Study material

Date: 2015-10-07; view: 419.

Pulpitis is one of the most common causes of visiting pediatric dentist. The knowledge of clinical signs of various forms of pulp inflammation and timely diagnostics may provide for the adequate choice of treatment method and prevention of complications.

Topicality.

Pulpitis of the temporary teeth in children. The peculiarities of clinical development in children of various age periods. The clinical picture, diagnostics, differential diagnostics.

Control questions

Treatment of congenital dentine disorders.

In cases, when the dental appearance remains without changes, no restorative treatment is usually required. The difficulties appear at the necessity of endodontic dental treatment, at which we must consider the pulp cavity anatomy. For example, in the 1^st type of dentine dysplasia, when the root canals are almost absent, we must create them artificially.

1. What are the signs of incomplete amelogenesis?

2. In what way are various types of incomplete amelogenesis different?

3. What are the signs of the first type of incomplete dentinogenesis?

4. In what way is Steinton- Kapdepon syndrome manifested?

5. How are various forms of dentine dysplasia manifested?

Aims: to master the diagnostics and differential diagnostics of pulpitis of the temporary teeth.

Tasks:

1. To know the classification of pulpitis of the temporary teeth.

2. To know the rules of clinical development of various forms of pulpitis of the temporary teeth.

3. To be able to perform the clinical and paraclinical examination at diagnostics of pulpitis of the temporary teeth.

4. To learn the characteristic clinical signs of acute and chronic forms of pulpitis of the temporary teeth on various stages of tooth development.

5. To be able to perform the differential diagnostics of pulpitis of the temporary teeth.

The development of inflammation in the pulp and clinical manifestations of pulpitis of the temporary teeth have some peculiarities:

1 – Inflammation of the pulp usually develops at a shallow carious cavity.

2 – The topographical-anatomical and morphological peculiarities of pulp of the temporary teeth provides for quick distribution of the acute inflammation onto the whole crown and root pulp( during 2-3 hours since its appearance).

3 – The predominating forms of pulpitis in the temporary teeth are the chronic ones.

4 – Clinical picture of one and the same form of pulpitis is manifested through a various complex of symptoms depending on the period of tooth development (immature root, period of stabilization or resorption of the root).

5 – Serous form of acute inflammation quite quickly develops into the purulent one, which is related to the prevalence of staphylococcal infection.

The classification of pulpitis of the temporary teeth has been accepted in the National Medical University according to I.O. Novik's classification.

I. Pulpitis acuta- acute pulpitis: 1) pulpitis acuta serosa diffusa;- acute serous diffuse pulpitis 2)acute purulent pulpitis-pulpitis acuta purulenta; 3)acute traumatic pulpitis-pulpitis acuta traumatica;

II. Pulpitis chronica- chronic pulpitis: 1) simple chronic pulpitis, fibrous -pulpitis chronica simplex, seu fibrosa; 2)chronic hypertrophic pulpitis- pulpitis chronica hypertrophica; 3)chronic gangrenous pulpitis - pulpitis chronica gangraenosa;

III. Pulpitis, complicated with periodontitis.

Acute serous diffuse pulpitis. There are complaints about spontaneous colicky painwhich appears predominantly at night. The attacks of pain are long, with short intervals of painless periods. A child can't sleep, often wakes up because of pain. Objectively: the carious cavity may have different depth( often it is deep), filled with light softened dentine. An attempt of removing the softened dentine as well as probing the floor of the carious cavity causes acute pain. The cold stimulus in the tooth causes acute pain. The tooth percussion may be painful.

Acute purulent pulpitis.There are complaints about the spontaneous, throbbing pain without the distinct localization. The pain increases at night. It gradually intensifies and becomes permanent. An attacks and intensity of pain appear because of hot, sometimes it decreases under the cold stimulus action. The purulent pulpitis develops in the temporary tooth predominantly in the end of the second day since the disease onset.

Objectively: the carious cavity isn't connected with the tooth cavity. An attempt of removing with the excavator of softened dentine from the carious cavity floor is accompanied with pain. The probing of the floor is often accompanied with opening of the tooth cavity and pus excretion, after which the pain decreases. At purulent inflammation of pulp of the temporary teeth percussion is always painful because of development of acute perifocal periodontitis. The general condition of the child aggravates, the body temperature increases, the sleep is disordered, the child refuses food.

Chronic fibrous pulpitisis the most common form of the chronic inflammation of pulp in the temporary teeth. Its peculiarity is that it may develop as the primary-chronic process.

Complaints: Sometimes the child complaints about pain in the tooth because of changes temperature or food that gets on the tooth during meals.

Objectively: the carious cavity with a softened dentine or remnants of the filling after removal of which we may see connection of the carious cavity with the tooth cavity. At its probing we observe abrupt tenderness and slight bleeding of the pulp. The roentgenological examination of the temporary tooth with the chronic fibrous pulpitis quite often reveals the destruction foci in the periapical tissues.

Chronic hypertrophic pulpitismay be diagnosed in the temporary teeth rarely and it develops as a result of continuous mechanical stimulation of the tissue of the denuded pulp, which leads to overgrowth of the granular tissue in the pulp and gradually fills the whole cavity.

The tooth almost doesn't trouble the child. The children may complain about “bleeding teeth” during the food intake.

Objectively: The polyp of the pulp is red, on the broad pedicle, it may fill the shole carious cavity, its' probing is slightly painful, always accompanied with bleeding. The percussion is painless.

The differential diagnostics is to be performed with the gingival polyps, grown into the carious cavity through the perforation orifice at the floor or wall of the tooth, or granulations, grown into the orifices of the root canals at a chronic granular periodontitis at the period of root resorption.

Chronic gangrenous pulpitisis a consequence of the acute purulent or chronic fibrous pulpitis of the temporary tooth. There are complaints about unpleasant sensations in the tooth, pain, especially during the hot food intake. Though it is quite often that the complaints are absent, and the parents note that the child has unpleasant smell from the mouth (foeter ex ore). The tooth crown color may be changed: from the dull to grayish.

Objectively: the examination detects carious cavity of various depth, the tooth cavity is opened, crown pulp is absolutely or partially necrotized, it is grey, with gangrenous odor. Its superficial probing is painless, the pain appears during deep probing in the orifices of the root canals or even deeper. It is necessary to be differentiated with a chronic granular periodontitis.

Pulpitis, complicated with a periodontitis.At chronic, fibrous and especially gangrenous pulpitis of the temporary teeth the roentgenogram reveals destructive changes in the area near the root or the bifurcation area. At these forms of pulpitis it is necessary to perform the roentgenographical examination.