Treatment of pulpitis in children, pulpitis of milk and permanent teeth. Pulpitis of primary (temporary) teeth in children Modern methods and means of treating pulpitis of primary teeth

Pulpitis is an inflammatory disease of the tissues inside the tooth (pulp). It develops as a consequence of untreated caries (or errors during its treatment), or as an independent process, for example, after a tooth injury. Inflammation can be acute or chronic. In this article we will look at pulpitis on baby teeth: causes, types, treatment.

Most often, pulpitis of a baby tooth develops as a result of the following factors:

• - the effect of toxins released by microbes in the carious cavity, their metabolic products and decaying tooth tissues;
• - tooth trauma (this also includes careless rough mechanical treatment of a cavity due to caries, accidental opening of a nerve by a doctor);
• - acute infectious disease of a child with the presence of bacteremia and decreased immunity;
• - toxic effect of incorrectly selected filling material in the treatment of caries, treatment of the cavity with strong irritating antiseptics (alcohol);
• - overheating of tooth tissues during preparation of a carious cavity (in the absence of water cooling for such a procedure);

Incidence of pulpitis

In primary front teeth, pulpitis develops more often at 2 years of age, and in molars (large distant teeth) - in children from 3 to 7 years of age. Inflammation of the pulp in primary molars occurs 5 times more often than in the front teeth. The lower teeth are affected more quickly.

Classification of pulpitis

• Acute pulpitis: serous, purulent, with involvement of periodontal tissue (surrounding tissues) and lymph nodes in the process
• Chronic pulpitis: fibrous, gangrenous, hypertrophic
• Exacerbation of chronic pulpitis.

Manifestations of pulpitis

Inflammation of the tissues of a baby tooth develops faster and often “skips” the classical stages of this process compared to pulpitis of a permanent tooth. The picture of pulp inflammation in childhood has some features:

1. inflammation of the pulp develops in teeth with a small carious cavity
2. the process spreads very quickly
3. an acute process becomes chronic after a short period of time, so chronic forms or their exacerbation are more common in children
4. symptoms of pulpitis strongly depend on the stage of tooth formation
5. frequent reaction to inflammation of the tissues surrounding the tooth
6. general reaction of the body (fever, drowsiness, headache, leukocytosis and increased ESR in the blood)

Acute pulpitis of temporary teeth

This form is found only in teeth with a fully formed root before its “resorption” (physiological resorption) begins. Acute inflammation is an active reaction of the tissues inside the tooth to an irritant, which a child’s healthy and strong body is capable of. Most often, the process develops at the age of 3-6 years. It is worth noting that the final formation of milk teeth ends only 1.5-2 years after their eruption (for single-rooted teeth) and 2.5-3 years (for multi-rooted teeth). The main symptoms of acute inflammation:

• sudden onset of severe toothache, most often in the evening or at night
• the pain intensifies from cold or warm (if pus appears in the tissues, the pain becomes stronger from hot, and calms down from cold)
• pain when clenching the jaws, getting food on the tooth
• There may be slight swelling of the soft tissues and enlargement of the lymph nodes

Acute pulpitis occurs in a tooth with a small carious cavity or its absence. If the cavity is deep or the tooth is severely damaged, such pulpitis is considered an exacerbation of chronic pulpitis. With the development of acute purulent inflammation, the pain is so severe that the child cannot accurately identify the diseased tooth, and sometimes even the side of the jaw. To clarify, you can watch the baby - he will lie on the “sick” side.

Chronic pulpitis

It often develops as an asymptomatic process. It often occurs both in deep carious cavities and in teeth with a filling. In 40-60% of cases, there is a hidden inflammatory reaction from the tissues surrounding the tooth, so it is recommended to take an x-ray to clarify the treatment plan. Pain in this form of pulpitis appears during the action of an irritant - food entering the carious cavity, from cold drinks, on the street. Of all the chronic forms, fibrous pulpitis is the most common. Its symptoms:

• pain while eating, children try not to eat on the “sick” side (when examined, there will be more plaque on this side)
• sometimes there is pain from cold water when it gets on a tooth

With chronic gangrenous pulpitis, pain does not always occur. Often the tooth is discolored (gray, dark) and differs from others. Symptoms of gangrenous pulpitis:

• pain is absent or occurs from hot
• pain does not appear immediately, but some time after the action of the stimulus
• In addition to pain, there may be a feeling of heaviness in the tooth, a feeling of fullness, a tooth “not like everyone else”
• there is an unpleasant odor from the tooth

It is noted that in children in 62% of cases, chronic gangrenous pulpitis of a baby tooth ends with periodontitis (inflammation of the tissue around the tooth).

Chronic hypertrophic pulpitis is rare and manifests itself in the form of growth of pulp tissue into a carious cavity, when the exposed exposed tissue is subject to constant mechanical irritation, and the tooth crown is severely destroyed.

Exacerbation of chronic pulpitis is clinically similar to acute inflammation (sudden severe pain in the tooth, aggravated by irritants, swelling, general reaction of the body). The differences come down to the main ones:

• the presence of a decayed tooth or a deep cavity in it
• pain in the past of varying intensity

Treatment of pulpitis of baby teeth

Timely treatment of pulpitis allows in most cases to save the tooth. The principle of treating inflammation of the tissues inside the tooth is to remove them. The difficulty of treatment lies in the fact that the doctor can only remove that part of the pulp that is in the crown. Its root part can be removed only in fully formed roots, but this is rarely done due to the risk of injuring deeper tissues and the rudiments of permanent teeth.

If the child allows injection anesthesia, then during the same visit the doctor removes the carious foci of the baby tooth and the coronal pulp, leaves a special medicine at the bottom of the cavity and the mouths of the canals, which disinfects the remaining tissues, causing them to mummify. This prevents the development of complications. Depending on the drugs used, such a medicinal “pad” is replaced over time, or left under a permanent filling. Some doctors still use the technique of applying arsenic or its analogues in order to first “kill” the nerve, and only then clean out the cavity a few days later. With this tactic, it is necessary to strictly observe the duration of action of the medicine and its amount, otherwise toxic inflammation of deeper tissues will follow with the development of periodontitis. Then it will be difficult to save the tooth. The doctor must warn parents about this.

Pulpitis of baby teeth is not an indication for their removal. But this disease needs to be treated on time. With improper treatment or lack of it, a tooth can easily be lost, and in the worst case, damage to the permanent tooth germ can occur. Therefore, the surest and most correct decision is to take care of your teeth on time, treat caries and monitor the child’s hygiene, monitor the presence of fillings in already treated teeth and undergo regular preventive examinations at the dentist.

Few children are able to react calmly to a visit to the dentist. What scares them most is the drill - an unknown, noisy and suspicious device. But the situation can become even more problematic if a sharp toothache is added to this, indicating childhood pulpitis. To avoid this, you need to know exactly how to prevent and identify dental pulpitis in children.

Pulpitis in children is the same inflammation of the pulp found in adults. But, as a rule, this disease is more common in childhood. This pattern is associated with the rather loose connective tissue of primary teeth, as well as wider root canals and less mineralized dentin. Also, pulpitis of baby teeth occurs more often than molars because children have an immature immune system. That is, the risk of having any inflammation or a common cold is much higher than in adults. But nature has balanced this nuisance - there are practically no painful effects in children. However, the absence of pain is not always a sign that there are no problems.

Pulpitis of primary teeth is a common disease in children.

Classification of the disease

Detecting pulpitis in a 2-year-old child is quite problematic, but if you know the types of such inflammation, then the chances of timely diagnosis of the disease will increase significantly.

Pulpitis of hypertrophic type

This type of pulpitis in a child 3 years of age or older is very unlikely and is mainly the result of long-term chronic irritation. Signs of this inflammation are considered to be an almost completely destroyed dental crown, as well as connective tissue that has grown due to prolonged damage. And although children do not experience pain in this case, except for minor pain during chewing, when probing the tooth begins to bleed. It is also important that when diagnosing pulpitis in children 4 years of age or another age, the doctor is able to distinguish the manifestations of its hypertrophic form from periodontal granulation tissue, as well as the gingival papilla.

Gangrenous pulpitis: symptoms

The development of the gangrenous form of the disease in non-molar teeth is mainly a consequence of acute diffuse inflammation, which, in turn, often begins to develop from acute focal pulpitis in children. In this case, there is a darkening of the diseased tooth and a virtual absence of pain. During the examination, a putrid odor from the mouth, caused by tissue decay, is sometimes detected, but the carious cavity generally remains shallow. A swollen fistula may be found on the gum, in the area of ​​the root apex. Also, there are frequent cases of painless enlargement of lymph nodes in a child.

Chronic pulpitis

Most often it occurs with shallow caries, without affecting the tooth cavity, and prevails over the acute version of the inflammation. This disease is prone to exacerbation if the child’s body’s immunity is weakened. Symptoms of exacerbation include complaints of constant nagging pain, which intensifies during mechanical stress (pressure on a sore tooth, chewing). In addition, an exacerbation of the disease is accompanied by inflammation of the lymph nodes and swelling in the soft tissue of the gums; sometimes there is a deterioration in general health and an increase in temperature. In general, this form of the disease in children is similar to a similar phenomenon in adults.

Chronic fibrous pulpitis

Chronic fibrous pulpitis in permanent teeth in children occurs as often as in milk teeth. At the same time, in teeth at the stage of resorption or formation, it often occurs with a closed dental cavity, and in already formed teeth - with rather thin dentin in the area of ​​the bottom of the carious cavity. Therefore, chronic fibrous pulpitis of baby teeth does not affect permanent teeth in any way.

This form of inflammation is characterized by complaints of pain when eating. Sometimes there are aching pains after eating that can last for hours. Depending on the duration of the inflammatory process and the general condition of the tooth, the severity of the pain varies. Therefore, the shorter the history (duration of inflammation), the more intense and severe the pain, and the longer it is, the less pronounced the pain effect is and appears only in the presence of external influence.

Partial acute pulpitis

Finding acute partial pulpitis in a 5-year-old child’s baby teeth is rare, because due to the characteristics of children’s bodies, this type of inflammation turns into an acute form in just a few hours. It is almost impossible to notice such a process at the initial stage of development, so parents will have to pay attention to the acute form of the disease. This is due to the fact that due to the structure of baby teeth with their wide root canals and unformed roots, the outflow of exudate occurs unhindered and therefore the pain is mild.

Features of the treatment of childhood pulpitis

Typically, the process of treating pulpitis of baby teeth is carried out after the development of inflammation, since it is very difficult to initially identify this disease in childhood. In addition, diagnosis is also complicated by the psychological characteristics of children who do not tolerate the examination procedure well. Therefore, in order to avoid the transition of caries of baby teeth into a further form - periodontitis, parents are recommended to take their child to a specialist every 4-6 months. And if the dentist identifies pulpitis of a baby tooth, the treatment of which is required immediately, he will proceed from the symptoms and group of teeth, choosing the correct method of therapy.

How is pulpitis treated in children?

In pediatric dentistry, a number of methods are used to treat pulp inflammation:

• With its preservation: treatment of pulpitis in children with unformed roots using a non-surgical method is a process in which the root and coronal parts of the pulp remain suitable for further functioning. In this case, the method of treating pulpitis in children with iodine, as well as treatment with forfenan (for poor patency of the canals), can be used. Forfenan is one of the best modern materials, which has a number of necessary qualities for maximum preservation of your own tooth - long-term and effective antiseptics, reliable canal filling. This paste does not shrink and is also radiopaque, which allows you to control the quality of the filling. However, even with conservative treatment, alkaline phosphatase can be suppressed and the deposition of replacement dentin slowed down, which is caused by the use of outdated filling materials;
• With partial amputation of connective tissue: only the coronal pulp is removed to provide conditions for the vital activity of the root part. This method is not relevant for temporary teeth, but is highly recommended in case of permanent teeth disease, since it allows you to preserve the root part of the pulp, which is responsible for the formation of tooth roots;
• Elimination of pulpitis in children by surgical treatment: in this case, both parts of the pulp are removed at once - root and coronal, and the canals are sealed;
• In some cases of advanced inflammation, a decision may be made to remove the diseased tooth.

Regardless of the chosen method, parents should remember that treating pulpitis in children in one visit is not always possible, and you should count on several sessions at once. At the first visit, the doctor will clean the tooth of dead tissue, apply a medicinal paste and cover everything with a temporary filling. It is possible that the canals will be sealed already at the first visit. A permanent filling is placed only if the dentist is confident that relapse of inflammation is prevented.

Among many parents, there is a very persistent and at the same time dangerous misconception that it is not necessary to treat baby teeth, unlike permanent teeth. They say that it is pointless to treat caries and even pulpitis in baby teeth, since these temporary teeth will soon give way to permanent teeth anyway. The most striking thing is that even the onset of severe pain in a child often does not become an argument that can destroy such a misconception. Meanwhile, such an attitude towards the treatment of baby teeth can lead to the most unpleasant and even dangerous consequences.

What is pulpitis?

The development of pulpitis in childhood is most often caused by advanced caries. Compared to an adult, a child experiences less painful sensations with pulpitis of a temporary tooth, and this gives rise to the practice of parents using improvised means that are unable to help solve this problem.

If you start treating this disease, then pulpitis of baby teeth in a child can provoke various complications, in particular, periostitis or periodontitis, but the saddest thing is that there are even deaths caused by infection of the baby’s blood. In order not to pose a threat to the life and health of the child, caries should be treated in a timely manner, but if treatment is delayed and pulpitis begins, then in no case should you try to drown out the pain on your own or wait until the tooth falls out; you should contact a specialist for help as soon as possible.

Forms of the disease

Speaking about pulpitis in children, we can distinguish the following forms:

1. Hypertrophic. The rarest variety, it develops as a result of prolonged exposure to irritants. The child does not feel any particular pain, except perhaps a slight one during the process of eating, but the gums bleed when probing is performed, in addition, its characteristic features will be overgrown pulp tissue and a completely destroyed crown.
2. Gangrenous. Despite the mild pain felt, the child experiences a change in the color of the tooth enamel and its darkening. The carious cavity does not have a particular depth, but due to the decay of the pulp and the influence of pathogenic microorganisms, an unpleasant putrid odor from the mouth is noted. A likely consequence may be inflamed lymph nodes and the appearance of a fistula.
3. Chronic. This form of childhood pulpitis develops as a consequence of caries in its shallow form. An exacerbation usually occurs as a result of a decrease in immunity; the symptoms will be: swelling of the soft tissues, constant pain, which begins to intensify with the slightest impact on the tooth, as well as a clear deterioration in the child’s well-being.
4. Exacerbation of chronic pulpitis. This usually happens when the child’s immunity is weakened in combination with poor outflow of harmful secretions. As a result, a 3-5 year old child complains of aching pain, which intensifies when the slightest impact is applied to the tooth, swelling appears, and the lymph nodes become inflamed. The carious cavity has varying degrees of depth, and the susceptibility of the nerve endings is at a low level. Detection of such problems becomes possible using an x-ray.
5. Acute partial pulpitis. Another rare form of the disease, the pain is minor and the disease quickly develops into general pulpitis.

Symptoms of the disease

Pulpitis of primary teeth is characterized by a rare variety. There are often cases when a child does not complain of any problems at all, but it happens that the patient has all the acute symptoms of the disease. The worst thing is that, due to the inherent looseness of tissues in baby teeth, childhood pulpitis often becomes the cause of periodontitis; in adults, this transition occurs much less frequently.

Diagnosing childhood pulpitis is difficult because, unlike an adult, a child can rarely accurately convey his feelings to the doctor, so the initial stage is very often overlooked by parents and a small patient comes to the dentist with an already acute form of the disease.

The main symptoms of this disease will be:

• paroxysmal pain, aggravated by impact on the tooth;
• swelling of the tissues around the diseased tooth;
• lymphadenitis;
• deterioration in the general well-being and condition of the child.

Traditional approaches to the treatment of pulpitis of primary teeth in children

The simplest solution to the problem of childhood pulpitis is the elimination of the problematic tooth, but only in theory, in practice it should be understood that such a surgical intervention, firstly, can psychologically traumatize the child, and secondly, can cause malocclusion in the future. Therefore, it is advisable to put treatment first and talk about removal in situations where there are no other options left.

The current standard practice of treating pulpitis in children is based on the already outdated method of devital amputation, which can in a certain sense be called concern for the mental state of the small patient, because when using this method there is no impact on the dental canals of dental instruments. The essence of the technique is that arsenic or devitalizing paste is applied to the tooth causing problems; the first acts faster, no more than two days, the second takes longer, about one week. After this, during subsequent visits to the doctor’s office, a resorcinol-formalin mixture and paste are pumped into the dental canals, which, due to the mummification of the affected pulp, prevents its further decomposition. Finally, a filling is placed on the temporary tooth.

After a certain time has passed after the completion of the treatment procedure, the teeth become stained in various shades of red, but this is not the most difficult consequence of this treatment technique. Much more problematic is the fact that the paste used by the dentist causes the creation of a kind of plug in the canals of already permanent teeth and subsequent treatment of such a tooth becomes difficult and sometimes even fundamentally impossible.

Modern methods and means of treating pulpitis of primary teeth

When a child is able to withstand, due to his calmer temperament, a fairly long-term treatment of pulpitis, then the method of vital or devital extirpation is used to combat the disease. During the first visit to the dentist, during vital extirpation, the “nerve” is immediately removed from the canal, and during non-vital extirpation, a special paste is applied to destroy the affected pulp. After this, the dental canals are treated mechanically and with the help of medications, then the pulp is extracted and sterilization is performed. Next, the paste is used to fill the canals, and the need for its use is determined by the anti-inflammatory effect of this paste. Over time, this paste is absorbed simultaneously with the roots of the temporary tooth. Zinc-eugenol paste, which is very popular among doctors, as well as Magipex paste have shown good results in dentistry.

There are also many supporters of another method - vital amputation. In this case, only partial removal of the coronal part of the “nerve” is subject to removal; after this, medications are placed on the pulp, for example, “Pulpodent” or Pulpotec. These products have excellent anti-inflammatory properties; in addition, they keep the pulp in a normal state and block pain, and they do this not only during the treatment procedure, but also after its completion.

Specifics of treatment of pulpitis of a baby tooth with unformed roots

Unformed roots are understood as the roots of a baby tooth, the apex of which remains uncovered when they erupt. Treatment of pulpitis in children of such teeth is associated with some difficulties, which are determined by the structure itself and the characteristics of the root structure:

• short length;
• large width of canals and apical openings;
• any disruption of the tissues of the apical part of the root can provoke their destruction, which dictates the need to carry out all operations with extreme caution and accuracy.

It is impossible to use the extirpation technique in this case, so doctors in most cases have to resort to amputation or biological treatment:

1. Amputation method. It is very popular and is based on extracting the affected pulp from its chamber.
2. Biological method. It is based on the preservation of the pulp in its normal state, but it must be taken into account that it has a lot of contraindications and is extremely demanding in maintaining antiseptics during work, otherwise the return of pain cannot be avoided. First, the cavity affected by caries is cleaned from dead tissue, after which a paste is placed on the bottom or directly on the pulp and after a few days a filling is placed.

Possible errors during treatment and how they threaten the child

Statistically, errors in pediatric dentistry occur more often than in adult dentistry, which is due to the specific nature of working with young patients. Often, children simply do not give the doctor the opportunity to work normally, throwing real tantrums and demonstrating absolutely inappropriate behavior. This is why dentists are often literally forced to use non-vital amputation, since they are unable to solve the problem in any other way. However, there are also medical errors in pediatric dentistry, even if they are partially caused by the behavior of a small patient, which makes it difficult to complete the treatment procedure:

1. Incorrect placement of the paste required for pulp devitalization. The worst thing is if the paste is arsenic, often due to the child’s behavior it ends up not on the “nerve”, but on the bottom of the cavity, resulting in quite severe pain. The solution to the problem is to reinstall the paste.
2. Installation of devitalizing paste on the gum. The result is severe pain and burns of the gums, which should be combated with the use of anti-inflammatory drugs.
3. Removing dental files beyond the root. Because of this, bleeding occurs as a result of injury to adjacent tissues.
4. Tool breakage in the canal. The consequence of this error can be inflammation of the tissues located near the root and the development of periodontitis.
5. Perforation of the root, causing similar consequences.

How to prepare a child for treatment?

Many adults are afraid of the dental chair; it is not surprising that a similar fear is widely present in children. To prevent your child from developing a fear of dental treatment, a preventative visit to the doctor should be made before any dental problems arise. This introductory visit will allow the little person to get acquainted with the environment, learn the tools, and it often happens that curiosity takes precedence over fear. However, in any case, children need to be prepared for visiting the dentist and for this purpose doctors recommend the following steps:

• talk about the upcoming visit a few days before it, so that his peers do not scare him with various “horror stories”;
• the emphasis should be placed only on the positive side of the issue;
• you should not pay too much attention to this topic, since it is necessary to form the idea that taking care of health is a common and even a little routine matter;
• Present your visit to the dentist as an opportunity to meet a new friend;
• play “to the hospital” at home, showing by personal example the lack of fear of the doctor;
• avoid using “scary” dental terms and words;
• control yourself and don’t show your excitement;
• It is best to visit the office in the morning, before the child is tired during the day;
• It’s good to take your baby’s favorite toy with you so that it gives peace of mind to the little patient;
• do not interfere with the doctor’s work and do not prevent him from independently establishing contact with the baby;
• do not intimidate or beg the child if he refuses to go to the procedure.

Causes

The most common cause of pulpitis is advanced caries. The developing infection first attacks the tooth enamel, then moves to the dentin and then moves directly into the pulp. Sometimes, however, pulpitis occurs as a result of injury, including exposure of the nerve by the dentist during the treatment of caries.

How to recognize the problem in time?

Due to the fact that the pulp in children is characterized by reduced sensitivity, it often happens that the disease develops unnoticed, since the child does not experience pain. This fact alone is already enough to confirm the need for regular visits to the dental office for preventive examinations and timely treatment of caries.

Signs of Severe Dental Damage

The absence of pain does not mean that the symptoms of such an illness are impossible; in such a situation, the following will help:

• discomfort and some pain when eating cold and hot food;
• the appearance of a stain on the tooth and an unpleasant odor;
• the beginning of the inflammatory process in the tissues surrounding the tooth;
• rise in temperature and deterioration in general health.

If such symptoms appear, not to mention pain, you should immediately take your child to the dentist for timely assistance.

Is it worth treating baby teeth for pulpitis?

The very formulation of such a question is fundamentally incorrect, since there can only be one answer - it must be done and as quickly as possible. Painkillers and waiting for tooth loss can lead to very unpleasant and even tragic consequences, including death.

How is pulpitis treated in children?

The doctor determines how to treat pulpitis in a child during an examination of the patient and clarification of a large number of different factors and aspects, in particular, the location where the tooth is located, the degree of spread of the disease, and the like.

So, how is childhood pulpitis treated? Among all the methods used, the following can be mentioned:

• treatment of the coronal or root part to ensure the preservation of the pulp;
• incomplete removal of the pulp, performed when its functionality needs to be preserved; in such a situation, the coronal pulp is subject to removal; as for the root pulp, it remains in place, since without it it is impossible to talk about the dentition and its formation in the future;
• complete elimination, accompanied by filling of the canals.

Prevention

The key means of prevention is timely treatment of caries. In order to prevent the process of tooth infection, it is necessary to pay the closest and most serious attention to oral hygiene; a child should be taught to brush his teeth from an early age. Proper nutrition of the baby is of great importance; therefore, all the substances necessary for the development of the body should be included in his diet. Sweets should be limited, and at night you should refuse food, drinking only water.

Video on the topic

On the website for mothers, you have already read about how important timely treatment is. Because if caries is not treated, even when the tooth is baby, there is a serious danger of complications, and one of them is pulpitis. We'll talk about this in more detail today.

Pulpitis of a baby tooth is an inflammation of the pulp, the connective tissue located deep inside the tooth, in which lymph vessels and blood vessels, as well as nerves, pass. The pulp is often called a nerve.

Usually it is the baby tooth that suffers from this pathology. Most often, inflammation occurs in the lower dentition, but it also happens that the front teeth are affected.

It is children who often suffer from pulp inflammation, because at this age the dentin has little strength and the enamel is too thin.

Let's talk about the reasons

As you already read at the very beginning, pulpitis of baby teeth in children most often occurs due to the fact that caries has not been cured. The infection first affects the enamel, then spreads to the dentin and then penetrates the pulp.

There are other reasons - tooth trauma. Sometimes it occurs just when visiting a dental office, when a specialist accidentally exposed a nerve during treatment.

Symptoms

Pulpitis that develops in the thickness of a baby tooth can be acute or chronic. The first is less common, but the symptoms are more pronounced. The inflammatory process occurs in two stages.

1. Serous. Inflammation of the pulp occurs, and its canals are filled with fluid with serous cells. In this case, the child complains that there is too much pain inside the tooth. Typically, such sensations appear during a night's rest or during chewing. Usually the pain is one-time. The lesion occurs in teeth whose roots are resorbing or have not yet formed. This stage takes from four to six hours, and then the process flows into the second stage.
2. Purulent. Pus forms in the canals. How severe the pathology will be depends on a number of factors: what kind of immunity the baby has, how active the bacteria are, and what condition the roots of the tooth are in. The pain may not be very pronounced if the immune system works like clockwork, the bacteria are weak, and pus flows out through the carious cavity. But more often the pain is severe and prolonged. Sometimes more than one tooth hurts, but the sensation spreads to others. Pain occurs when chewing, as well as if you eat food at different temperatures. The child may refuse to eat and is afraid to touch the tooth. The general condition may worsen. Other symptoms also appear: fever, lymph nodes enlarge.

How to understand in time that a child has pulpitis?

It is better to begin treatment of pulpitis of primary teeth in children as soon as possible. But the problem is that the sensitivity of the pulp at such a young age is usually reduced. Therefore, the development of pathology can occur without pain. In order to detect pulpitis in a timely manner, it is worth visiting the dentist regularly and treating caries at an early stage.

The following signs indicate that you need to take your child to the dentist:

• pain in the tooth is pronounced;
• pain occurs when drinking hot food or cold drinks;
• an unpleasant odor emanates from a darkened tooth;
• inflammation is observed around the dental tissues;
• the temperature increases.

If the tooth is baby, is it treated?

The site has already touched on this issue in response to the opinion of some people that if the tooth is a baby tooth, then it cannot be treated, but must be removed. In this case the same thing: treatment is necessary.

It would be wrong to give your baby painkillers and wait for the baby tooth to fall out on its own.

If you do not take the right actions, complications are possible: periostitis, periodontitis. We don’t want to scare you, but we simply have to warn you that the infection can penetrate the blood and cause swelling.

How does the treatment proceed?

It happens that the process is very advanced, and there is a threat to the baby’s health, then it is easier to remove the tooth. But sometimes they try to preserve a baby tooth so that malocclusion does not occur later.

Let's look at some treatment methods.

Devital amputation - for this you need to visit the doctor several times. First, they will open the nerve and apply a paste that has devitalizing characteristics, that is, allowing it to “kill” the pulp. If it contains arsenic, then you need to keep the paste for a day or two. And the product without arsenic is applied for a week.

In the next couple of visits, the canals are filled with a special mixture, which allows mummification of the pulp with a developing infection. Then a permanent filling is placed on the baby tooth.

Another method is extirpation. It may be vital - in this case, the nerve is removed at the first visit. Another option is devital - the pulp is opened and then treated with a special paste in order to perform killing.

With careful treatment of the dental canals, tissues infected with bacteria are eliminated and sterile conditions are created.

In order to carry out filling, a paste with an anti-inflammatory effect is used. It will begin to dissolve, just like the roots during the period when the baby tooth is replaced by a permanent one. Zinc eugenol paste is often used.

The method is effective in preventing the infection from reactivating again. But the channels should be cleaned thoroughly.

During vital amputation, the upper portion of the nerve is removed. A drug that has anti-inflammatory and antiseptic effects is installed on the remaining part of the pulp. The lower part of the pulp is closed with a fairly high tightness, which allows maintaining its viability.

How is a dental unit treated if the roots are not formed?

When a tooth is a baby tooth, its roots take a long time to form even after eruption has occurred. That is why it happens that when infected with caries, it is the baby tooth whose roots are not yet covered by the apex that suffers.

Pulpitis is difficult to treat taking into account the following factors:

• the roots are short, and the channels are, on the contrary, wide;
• the upper part is the so-called growth zone; if it is injured, difficulties arise with root formation;
• there is a fairly high risk of infection of the germ of a permanent tooth.

Treatment of pulpitis of primary teeth must be performed with maximum care and thoroughness. The filling material and instruments should not be allowed to extend beyond the zone in which there is an expansion of the special apical foramen.

It is necessary to understand that it will not be possible to completely remove the pulp or treat all canals. Therefore, it is better to use the amputation method of therapy. The infected pulp is removed from the tooth. A biological method is often used, and its essence is to get rid of dead cells, as well as adding a healing paste for several days.

Preparing for therapy

Treatment of caries and pulpitis of baby teeth requires proper preparation of the child for a trip to the dentist. Often children are afraid to undergo treatment due to fear of doctors and the instruments they use. Therefore, before eliminating pulpitis, you need to talk with your baby.

Tell them that the doctor is helping, that the therapy is useful. It is important to emphasize that all people undergo this procedure; it is not something exceptional. Often, due to misunderstanding and fear, a child thinks that they want to punish him in this way.

When a child has pulpitis, he is already scared, so there is no need to show your panic and scare him with it. Also, you should not beg your baby if he is too resistant and capricious. Perhaps, before visiting the doctor, you should play a game about how toys treat each other’s pulpitis.

Many children, and what’s more, even adults are afraid of dentists, and often because of stereotypes, as well as the neglect of the situation. In order not to remove a dental unit, you need to follow the rules of hygiene and take preventive measures.

Dear visitors, especially moms and dads. I myself went to the doctor more than once as a child. Teeth often deteriorated, holes were common, and pediatric dentistry in those days was far from being at the highest level. Now there are many more opportunities. Therefore, I recommend everyone to read this material in order to better understand the essence of the problem.

Parents of a small child are always worried when he has some health complaints. First, then they spoil. And if they start to get sick, then everything is even more difficult. You have to run to doctors, trying to solve the problems that have piled up.

Causes of the disease

You must have wondered how a child, whom we feed with healthy foods and whose teeth we brush regularly, gets .

Doctors identify five main reasons.

As you can see, there are many options and they are always very individual for each child. You can brush your teeth three times a day with a good toothpaste, don’t eat candy or cookies at all, and don’t put dirty hands in your mouth, but still end up in the dentist’s office with a toothache.

Features, forms and symptoms

Doctors note that pulpitis occurs more often in children than in adults. The point is in the characteristics of the child’s body, the structure of the teeth. We have thicker layers of enamel and dentin. The level of dentin mineralization in a child is also much lower.

When children's teeth are affected, bacteria need much less time to reach the pulp. During this time, you may not have time to detect and clean the carious cavity or install a good filling. As a result, many children are left without several baby teeth.

Interestingly, the clinical picture is very different in different children. Some people don’t feel any changes or discomfort at all. Others experience pain. Still others complain of fever, swelling of the cheeks and gums, and inflammation of the lymph nodes. Moreover, the disease is often accompanied by periostitis (inflammation of the periosteum tissue).

More than 60% of all cases of pulpitis in children are accompanied by periodontal lesions. The fact is that in children's periodontal tissue there are a lot of vessels, both lymphatic and circulatory, and the tissue itself has a looser structure.

The problem with many parents is that they believe that treatment is not necessary. They say that they will fall out in any case, and new ones will grow in their place. As a result, carious teeth are not treated, neglected caries turns into pulpitis, then the periodontium is affected and more complex and lengthy treatment has to be carried out. Another fact is that the chronic form is much less common in children than in adults.

Pulpitis in children treatment

Methods to resolve the problem. Conservative and radical options

Proper treatment of acute pulpitis in children is not an easy task. In particular, when it comes to baby teeth, it is extremely important that the infection does not penetrate into the tissues of the buds of permanent teeth. If they are destroyed, this will lead to edentulism (the complete absence of permanent teeth).

Most parents are interested in knowing how pulpitis in children is treated? Methods are divided into conservative and surgical.

Let's start with the least radical methods. They are aimed at saving the pulp. Their use is acceptable for acute partial or chronic fibrous pulpitis. The doctor removes all dead tissue from the carious cavity and treats the tooth with antiseptic solutions. After this, a medicated paste with calcium hydroxide is applied. Next, you can put a filling. In some cases, physical therapy is prescribed, which reduces the risk of relapse.

It is worth recognizing that effectiveness is not observed in 100% of cases. We have to resort to surgical techniques. They, in turn, can also be more or less radical.

I'll start my story with the so-called vital amputation. Sounds weird? In general, for our people the word “amputation” seems something scary. In this case, we are talking about the fact that the pulp is not completely removed, preserving its root part. The pulp located in the coronal part and the mouths of the tubules must be removed.

Causes of pulpitis in children

Further, the procedure differs little from the conservative treatment option. The doctor applies calcium paste, and the little patient needs to come back three months later. Then, in order to prevent relapse, you need to come every six months.

They also sometimes resort to vital extirpation. It implies the need to completely remove the affected pulp under anesthesia. At the same time, they do not resort to arsenic, which “kills the nerve.” This method, although officially existing in pediatric dentistry, is used much less frequently. This is due to the fact that it requires a lot of work, and children are impatient and do not like painful procedures. In addition, this leads to stress, and subsequently to fear of the dentist, which many people continue throughout their lives.

The third method is more popular among doctors. It is called devital amputation. As the name suggests, the pulp is “killed” using a paste containing arsenic compounds. After this, it completely loses sensitivity and can be removed. The paste is placed in the tooth for 1-2 days. Formulations based on paraformaldehyde are also used. This is the method most often used in our country. This is due to the fact that doctors take into account the psychological factor. After all, this option does not cause stress associated with the painfulness of the procedure.

At the same time, Western experts are actively arguing about how dangerous the compounds used can be for the child’s body.

This method also has another drawback. It leads to difficulty in the eruption of permanent teeth in the child. Therefore, it is recommended to remove the milk tooth with sealed canals at the time when it is necessary for the timely eruption of permanent teeth.

This method of treatment is also used for permanent teeth. It is especially popular in cases where children have an individual allergic reaction to the use of anesthesia or there is an urgent need to stop the development of the inflammatory process and eliminate severe pain.

The decision about which treatment method to use must be balanced. It is important to determine exactly what condition the pulp is in and whether its partial salvage is possible.

Girl at the dentist

Nowadays one can often find criticism of radical methods of treating pulpitis in children used in the post-Soviet space. Only the degree of preparation of the population and equipment of clinics for diagnostics leaves much to be desired. It is not dentists who are to blame for children losing teeth.

If pulpitis is a consequence of advanced caries, then the culprit is the carelessness of the parents, who did not take him to the doctor on time and did not cure the tooth at an early stage. Blaming dentists in this case is pointless and completely unfair.

That, in fact, is all I wanted to write on this topic. If you have something to say, I look forward to your comments. Perhaps there are professional dentists among the readers whose opinion will be very valuable. Also subscribe for updates. Be healthy!

Video - Smile of the future: treatment of pulpitis in children