root canal orifice; 6 —pulp extirpation; 7 — determination of canal length; 8 — instrumental treatment of root canal; 9 — medicament treatment of root canal; 10 — root canal sealing using canal filler and paste; 11 — final crown restoration.

Main symptoms of pulpitis

The characteristic feature of pulpitis it is sharp, spontaneous pain with irradiation that usually increases at night. There are usually attacks of pain, arising spontaneously; sometimes pain is provoked by temperature, chemical or mechanical stimuli, with a duration of pain for a few minutes after stimuli stops its action (for opposite to caries – pain stops immediately after elimination of irritant).

Duration of pain depends on the intensity of irritant, level of pulp tissue inflammation and capacity of organism to manage diseases.

One of the main characteristic features of pain due to pulpitis it is presence of short periods without pain, so called “light periods”. Attacks of pain could be short with long “light periods” or long periods of pain attack with short “light periods” depending from level of pulp inflammation.

Purulent inflammation of pulp is accompanied by long lasting sharp attack of pain without “light periods”. Pain could be weaken by rinsing oral cavity with cold water.

Pain could be localized or irradiate following V cranial nerve (nerve trigeminal) branches.

From affected maxillary tooth pain could irradiate to adjacent teeth, temporal part of head and forehead (following II division of nerve trigeminal).

From affected mandible tooth pain irradiate into occipital part of head and ear.

It is characteristic that spontaneous, stabbing pain is increased at night, during dreaming, when all outer irritants are excluded.

Irradiation of pain in the course of pulpitis: А - maxillary teeth; Б - mandible teeth. 1 — n. infraorbitals; 2 — n. maxillaris; 3 — n. mandibularis; 4 — n. occipitalis. Zones of pain irradiation are marked in black color.