Pulpitis
| Classification according to ICD-10 | |
|---|---|
| K04.0 | Pulpitis |
| ICD-10 online (WHO version 2019) | |
The Pulpitis (from latin pulpa "meat" and ancient Greek -ῖτις -itis as a designation of inflammation) denotes an inflammation of the tooth pulp (pulp), the tissue in the pulp cavity, the tooth interior. The pulp consists of connective tissue with blood and lymph vessels and nerve fibers .
causes
The pulpitis is caused by mechanical, thermal or chemical irritation (for example, during dental treatment) or by bacteria which in caries lesions or by cracks or fractures in the tooth to penetrate.
Toothache is a symptom of acute pulpitis. If the stimulus is short-term or locally limited, healing occurs (reversible pulpitis). If the irritation persists, the inflammation becomes chronic. The following processes can then take place:
- Irritant dentin formation: a thicker layer of dentin is formed on the inside of the dentin , where the dentin tubules open under a cavity or dentin exposed through wear and tear.
- Blood vessel reaction: the blood flow increases, red blood cells accumulate.
- Leukocyte infiltrate: inflammatory substances are released at the relevant point on the pulp . These ensure increased permeability of the vessel walls, through which plasma and leukocytes escape.
- Increased formation of connective tissue fibers, this is done to make the pulp impermeable to stimuli.
- In the advanced stage, local micro- abscesses can form, the tissue dies and is encapsulated. New odontoblasts can form at the border to encapsulate the process with newly formed dentin.
to form
A distinction is made between forms of acute and chronic pulpitis.
Acute inflammation
Hyperemia
The first stage of pulp inflammation is hyperemia , which is usually reversible. Lymphocytes and plasma cells migrate into the subodontoblastic area, combined with an expansion of the arterioles and a significant increase in the flow rate of the blood.
Acute pulpitis serosa
After the stage of hyperemia, serous exudate emerges . A distinction is made between partial and total pulpitis. In acute serosa partialis pulpitis, this is limited to a small part of the coronary pulp. If the entire pulp is involved, one speaks of total serosa acute pulpitis , which is irreversible but can turn into chronic pulpitis.
Acute pulpitis purulenta
Comes in pulpitis acuta serosa a leukocyte extravasation added, the serous to purulent inflammation. In infected necrosis, the dead pulp is broken down by a bacterial mixed infection . It represents the final stage of all pulpits.
Chronic inflammation
Pulpitis chronica clausa
The chronic pulpitis (lat. Clausus closed) is the most common form of chronic pulpitis and the closed mold, d. H. the pulp cavity is not connected to the oral cavity. One finds infiltrates of lymphocytes , from plasma cells as well as from mast cells . The chronic pulpitis may be clinically unremarkable exist for a long time. Cause of chronic pulpitis granulomatous clausa is often a dental trauma. This form of pulpitis can be followed by resorption of the dentine, which can lead to a spontaneous fracture of the tooth.
Chronica aperta pulpitis
Extension of a carious lesion or trauma to the tooth can create a connection between the oral cavity and pulp tissue. There is an open chronic pulpitis (lat. Apertus open).
Chronic aperta ulcerative pulpitis
In ulcerative chronica aperta pulpitis (lat. Ulcus ulcer) there is an ulcerating pulp surface in the area of the opening of the pulp cavity.
Aperta granulomatosa pulpitis
If there is an adequate blood supply, so that may pulpitis chronica aperta colitis in the chronic pulpitis aperta granulomatosa (lat. Granule grains) (pulp polyp) merge. A granulation tissue grows slowly as enlarging mass of tissue through the opening of Pulpendaches from the pulp cavity out.
procedure
Initially, the inflammatory reaction is localized (partial pulpitis). If the stimulus persists, the pulp in the crown area becomes inflamed in the so-called pulp cavity , later the process can also spread into the root canal . If bacteria enter the pulp, the concentration of endotoxins increases and the inflammatory process intensifies. The tissue pressure increases locally due to blood vessel reactions. This leads to local infarcts, necrosis and finally to microabscess formation. As a result, neighboring local pulp tissue becomes inflamed and the cycle continues. The tissue dies (infected necrosis , formerly also called " gangrene "). Bacterial endotoxins can get into the periodontal gap and an odontogenic infection forms at the tip of the root, which is known as apical periodontitis .
The pulp can also die as a result of trauma , if the blood vessel cord at the root tip is torn off by tooth movement . If the tooth is heated up (for example, if the tooth is ground with insufficient cooling), the pulp can die. As long as no bacteria penetrate, the pulp remains sterile ( sterile necrosis). In this case, there is no inflammatory reaction in the periodontal area at the tip of the root.
Even up to the stage of pulp necrosis, the process can be completely painless and only become noticeable through a preventive examination or through external influences, for example through a hard bite.
Diagnosis
The diagnosis of the individual forms of pulpitis has so far proven difficult or even impossible. As an alternative, the dentist uses therapy-oriented diagnostics. These include x-ray diagnostics , sensitivity testing , percussion pain , night pain , medical insoles , radiation pain , elimination procedures through local anesthesia , palpation , determination of tooth mobility and others.
Differential diagnoses
- Pulp gangrene : the pulp tissue dies by anaerobic bacteria , and dissolves.
- Denticle : Calcifications of the pulp tissue by means of rounded to oval hard tissue bodies. Causes can be old age or trauma; Denticles can also arise as a result of healing processes or therapeutic interventions. They are mostly as incidental findings on radiographs or during a root canal treatment discovered
- Apical periodontitis : inflammatory processes in the area of the tip of a tooth
- Odontogenic infections : abscesses with and without connections to the oral cavity or in the jawbone (fistula)
therapy
In the case of irreversible pulpitis or pulp necrosis, performing a root canal treatment is the method of choice. The vital or non-vital pulp tissue is removed from the root canal, the root canal is expanded and the infected root dentine surrounding the root canal is removed by filing out.
history
Pulpitis was already known in ancient Mesopotamia. A so-called toothworm was assumed to be the cause of the disease .
See also
Web links
Individual evidence
- ^ Konrad Morgenroth, Stathis Philippou: Oralpathologie II . Springer, 1998, ISBN 978-3-540-64442-2 , pp. 32 ff . ( limited preview in Google Book search).
- ↑ Peter Gängler, Thomas Hoffmann, Brita Willershausen: Conservative Dentistry and Periodontology . Georg Thieme, 2010, ISBN 978-3-13-154073-7 , p. 151–152 ( limited preview in Google Book search).
- ↑ Endodontics: Basics and Practice . Deutscher Ärzteverlag, 2003, ISBN 978-3-934280-13-7 , p. 153 ff . ( limited preview in Google Book search).
