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4TREATMENT OF PULP PATHOLOGY IN PATIENTS WITH
CHRONIC PERIODONTITIS
1Xaydarova Durdona Munisovna, 2Tilavov Xasan Isomiddin o'g'li
1,2Samarkand State Medical University. Faculty of Dentistry, Department of Therapeutic
Dentistry
https://doi.org/10.5281/zenodo.10281121
Abstract. Our teeth are not only dense organic tissues covered with hard tooth enamel. Inside each tooth is hidden a complex system of blood vessels and nerves necessary to maintain the health of the gums. The sensitivity of the soft tissues in the oral cavity is ten times greater than the sensitivity of other organs. Therefore, any infection that enters the tooth causes inflammation and severe pain. Pathology is also triggered by temperature changes: burns or hypothermia. Unbearable pain forces a person to treat pulpitis and seek help from a dentist. In order to find the right way to treat the disease, you need to know the origin of its occurrence. The core or pulp of the tooth is responsible not only for tooth sensitivity, but also for the production of dentin. Tissue strengthens the tooth from the inside.
Keywords: anatomical characteristics of the pulp, periodontitis, pulp pathology, chronic periodontitis.
Anatomical characteristics of the pulp depend on the type of teeth. In the lateral row, as a rule, there is a chamber with three dental canals. The front row and incisors each have one horn. Logically, molars are more difficult to treat than canines or premolars.
Pathological changes in pulp tissues cause swelling and unbearable pain. The pain worsens when touching hot food or pressing on the tooth.
The most common cause of inflammation of the dental nerve (pulp) is the presence of caries. And in a deep stage. The infection reaches the soft tissues through the destroyed tooth tissue, provoking the inflammatory process. A similar situation occurs when the filling falls out or is damaged, when the pulp "opens".
Bacteria can enter the tooth cavity from another source of infection in the body. Inflammation also occurs when the tooth is damaged, when minerals accumulate in the pulp, or when low-quality components are used to fill the canals.
Also, if the nerve is heated during the preparation for prosthetics, treatment of pulpitis may be required. If the sensitivity is increased, swelling of the pulp may occur as a result of the use of chemicals during therapy. During the destruction of the carious cavity, the infection may accidentally enter the pulp chamber.
The dangers of not taking care of your teeth
If the inflammatory process has started, the infection will completely destroy the nerve over time. This requires removing the pulp. But in the absence of therapy, the main risk is the spread of the pathology to the root of the tooth. Here we are talking about tooth loss. Well, the final chord: in an advanced stage, purulent inflammation causes gumboil (destroys the jaw tissue). In this case, decide for yourself how much your patience will be justified.
Stages of the disease
The classification of any disease helps to make a quick and correct diagnosis and to choose an effective treatment method for the patient. In the case of pulpitis, everything is relatively simple, there are only two subtypes - acute and chronic.
The first type of inflammation occurs with advanced forms of caries. Bacteria destroy tooth enamel and dentin and the infection enters the pulp. The disease is accompanied by aching, sharp pain, which is aggravated by mechanical or thermal effects on the tooth. Severe pain attacks may occur at night.
Then the process goes to the next stage - all the tissues of the tooth nerve are damaged. The pain syndrome changes from pulsating to constant, unpleasant sensations spread throughout the jaw. Pus forms in the tooth cavity. The phase lasts no more than two weeks. If the treatment of pulpitis is not started in time, the pathology will go to a chronic stage.
To determine the correct diagnosis, the dentist will conduct a preliminary examination. Because if pulpitis develops against the background of other diseases, the diagnosis includes 4-5 stages. The process begins with communication with the patient. It is necessary to understand the stage of inflammation, which is especially important in chronic pulpitis. Therefore, the doctor asks you to describe the nature of the pain in detail. Then a "manual" examination is carried out using medical devices (dental mirror, etc.). In addition, the doctor checks the sensitivity of the affected tooth to temperature changes and weak electric current.
The examination ends with an X-ray examination to assess the condition of the dental nerve and canals. After collecting data and analyzing the image, the doctor plans the pulpit treatment process and coordinates it with the patient.
How to fight the disease
It is not difficult to deal with pulpitis at the initial stage. The nerve in the tooth is preserved, and the doctor relieves inflammation with the help of therapeutic procedures. Biologic treatment eliminates inflammation by antibacterial treatment of the damaged tooth without removing the nerve. After removing the carious tissue and disinfecting the pulp chamber, the dentist applies a compress with calcium hydroxide and places a temporary filling. Then, 3-7 days later, during the next visit, the doctor will take an X-ray. If there is no inflammatory process, then a permanent filling is installed. However, this technique requires a highly qualified doctor, so it is rarely used. For example, with traumatic inflammation of the dental nerve.
It is very important to preserve the pulp, because ... If it is present, the tooth is constantly strengthened due to the production of dentin. Conservative therapy has age restrictions - it is carried out up to the age of 30.
Partial and complete nerve removal!
If the coronal component of the nerve is separated from the root, partial extraction of the pulp is also acceptable. There must be a large amount of intact periodontal tissue to warrant surgery.
The procedure is performed under anesthesia for patients under 45 years of age.
In practice, pulpitis is treated surgically. The nerve is completely removed, which saves the patient from relapse and retreatment.
Pulp removal is done in two ways:
Release of living nerve.
Pulp pre-killing (devitalization) with subsequent removal.
In the first option, all work is done in one session. The dentist removes the affected tooth tissue, thoroughly disinfects the cavity, and then removes the inflamed nerve. At the final stage, the filling is installed.
If it is not possible to remove the living nerve from the tooth, it is treated with a medical paste made of arsenic or paraformaldehyde. After 1-2 days, the pulp dies and is removed painlessly. Patients cannot always visit the doctor the next day, in which case the dentist fixes a less concentrated composition for up to two weeks. A temporary filling is placed on top. During the next visit, the doctor will treat the canals with an antiseptic and fill the tooth. Important: this method of treating pulpitis is not used when there is pus and dead tissue in the pulp.
Traditionally, the treatment of pulpitis consists of 4 stages:
Application of local anesthesia. Nerve nodes are very sensitive to any impact, so painkillers are indispensable. If caries is present, the affected tooth tissue is removed first. Sometimes it is necessary to remove a healthy part of the tooth to access the pulp. The tooth nerve is removed using a special tool, a pulp extractor. Depending on the stage of the disease, the pulp is pre-treated with arsenic or removed alive. Dental canals are measured and thoroughly disinfected. After treatment, the tooth is filled: first the root canals, then the upper, coronal part of the tooth. In difficult cases, for example, with chronic pulpitis, the doctor installs filling materials only in the canals to monitor the possible recurrence of the disease. If inflammation reappears, intermediate therapy with antibiotics is prescribed. After the permanent filling is installed, the patient may experience pain. It usually does not last more than 2-3 days, a reaction to cold foods and drinks. If the discomfort continues, then the inflammatory process has started again and you should visit the dental office as soon as possible.
Instructions during pregnancy
There is a myth that it is impossible to treat teeth while expecting a child. This misconception can have serious consequences. Infection, for example, in the form of caries, can spread throughout the body through blood vessels.
In addition, it is a false belief that X-rays harm the development of the fetus. It has been proven that modern equipment has a minimum radiation dose that does not affect the body. Chronic inflammation is more dangerous. Therefore, when symptoms appear, you should not delay the treatment of pulpitis or caries. The process of childbirth is associated with a decrease in immunity and, as a result, an increase in sensitivity to bacteria and infections. Tooth enamel is not very strong in pregnant women, because... All nutrients are directed to the growth of the baby. Therefore, the appearance of pulpitis and deterioration of the condition of the teeth is a common phenomenon. The second trimester is the most favorable period for dental care. During this period, the child is protected from harmful substances by the placenta. However, if an inflammatory process occurs in the dental nerve, it is not recommended to delay the treatment in order not to expose the baby to unnecessary risk.
During pregnancy, the doctor chooses a gentle treatment method, the filling is installed only in the dental canals. If possible, without using anesthesia. After birth, the patient is given a permanent filling. X-ray examination is performed only in emergency cases.
Inflammation of the nerve in the wisdom tooth
Eight has its own characteristics and the doctor often chooses to remove the tooth. The complexity of the therapy depends on the anatomical features of the third molars. Crooked roots, lack of access to the tooth, partial coverage of the gums make the treatment of pulpitis of the eighth
number equal to jewelry work. And this requires the experience and high qualification of the
doctor.
Conclusion
Periodontitis results in the loss of periodontal attachment structures. If left untreated, tooth
loss eventually may result.
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