The main thing is not to miss the moment! What is the difference between caries and pulpitis? Caries and pulpitis - their differences

One of the most common dental pathologies is caries, which is characterized by a long process of destruction of hard tooth tissues. If you do not consult a doctor in a timely manner for treatment, the disease may progress to a deep stage, in which a complication such as pulpitis develops.

Expert opinion

Biryukov Andrey Anatolievich

doctor implantologist orthopedic surgeon Graduated from Crimean Medical University. Institute in 1991. Specialization in therapeutic, surgical and orthopedic dentistry including implantology and implant prosthetics.

I believe that you can still save a lot on visits to the dentist. Of course I'm talking about dental care. After all, if you carefully look after them, then treatment may indeed not come to the point - it won’t be necessary. Microcracks and small caries on teeth can be removed regular paste. How? The so-called filling paste. For myself, I highlight Denta Seal. Try it too.

The main difference between these two diseases is the area affected. With pulpitis, the pathological process affects the nerve of the tooth - the pulp.

How to distinguish the two diseases?

Due to the fact that during caries the nerve of the tooth remains unharmed, it clinical picture less severe than with pulpitis. The manifestation of certain signs of these diseases depends on the intensity of the pathology. At chronic stage The clinical picture is characterized by mild symptoms, which allows a person to postpone a visit to the dentist to a later date.

In the following table we consider the main differences in the symptoms of these two diseases.

With pulpitis, there is also an increase and pain in the regional lymph nodes, as well as swelling of the cheek in the area of ​​the diseased tooth, especially after waking up.

The clinical picture of caries in comparison with pulpitis does not cause much discomfort in humans, but in the absence necessary treatment it will worsen, which will lead to the development serious complications.

Diagnostic methods

To differentiate caries from pulpitis, the dentist uses the following diagnostic measures:

• interviewing the patient allows you to find out the nature of the symptoms, the time of their manifestation and the presence of a reaction to various stimuli. IN mandatory clarifies whether there were injuries to the lower part of the face, and whether any dental treatment the affected element shortly before discomfort occurs;
• examination of the oral cavity with a special mirror. The doctor examines the condition of the enamel, examines the depth of the carious cavity and the degree of damage to the crown;
• probing. During the insertion of a probe for caries, the patient will experience short-term pain when the instrument comes into contact with the walls of the tooth, and for pulpitis painful sensations arise when it is immersed in the mouth of the root canal. In this case, discomfort will persist even after the probe is removed;
• The dentist can determine the degree of destruction of the crown and the area of ​​damage by applying a caries indicator to the tooth, which will color the surface of the element in places of demineralization. This method is also used for differential diagnosis these diseases from fluorosis and hypoplasia. Such pathologies are not accompanied by a change in enamel color when caries indicators are applied;
• thermal test. The affected unit of the dentition is exposed to cold and hot water. If the pain goes away quickly after contact with the irritant ends, this indicates caries. In the case of pulpitis, the pain will be intense and will persist for another 10-15 minutes. after the procedure;
• electroodontometry. With caries, the device readings will be within 2-20 microns, and with pulpitis, the range of pulp excitability reaches 20-100 microns;
• radiography. In the image, the doctor can clearly see the degree of destruction of the tooth crown, the condition of its root and the depth of development pathological process. If the diagnosis is carried out by a pregnant woman, then a radiovisiograph is used, with which a digital image is obtained. Children are prescribed x-rays of both jaws;
• if necessary, the PCI index is calculated, which makes it possible to clarify the stage of the carious process.

The dentist makes the choice of instrumental and hardware diagnostic methods based on a survey and visual inspection patient's oral cavity.

Treatment methods

Treatment of caries and pulpitis is also carried out using certain methods that have a significant difference. This is due to the fact that the first disease is not accompanied by such deep destruction of dental tissues as pulpitis.

Treatment of pulpitis

Elimination dental problem This type is carried out in 2 ways:

• Vital. It involves removing areas and preserving the vitality of the pulp.

The procedure is carried out as follows:

• injected into the gum area local anesthetic, allowing to prevent the occurrence pain;
• in about 10-15 minutes. the pulp chamber is opened;
• using a file, the root canals are cleaned from affected tissues, as well as their expansion to the required size by alternately screwing in instruments of various lengths;
• after this, antiseptic treatment of the canals is carried out;
• a gasket impregnated with an anti-inflammatory agent is placed in the cavity;
• after 2 days, the doctor cleans the canals a second time and uses a cone-shaped bur to drill out a hole for filling;
• on next appointment A permanent filling is installed, ground and polished.

This method is used in the treatment of patients whose age does not exceed 27 years or in the case of diagnosing an early stage of pulpitis.

• Devital – pulp removal.

This method of treatment differs from the previous one in that at the first appointment the dentist places a special paste into the cavity of the treated canal, which ensures the death of the pulp. It can be either arsenic-based or without it. The tooth is covered with a temporary filling for 7 days.

At the second appointment, the doctor will remove the installed filling, re-clean the canals, remove the pulp, fill the canals and install a permanent filling on the tooth.

Patients prefer the first method of treatment, which will preserve the viability of the affected element, but in cases of progression of the pathology, only the devital method is used.

Treatment of caries

Depending on the stage of the disease being diagnosed, there are following methods treatment:

1. On initial stages The dentist suggests remineralization or fluoridation of the enamel.
2. At the superficial stage, you can use minimally invasive methods treatment:
3. laser use;
4. ozone therapy;
5. infiltration method (Icon);
6. air-kinetic processing.

Such methods allow you to avoid using a drill, which is very convenient when treating children, because the procedure will not leave in their memory a feeling of fear before a visit to the dentist. Their only disadvantage is their high price.

Filling is carried out to prevent the spread of the pathological process to nearby areas.

The procedure includes the following steps:

• cleaning the surface of the damaged element from dental deposits (plaque or stones) by mechanical or ultrasonic methods;
• a filling material is selected that matches the color of the enamel of healthy teeth;
• if necessary, give an injection of anesthetic into the gum;
• the carious element is prepared with a drill to remove damaged tissue;
• the installation of a rubber dam is carried out to isolate the working area from saliva, which will improve the quality of the subsequent installation of the filling. In ordinary dental clinics for this purpose, cotton balls are used, placed around the affected element;
• the tooth cavity is treated with an antiseptic and phosphoric acid, which improves the connection between tooth tissue and filling material;
• the hard tissues of the element are treated with adhesive, which ensures fixation of the filling;
• the tooth cavity is filled with filling material;
• The filling is grinded to eliminate irregularities and polished.

Differences in disease treatment

Treatment of caries requires less material and time costs, because the pathological process in this case does not affect the nerve of the tooth. In the initial stages you can use folk recipes based medicinal herbs which will help strengthen the enamel and relieve the symptoms of inflammation.

In case of pulpitis traditional therapy prohibited, it can cause serious complications.

The cost of treatment for pulpitis will also be much higher, because it will include additional procedure to remove the nerve.

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Preventive measures

To maintain the health of your teeth and prevent the development of such pathologies, dentists recommend doing the following:

• Thoroughly clean your mouth every day with toothpaste (morning and evening, and, if possible, after eating food);
• rinse the mouth, and also use irrigators, dental floss and brushes after meals;
• choose the right one toothbrush to avoid damage to the enamel;
• enrich the diet with vegetables and fruits containing the necessary micronutrients that nourish the protective shell of the tooth;
• limit the consumption of sweets;

Often, teeth start to hurt at the most inopportune times - many people know this well from their own bitter experience. Often the symptoms of pulpitis are taken by surprise during long holidays, at work, on vacation, and it is not always possible to immediately consult a doctor for help. Guess at what point deep caries, as the most common cause of pulpitis, will be complicated by inflammation of the dental “nerve” with the appearance characteristic symptoms, it is impossible in advance, it can happen at any moment.

It is important to keep in mind that if you do not go to the clinic in a timely manner, pulpitis often turns into when you can endure tooth extraction and expensive prosthetics, or even irreversible for general health human processes, sometimes bordering on life and death.

The photo below shows a tooth removed due to complications after pulpitis:

But how to distinguish the signs of pulpitis from other dental diseases (say, from severe pain when), what complications may arise and whether there are ways to prevent them - this and much more will be discussed further.

Characteristics of pulpitis as inflammation of “living” tissue

To better understand the root causes various symptoms pulpitis and imagine in advance what may await you during future treatment, you must first figure out what, in fact, inside the tooth can hurt in principle. The very definition of pulpitis greatly clarifies this issue.

Pulpitis is inflammatory process, which occurs in the so-called pulp chamber, or, otherwise, in the dental “nerve” (neurovascular bundle). And this process in most cases is associated with the activity of microorganisms: as a result of untreated deep caries, pathogenic microflora sooner or later penetrates through thinned dentin into soft fabrics pulp with the appearance characteristic features tooth pulpitis.

Inflammation in the pulp proceeds according to the same laws as in any other tissue. Against the background of the aggressive impact of bacteria and their toxins on living tissue, gradual cell death occurs, which activates inflammatory factors. If we could observe this picture under a microscope, its meaning would be as follows:

• to fight the infection, the immune system sends cells (leukocytes) to destroy the source of damage to the pulp;
• the result of this struggle is structural changes in the pulp tissue, up to its complete necrosis (death) and the appearance of a characteristic clinic of chronic or.

The soft tissues inside the tooth cannot recover on their own, but the process can turn into a long-term chronic process with limited inflammation from the tissues surrounding the root - this allows them to be protected from spilled purulent melting.

The picture below shows this process schematically:

Question: Why does pulpitis sometimes cause a strong bad smell from mouth?

With deep carious process Food particles accumulate on the walls and bottom of the carious cavity, and often there is practically no self-cleaning of the cavity or it is very weakly expressed. The result of the gradual decomposition of organic residues is the appearance putrid smell from the mouth - this symptom often accompanies deep caries. Moreover, if pulp necrosis occurs, then the smell of rotting food debris is also accompanied by the smell of the dental “nerve” rotting in the pulp chamber. And the more carious cavities there are (especially with pulpitis), the more pronounced are the signs of bad breath, which interferes with normal communication with people.

Photo of a tooth with a deep carious cavity, which at any moment can cause pulpitis:

Classic symptoms of pulpitis

First aid for pulpitis pain

If the symptoms of dental pulpitis interfere with work or rest, but getting to the dentist is problematic in the next 24 hours, then it is not forbidden to help yourself by choosing either or medications.

Common folk methods:

• rinsing the mouth with warm decoctions of chamomile, St. John's wort, sage, oak bark, mint, lemon balm, valerian - until the attack completely disappears or its severity is significantly reduced;
• rinsing with warm soda-salt solutions (usually a teaspoon of soda and salt are diluted in a glass of warm water);
• rinsing your mouth with vodka or holding it near the sore tooth for a while. This method of treatment has age restrictions.

Common medications for relief pain symptoms pulpitis:

• Use conventional painkillers for oral administration (Pentalgin, Dexalgin, etc.) in therapeutic doses. Before taking them, you should consult (you can remotely) with a therapist or dentist, as possible side effects, contraindications or individual intolerance.
• Alcohol tinctures of eucalyptus or valerian. They are suitable for both applications and carious cavity treatment. This achieves a certain anti-infective and analgesic effect.

Propolis is also often used to close a cavity with an exposed “nerve” as a temporary filling. If you are not allergic to this drug, then it is perfect for temporary use.

And finally, advice: Is it possible to heat a tooth when the first signs of pulpitis appear?

In case of acute toothache, it is not recommended to heat the sore spot from the outside. A warm heating pad, scarves and warm compresses will stimulate inflammation, turning it into a purulent process literally overnight. Heating always aggravates infectious process, which cannot be said about warm rinses of the oral cavity itself. Therefore, there is no need to put your sore cheek against the battery to reduce pain - the opposite effect occurs.

Interesting video: treatment of pulpitis under a microscope

What is important to know about pulpitis

Caries and pulpitis are the most common diagnoses made by dentists. 95% of the population suffers from these diseases in one form or another. Pulpitis and caries, being very closely related to each other, affect different parts of the tooth and often the cause of pulpitis is precisely advanced caries.

How to recognize that caries has gone too far and can cause complications? What are the causes of caries and pulpitis?

At the very first stage of the disease - spot stage- appears on the surface of the tooth soft coating. The microbes living in it form organic acids, which lead to demineralization of the enamel. Visually, such a spot differs from healthy tissue in color. It may be brownish, yellowish or chalky. At this stage, the patient does not experience pain, but the reason for contacting a doctor should be a change in the color of the enamel. Only a dentist can definitively diagnose caries at this stage.

When destructive processes intensify, the surface of the tooth becomes rough. From mechanical pressure or contact with too cold, sweet, hot or sour foods the tooth starts to hurt. If such symptoms occur, it is necessary to begin treatment as quickly as possible. At this stage, it usually consists of sanding off the affected areas and restoring mineral composition enamels.

The destructive process affects not only the surface enamel, but also dentin. Visual sign disease is a clearly visible tooth lesion. The patient experiences intense and frequent pain , and not necessarily after exposure aggressive factors, for example, cold food. Treatment consists of cleaning the affected tissue and installing a filling.

At this stage there is a fairly large cavity on the tooth. Touching this area causes pain. Bad breath may occur. If the disease takes this form, treatment should follow immediately. If treatment is not promptly addressed, dental caries will progress to a complicated stage, accompanied by pulpitis. Very often, the inflammation of the nerve during pulpitis is so severe that the nerve has to be removed

Poor oral hygiene

Insufficient dental care, irregular brushing and irregular visits to the dentist are the main factors in the occurrence of caries. Accumulations of soft microbial plaque, hard tartar and food debris due to poor hygiene inevitably lead to disastrous consequences. Brushing your teeth for 2 minutes after eating with a properly selected toothpaste and brush, as well as promptly removing tartar, is extremely important to prevent dental problems in the future.

Poor nutrition.

Lack of vitamins, abundance of foods containing sugar, lack of raw vegetables and fruits are one of the main causes of caries development. The rural population is much less susceptible to caries than the urban population due to food consumption natural products. Natural food, correct ratio proteins, fats and carbohydrates provide higher resistance to dental caries. In addition, an important factor in the issue of caries occurrence is the low content of calcium, fluorine and phosphorus in drinking water.

General state of human health.

Various diseases suffered in childhood (tuberculosis, rickets, etc.) can impair correct formation dental tissues and make them more susceptible to caries in the future. Diseases gastrointestinal tract, hereditary predisposition And weak immunity organisms also place a person at risk.

Social factors.

It should also be noted that there are a number of occupational hazards that affect tooth enamel. Production of acids and alkalis, waste from the confectionery industry, production waste associated with salts heavy metals increase the prevalence and intensity of diseases such as dental caries.

Stage of pulpitis

Caries, if it is not treated on time, turns into pulpitis. The difference between caries and pulpitis is that during caries, only the hard tissues of the tooth are destroyed without concomitant inflammation of the neurovascular bundle (pulp). When the process of destruction goes very deep and destructive impact penetrates the tooth pulp, inflammation occurs, which is accompanied by acute or chronic aching pain.
Pulpitis, if it is also not treated in time, turns into periodontitis - a disease in which inflammation already extends beyond the boundaries of the tooth. In this case, purulent sacs form in the area of ​​the apex of the roots of the diseased tooth, and fistulas form on the gums.

It is not always caries that gives impetus to the development of pulpitis. In some cases, the tooth breaks due to mechanical stress, the enamel falls off, and again a “gate” for infection is formed. Sometimes tooth enamel is damaged chemicals, corroding her. The most common cause of the disease is a coccal infection, or more precisely streptococcus. At first, it is the area of ​​the soft tissues of the tooth that is adjacent to the carious cavity that becomes inflamed. And then the inflammatory process goes deep into the tooth.

The sooner treatment is started, the better. Professional dentist is able to determine the degree of caries development, including on early stages, and select the most appropriate effective method treatment. To treat caries in the spot stage, it is enough to restore a sufficient amount of mineral using a special solution. For superficial, medium and deep caries, the carious cavity is treated with subsequent filling. For the deepest caries, medicated pads containing calcium hydroxide are used, which promotes the formation of “secondary” dentin, i.e. allows for additional protection for the integrity of the tooth nerve.

Both caries and pulpitis are curable and after treatment the teeth fully perform their functions. Modern methods treatments allow you to treat teeth with both caries and pulpitis, preserving the nerve. But the effectiveness of such treatment directly depends on the patient himself and the stage at which he turned to the dentist.

Caries and pulpitis are two of the most common dental diseases. By diagnosing the first of them in a timely manner, you can avoid the second. To do this, you need to know a minimum set of signs of illness in order to understand when you should go to the dentist for help. The doctor will conduct a more thorough examination and determine treatment tactics.

What is the difference between the two diseases?

The difference between caries and pulpitis lies in the mechanism of development of the pathological process, as well as in the tissues that fall into the affected area. Caries is a destructive phenomenon that occurs in the hard structures of the tooth: enamel, dentin. At the same time, the tooth remains vital and fully performs its functions. Pathology begins with small area. Over time, it turns into a clearly visible defect in the form of a cavity.

Pulpitis is an inflammatory process affecting the pulp of the tooth. The latter is a connective tissue formation consisting of a network blood vessels, nerves and receptors and responsible for the nutrition of the dental unit. The disease develops in response to the entry of microorganisms and their toxins through the dentinal tubules from the carious lesion. The pulp reacts to this with swelling. Its tissues are gradually destroyed, which ultimately leads to the death of the nerve.

The main difference between the diseases is the ability to save the life of the tooth. With a carious lesion, the chances of this happening are high, and inflammation of the nerve inevitably leads to its death. It is also worth noting that a living tooth lasts much longer than its “dead” counterpart.

How to distinguish pulpitis from caries yourself?

This article talks about typical ways to solve your issues, but each case is unique! If you want to find out from me how to solve your particular problem, ask your question. It's fast and free!

In order not to wait for the carious hole to grow or not to experience all the “delights” of pulpitis pain, it is important to know which symptoms are characteristic of caries and which are characteristic of pulpitis. Distinctive features pathologies:

Only a dentist can distinguish deep caries from pulpitis. Diseases balance on the brink: one wrong move and the opening of the pulp chamber is guaranteed.

Will help the doctor in diagnosing deep pulpitis:

• percussion and probing;
• thermometry;
• radiography.

Causes

Both diseases are caused by pathogenic microorganisms. Streptococci play a primary role in cariogenic situations. They form the basis of soft and hard plaque.

The development of caries is affected by:

In addition to the infectious agent, pulp inflammation can be caused by:

1. injuries (mechanical, thermal, chemical);
2. hypersensitivity to medications (antibiotics, zinc oxide-eugenol paste);
3. metabolic disorders in the pulp, during which denticles and petrification are formed.

Attention! Dense formations in the pulp, like denticles, compress and irritate its vessels, causing swelling.

The following health problems can accelerate the development of pulpitis:

How is caries treated?

Caries is treated under anesthesia for medium and deep forms, the cervical version (we recommend reading:). Anesthesia is used when the patient’s psyche is labile. Sequence of caries treatment:

1. preparation of a carious cavity under running cold water;
2. expanding the working cavity, giving it the desired shape;
3. antiseptic treatment of the cavity;
4. tooth filling with predominantly composite material.

Deep caries requires application medical pad between the filling and the thin layer of remaining dentin near the pulp. The basis of such a gasket is calcium. It will promote the production of replacement dentin.

Features of treatment of pulpitis

Treatment of pulpitis for initial stage no different from the treatment of caries: it is prepared carious cavity. The process then proceeds as follows:

1. the canal mouths are opened for good access to the canals;
2. the dead nerve is removed;
3. the canal is mechanically processed (passed along the entire length and expanded);
4. the canal is treated with medication;
5. either medicine is left in the canal, or filling material with gutta-percha.

The treatment ends with the installation of a pin and a permanent filling. Treatment may take up to 3 visits (depending on the number of canals in the tooth and the severity of the clinical situation). Previously, doctors practiced partial extirpation of the pulp, leaving its viable part in the tooth cavity. However, this method of therapy turned out to be ineffective: now both the coronal and root pulp are removed at the same time.

Know what the difference is between dental diseases, is important even for the average person who knows nothing about medicine. It is the primary actions of the patient that determine what the success of dental treatment will be and whether it will be successful at all. Don't delay going to the dentist!

From this article you will learn:

• disease Pulpitis of the tooth - what it is, how to treat it,
• tooth pulpitis - symptoms,
• how to distinguish it from other dental diseases - caries and periodontitis.

Pulpitis is inflammation of the nerve in the tooth. The term “pulpitis” arose from a combination of the word “pulp” and the ending “itis,” indicating the presence of inflammation. The pulp is a neurovascular bundle that penetrates the tooth through holes at the tops of the roots.

The pulp is usually divided into root and coronal parts. The root is located in the root canals, and the coronal is in the pulp chamber in the center of the tooth crown. This division is conditional, because the neurovascular bundle is a single whole. It consists of many intertwined nerve fibers and microvessels.

What is tooth pulpitis: photo

Most often, pulpitis (inflammation of the nerve) occurs as a result of infection from tissues affected by caries - into the tooth cavity in which the neurovascular bundle is located (Fig. 1-2). But inflammation of the nerve in the tooth does not develop immediately when caries appears, but only when the carious cavity becomes deep enough.

Tooth pulpitis: how to treat

Pulpitis in dentistry accounts for about 20% of all visits to the dentist. Treatment of nerve inflammation due to pulpitis is carried out using two methods -

Tooth pulpitis: treatment video traditional method with nerve removal

The first video clearly shows the moment of removal/extraction of the nerve from the tooth.

How to distinguish pulpitis from other dental diseases -

• How to distinguish pulpitis from caries –
  for caries pain syndrome occurs only in the presence of irritants (thermal, chemical). When the irritant is removed, the pain immediately disappears.

  With acute pulpitis, everything is different: the pain is usually acute, spontaneous and not associated with any irritants. Of course, they can be provoked (mainly by chronic forms pulpitis) thermal irritants - cold or hot water. But the difference between chronic pulpitis and caries is that with caries the pain goes away immediately after the irritant disappears, and with chronic pulpitis the pain does not go away immediately, but only after 10-15 or more minutes.