PULP HYPEREMIA

Criteria of diagnostics:

Clinical:

Subjectively:

• the localized spontaneous pain, which lasts by 1-3 min with the wide intervals (intermissions) to 6-12-24 hours;

• subacute pain;

• pain from the action of the different irritants (thermal, chemical, mechanical), after elimination of which it lasts 1-2 min;

• painful attacks more frequently appear in the night time;

• pain arose for the first time twenty-four hours ago.

Objectively:

• deep carious cavity in the limits of circumpulpar dentine;

• dentine is softened, poorly pigmented, cartilage-like consistency or little softened with the sharp pigmentation (chronic caries);

• probing gives the sensation of unpleasant pressure throughout entire bottom and painfulness in the projection of the horns of pulp;

• pulp cavity is closed;

• the pain appears from the cold water, which lasts 1-2 minutes;

• the percussion of tooth is painlessness;

• index EOD in the comparison with the healthy tooth is reduced and it is 10-15 mcA.

Pathohistological features. The end result, whether induced by direct irritation or from the immune system, is the release of chemical mediators that initiate inflammation. This is a vascular response. The increase in the permeability of vessels nearest the site of injury and extravasation of fluid into the connective tissue spaces (edema) cause an elevation in local pressure. This edema alters or destroys the odontoblast layer. Chemical modification of the ground substance also occurs, as evidenced by an increased eosinophilia. Marked dilation of vessels leads to slowing of erythrocytes and the margination of leukocytes along the walls. The leukocytes then squeeze through the intracellular spaces of the vessel endothelia in response to chemotactic signals originating in the damaged tissue. This is called diapedesis.

ACUTE CIRCUMSCRIPTION PULPITIS

Criteria of diagnostics:

Clinical:

Subjectively:

• pain is acute, localized, cramping, spontaneous, the duration of attack is 15-30 min., but with the development of inflammatory phenomena its duration increases to 1-2 h. Light intervals usually last by 2-3 h, but they are reduced in the course of time;

• the attack of pain can appear under the action of different irritants (temperature, chemical and so forth);

• painful attacks are strengthened and are repeated at night;

• pain arose for the first time 2-3 days ago;

• usually patients indicate the causal carious tooth, since painful phenomena in the initial period of their development are still localized and do not irradiate.

Objectively:

• deep carious cavity in the limits of circumpulpar dentine;

• dentine is softened, poorly pigmented, cartilage-like consistency or little softened with the sharp pigmentation (chronic caries);

• during the probing the pain appears at point, with respect to the projection of the inflamed horn of pulp;

• pulp cavity is closed;

• the percussion of tooth is painlessness;

• sharp painful reaction from the temperature irritants;

• index EOD is 15-30 мcА.

Pathohistological features. It is determined marked dilation of vessels leads to slowing of erythrocytes and the margination of leukocytes along the walls. In some areas located near the caries cavity there are haemorrhages into pulp tissue, which is saturated with serous exudate. There are accumulations of erythrocytes and leukocytes in the pulp near the caries cavity. With increasing of vascular wall permeability the inflammatory infiltration increased. As a result the odontoblast layer altered or destroyed..

ACUTE DIFFUSE PULPITIS

Criteria of diagnostics:

Clinical:

Subjectively:

• pain is acute, radiating on motion of the branches of n. trigeminus, cramping, spontaneous, duration of attack is 2-4 hours, without pain (light) intervals – 10-30 minutes;

• pain takes character neuralgic attacks;

• attack of pain can arise under the influence of different irritants (temperature, chemical and others like that);

• pain attacks increase and become more frequent at night, it is strengthened in the lying position;

• pain is shooting, pulsing;

• pain arose for the first time 2-3 days ago;

• patients usually can not localize pain, frequently they indicate other teeth, where is a cavity or filling, sometimes bad tooth is diagnosed even on another jaw (but necessarily to the same to side). One of the differential signs of diffuse pulpitis is the irradiation of pain on the motion of n. trigeminus into the temple and the superciliary region (II branch) mainly with the inflammation of the pulp of the teeth of maxilla, into the region of ear and back of the head with the inflammation of pulp in the teeth of mandible (III branch). It is necessary to note that frequently the pain with the diseases of the teeth of upper or lower jaw irradiates both on the II and on the III branch n. trigeminus.

Objectively:

• deep carious cavity in the limits of circumpulpar dentine;

• dentine is softened, poorly pigmented, cartilage-like consistency or little softened with the sharp pigmentation (chronic caries);

• during the probing the pain appears on all bottom of carious cavity pain is more acute at the acute course of caries;

• pulp cavity is closed;

• there can be painful reaction with the vertical percussion of the struck tooth (phenomena of perifocal periodontitis);

• thermometry - action by any temperature irritant causes the attack of pain with the irradiation;

• index EOD is 20-30-40 мcА.

Pathohistological features. It is determined marked dilation of vessels leads to slowing of erythrocytes and the margination of leukocytes along the walls. In all pulp (coronal and radicular) there are haemorrhages into pulp tissue, which is saturated with serous exudate. There are accumulations of erythrocytes and leukocytes in the pulp near the caries cavity. With increasing of vascular wall permeability the inflammatory infiltration increased. As a result the odontoblast layer altered or destroyed.

ACUTE PURULENT PULPITIS

Criteria of diagnostics:

Clinical:

Subjectively:

• pain is acute, spreading, cramping, spontaneous, pulsing, increasing, pulling, undulating, painless intervals are absent;

• irradiation of pain is on motion the branches of n. trigeminus;

• the attack of pain can arise under the action of different irritants (temperature, chemical and others like that);

• frequently painful attack increases gradually, it becomes pulsing, continuous and only partially it weakens by several minutes (remission), after which again it is renewed. Pain is considerably more intensive at night. Reactive pain appears and is strengthened under the effect of the thermal irritants (pain from hot food at a temperature higher than 37°С). Cold irritant somewhat decreases the force of attack.;

• pain arose for the first time 2-3 days ago.

Objectively:

• deep carious cavity in the limits of circumpulpar dentine;

• dentine is softened, poorly pigmented, cartilage-like consistency or little softened with the sharp pigmentation (chronic caries);

• superficial probing is painless, deep probing is painful;

• during probing it is possible easily to easily perforate the arch of the cavity of tooth, in this case the drop of pus or blood is separated and the pain feelings decrease;

• from the warm water the attack of pain appears (cold water decreases the intensity of pain);

• there can be painful reaction with the vertical percussion of the struck tooth (phenomena of perifocal periodontitis);

• ЕОD is 40-60 мcА.

Pathohistological features. It is determined marked dilation of vessels leads to slowing of erythrocytes and the margination of leukocytes along the walls. In all pulp (coronal and radicular) there are haemorrhages into pulp tissue, which is saturated with serous exudate. In the coronal pulp there are forming abscesses. There are accumulations of erythrocytes and leukocytes in the pulp near the caries cavity. With increasing of vascular wall permeability the inflammatory infiltration increased. As a result the odontoblast layer altered or destroyed.

ACUTE TRAUMATIC PULPITIS

Criteria of diagnostics:

Clinical:

1) Accidently opening the pulp.

The main cause of this form of acute pulpitis is careless preparation of caries cavity, which results in perforation of pulp chamber with insignificant pulp trauma by rotary instrument (burs). Enough often it occurred during acute caries coarse preparation of carious cavity or removal of leather decalcinated dentin during excavation. As a result appeared a blooding point perforation. Trough this perforation dentist may see the rose color pulp. The probing of pulp is very painful and it is not recommend.

• the sign of the baring of pulp is the surrounded by the rim of white predentine perforated opening, from which the drop of the blood can be separated;

• the exposed pulp has bright red colour;

• it appears acute, short-term pain, which is strengthened during probing of perforation;

• its probing is very painful, it can lead to the mechanical injury; therefore it doing is not recommended;

• after injury the inflammation is developed not immediately, but only after 6 hours in connection with the entry of microorganisms.

Pathohistological features. It is characteristic for the acute course of deep caries. There are sign of reactive changes of the pulp, dilation of vessels located near caries cavity and perforation.

2) Accidentaly pulp wounding.

The main cause of this form of acute pulpitis is penetration of instrument (burs, excavator) into the pulp chamber and pulp wounding. In these case usually pulp tissue microbial contamination from caries dentin is occurred. The first sign of wounding is acute pain in moment of trauma. On the caries cavity floor appeared area of wounded blooding pulp.

• the first sign of injury is the acute short-term pain, which attacks at the moment of putting the injury;

• the sign of the baring of pulp is the sufficiently large perforated opening, through which the evidently wounded pulp of pink colour;

• from the perforated opening the blood is separated by drops;

• it appears the acute, short-term pain, which is strengthened during probing of pulp in the section of perforation.

3) Opening the pulp at crown fracture.

Clinic:

• this clinical picture is possible usually as a result obtained acute injury;

• the line of the break of the crown of tooth can pass through the level of cavity of tooth (on the equator of tooth, in the section of the neck of tooth and so forth);

• the tissue of pulp is exposed, rapidly it is infected on the significant draft;

• the exposed pulp has bright red colour;

• it appears the acute pain, which is strengthened under the action of different external irritants, even from the movement of air.

Pathohistological features. It is characteristic for the acute pulp inflammation and depends on the term of trauma and cause of inflammation.

- EОD - 6-12 мcА.

DIFFERENTIAL DIAGNOSTIC OF ACUTE PULPITIS

Diagnos-tic tests	Diagnosis
	Pulp hyperemia
Anamne-sis	Pain arises up spontaneously or as result of irritant action, pulp attacks shot duration 1-2 minutes with large painless intervals (intermission) up to 6-12-24 hours. Pain attacks more frequent arise up at night.

DIFFERENTIAL DIAGNOSTIC OF ACUTE PULPITIS AND ANOTHERDISEASES

Diagnostic tests	Diagnosis
	Acute pulpitis
Pain character	Spontaneous (i.e., unprovoked), intermittent, or continuous paroxysms of pain, which may referred to another area, refèrred from one arch to the other and along the branches of n. trigeminus, more frequent at night.
Factors, which provoked pain	The pain attack can provoke different irritants, frequently the cold.