Pathological grades of the pulp

The article was professionally consulted by Specialist Doctor II Nguyen Khanh Nam - Doctor of Odonto-Stomatology - Department of General Surgery - Vinmec Nha Trang International General Hospital.

Dental pulp disease is a common disease today. Diseases of the pulp will cause the patient to have a toothache, if left untreated for a long time, it will cause tooth loss due to pulpitis. The article will help you better understand tooth pulp disease as well as the pathological levels of the tooth pulp, thereby helping you prevent and treat this disease in the most effective way.

Dental pulp is an organization made up of connective tissue with many blood vessels, located in the pulp cavity (pulp cavity), including blood vessels, lymph vessels and nerves.
Blood vessels of the tooth pulp are the terminal blood vessels, entering and exiting the pulp cavity by the apical foramen of the root. This is the reason why when the pulp is inflamed, it will easily become congested, pressurized, causing pain, even causing necrosis.
The tooth pulp is surrounded by a layer of hard tissue - hard dentin tissue and is composed of 2 parts: the pulp chamber and the canal system. The pulp has the function of nerve transmission and nourishment of the tooth.
2. What is the pulp disease? Causes of pulpal pathology Dental pulp disease is a common disease, usually manifesting as inflammation of the histological components of the pulp stem from complications of tooth decay.
The main causes of dental pulp diseases include:
Cavity: If tooth decay is not treated properly and promptly, this is a favorable condition for bacteria to survive in the mouth for a long time. penetrate into teeth with open pulp through deep holes and cause disease; Bacterial: Bacteria enter the pulp through the dentinal tubule or through the apical foramen; Pulpitis due to periodontitis , inflammation around the teeth caused by bacteria; The blood vessel supplying the tooth pulp is broken due to physical trauma; Worn teeth, external impact causes chipping or strong trauma to break teeth; Sudden change in ambient pressure; Patients are poisoned with chemicals such as lead and mercury.

Diseases related to tooth pulp are divided into pathological levels from mild to severe.
3.1 Level 1: Reversible pulpitis Reversible pulpitis is the mildest form of pulp disease caused by caries that are not detected and treated in time.
Usually patients with reversible pulpitis do not have any characteristic symptoms. If there is, it is just the feeling of sensitive teeth when encountering irritants when eating cold or hot foods, eating sour foods, feeling sensitive teeth but not for long. These manifestations disappear as soon as the stimulus is removed.
In fact, when people have a mild case of pulpitis, there are no symptoms, so they are often ignored. Patients only feel pain when they go to the doctor and when it is discovered, the pulpitis has progressed to a more severe stage.
3.2 Grade 2: Irreversible pulpitis c Irreversible pulpitis is divided into two types as painless or painful. In the painful form of irreversible pulpitis, the patient may see the appearance of typical pulp pain such as:
Natural toothache; radiating pain on hemifacial and ipsilateral migraine; Pain in the region, can not determine the exact location of the tooth pain; The pain can be for just a few minutes or it can last for hours; The pain is aggravated by changing positions or by hot/cold stimuli. For the painless form of irreversible pulpitis, it can be detected through clinical examination, seeing the teeth with open pulp with yellow speckling, dark red mass or cavities.

3.3 Grade 3: Acute Myelitis Typical symptoms of acute myelitis include:
Spontaneous pain often occurs at night and may persist; When there is food falling into the wormhole or a sudden change in temperature causes pain; Constant dull pain or throbbing pain. Patients can return to their normal activities once the pain is over. However, when acute myelitis appears purulent, the pain will become more severe and intense:
Feeling like a drum in the ear; Painful twitching in the tooth area like a pulsating pulse; Painful teeth protrude higher than normal and have a slight wobble. 3.4 Grade 4: Chronic myelitis This form of the disease is common in young people. Chronic pulpitis is caused by intermittent stimuli of mild intensity and affects the rich vascular pulp tissue.
The pain of chronic pulpitis often has characteristics such as lasting many hours, natural and dull pain, pain in episodes that the interval between pain is very short. There are also cases where the patient has no specific symptoms, but only a slight pain when chewing food.
On clinical examination, if it is chronic pulpitis, the doctor will detect a red nodule growing between the root of the tooth.
3.5 Grade 5: Pulp necrosis Pulp necrosis is the most severe degree of pulp related disease. Some cases of tooth necrosis will experience prolonged pain. However, the majority of the remaining cases do not have any pain symptoms, the pain only appears when the infection and necrosis spread to the root of the tooth. Diseases in the pulp if at the initial stage do not affect the teeth. too much influence on the patient's daily life. However, if not detected and treated promptly, the disease can progress to chronic pulpitis or cause pulp necrosis. The fact that the tooth has necrotic pulp, accumulated at the root of the tooth, will spread to the adjacent teeth, which can lead to inflammation in the adjacent areas, causing serious complications.

4. How to treat pulpitis? Depending on the patient's level of myelitis, the doctor will give different treatment methods:
If it is at level 1, based on the cause of myelitis, the doctor will give appropriate treatment . In some cases, the doctor will perform a filling to protect the pulp from the attack of bacteria.
When pulpitis has reached level 2 and 3, the patient will need root canal treatment and the doctor will fill the tooth.
If the pulpitis is grade 3 in case the tooth is very loose, clinical examination has a large infection around the tooth apex, necrosis, then the doctor will appoint extraction and implant placement after the extraction area is stable. In case the infection is small and the tooth is not loose much, it will need root canal treatment and apex cut to keep the patient's real tooth.
Pulpitis is a disease that causes a lot of discomfort, pain and affects the health of the patient. To safely treat pulpitis, you should choose a reputable clinic or hospital, do not self-treat at home because it can lead to loss of money due to unsafety as well as incorrect treatment. way.

In the process of daily chewing, our teeth face a very high risk of decay, if not properly cleaned, this caries will increase in size and position, destroying enamel and dentin and pulp. Cavities entering the pulp will cause pulpitis.
The situation of caries and pulpitis is increasing, if not properly cleaned, dental fillings will cause pulpitis, irreversible pulpitis, in addition, if the pulp is infected for a long time, it will destroy the pulp, leading to apical inflammation.
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