Study material.

Date: 2015-10-07; view: 413.

Aims: to learn to diagnose various forms of pulpitis in the permanent teeth in children of different age periods.

Clinical manifestations of the pulpitis of the permanent teeth depend on the inflammation stage, degree of root formation and condition of the immune system of the child.

Topicality.

Pulpitis of the permanent teeth in children. The peculiarities of clinical development in children. Clinical picture, diagnostics, differential diagnostics.

Control questions

1. What clinical patterns are characteristic for the acute forms of pulpitis of the temporary teeth?

2. What clinical patterns are characteristic for the chronic forms of pulpitis of the temporary teeth?

3. Tell about the differential diagnostics of acute forms of pulpitis.

4. Tell about the differential diagnostics of chronic forms of pulpitis.

The clinical manifestations of pulpitis depend on the form of inflammation, permanent tooth development period, etiological factor and immune reaction of the child's body.

Hyperemia of the pulp-is a primary stage of acute pulp inflammation. The following complaints are observed: complaints about short, self-induced coclicky aches. The temperature (cold) stimulus produces an attack of pain. An attack of pain lasts for 1-2 min. and it is changed by the painless stage that lasts from 12 to 48 h. . The pain is usually localized. Quite often there are no complaints, but at acute deep caries in the tooth pulp the pathological examination may reveal changes that correspond to the pulp hyperemia.

Objectively: deep carious cavity, the walls and the floor of the cavity contain softened, light-colored or slightly pigmented dentine. The probing of the carious cavity floor is painful in the pulp horn area. The cold stimulus causes acute pain that lasts for 1-3 min. and it doesn't disappear after removing the stimulus.

The differential diagnostics must be performed with: acute deep caries, acute local pulpitis.

Acute serous local pulpitis. The inflammation involves the crown pulp or some part of it, which surrounds the carious cavity.

There are complaints about: acute, colicky, spontaneous pain that appears predominantly at night. The attacks at first last for 15-30 min., with continuous remissions. The periods between attacks of pain at first last for 2-3 hours, but then they become shorter. The pain is localized and the child can show what tooth hurts him. The cold stimulus causes an attack of pain which lasts for 10-20 min. Objectively: deep carious cavity, the cavity floor is covered with the light softened dentine, which is demarcated in layers. The carious cavity isn't connected with the tooth cavity; the pulp horn is often translucent. Probing is painful, more expressed in the local area, in the pulp horn projection.

Acute serous diffuse pulpitis. There are complaints about: acute spontaneous colicky pain irradiating into the branches of trifacial nerve. The tooth aches at night, the child wakes up because of pain, an attack lasts for 30-40 min. Usually anamnesis shows that a day or two before visiting the doctor attacks of pain appeared once or twice at night and lasted for 10-15min, at the time of the visit the pain lasts for hours. The cold stimulus provokes an attack of intense pain. Objectively: deep carious cavity, the cold stimulus causes acute prolonged pain, warm stimulus calms down this pain. The probing causes considerable tenderness through all carious cavity floor.

The differential diagnostics is to be performed with the acute local serous pulpitis, acute purulent pulpitis.

Acute purulent pulpitis. There are complaints about the spontaneous throbbing pain, which develops in waves, from time to time its intensity increases and then decreases, the child can't point to the troubling tooth. At night the pain is more expressed. The pain is intensified under the action of the warm stimuli (higher than 37°С). The cold stimuli possess the calming effect. The pain is less intensive in the teeth with immature roots, it doesn't irradiate into the trifacial nerve branches.

Objectively: the carious cavity, situated within the peripulpal dentine, has softened floor. Probing of the carious cavity floor is painless, at disclosure of the tooth cavity some amount of pus or bloody-purulent exudate is excreted. The deep probing is painful. After opening the pulp chamber of the tooth cavity the pain intensity quickly subsides. If the tooth cavity is opened spontaneously, the inflammatory process may attain the chronic development. The tooth percussion is often painful which evidences about perifocal periodontitis.

The differential diagnosis is to be made with the acute serous diffuse pulpitis and acute purulent periodontitis.

Acute traumatic pulpitis.The first sign of the pulp affection is an acute pain and blood appearance. The pain is abruptly intensified during probing. If the perforating orifice is visible, we shouldn't attempt to probe an opened pulp to prevent its additional injuries and infecting. On the floor of the carious cavity we can see a punctuate orifice, through which we see the scarlet red pulp. opening the pulp that results from the tooth crown fracture is a consequence of the obtained acute trauma( contusion). At the traumatic injuries of the dental crown ( without opening the tooth cavity) we often observe an acute pulpitis with the subsequent posttraumatic pulp necrosis which usually develops in 6-7 days after the injury.

Chronic fibrous pulpitisis the most common form of the permanent teeth pulpitis on both stages of mature and immature root. The peculiarity of the chronic fibrous pulpitis in children is that it may develop as a primary-chronic process without the preceding stage of acute inflammation.

There are complaints about pain after the action of a mechanic stimulus ( food, bristles of the toothbrush). The pain slowly subsides after removing the stimulus. Though, in children the chronic fibrous pulpitis may develop asymptomatically, it is detected during the planned sanitation of the oral cavity

A spontaneous colicky pain is characteristic for the chronic fibrous pulpitis, during exacerbation of the chronic inflammatory process. Objectively: deep carious cavity connected with the dental cavity. Though in children the chronic fibrous pulpitis may develop at closed dental cavity. If there is connection between the dental cavity and the carious cavity, then probing of the orifice is painful, the pulp is dark-red, slightly bleeding.

Differential diagnosis: we should differentiate between the acute chronic deep caries, chronic gangrenous pulpitis ad the chronic periodontitis.

Chronic hypertrophic pulpitis. There are complaints about:bleeding “from the tooth”, quite rarely- onto the pain at tooth brushing, food intake.

Objectively: the carious cavity, filled with epithelized granular tissue which overgrew as a red polyp with the smooth surface, fills almost all the carious cavity. Its surface is slightly sensitive, its probing causes tenderness and slight bleeding. The differential diagnostics: we should differentiate between the overgrowth of the dental papilla into the carious cavity and the granular tissue which got into the carious cavity through the perforation on the floor or wall of the tooth. The roentgenographic examination will provide for the differential diagnosis.