Endodontic disease

Introduction to endodontics Endodontics refers to diseases of the pulp tissue, including pulp inflammation, pulp necrosis, and pulp degeneration. Because the pulp tissue is in the hard tissue of the tooth, only the apical foramen and the lateral root canal are connected with the outside world. When the pulp is acutely inflammatory, the blood vessels become congested and the exudate accumulates, causing the pressure in the medullary cavity to increase. The nerves are compressed and stimulated by inflammatory exudates to cause severe pain. The main causes of the disease are: microbial infection, chemical stimulation, physical stimulation. Bacteria are the most important pathogenic factors of endodontic diseases. The bacteria are mainly facultative anaerobic bacteria and obligate anaerobic bacteria, such as streptococci, actinomycetes, and lactobacilli. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: acute periapical periodontitis

Cause of endodontic disease

Microbial infection (30%):

Bacteria are the most important pathogenic factors of endodontic diseases. The bacteria are mainly facultative anaerobic bacteria and obligate anaerobic bacteria, such as streptococci, actinomycetes, and lactobacilli. The routes of bacterial infection are:

(1) Infected by a tooth defect, such as deep sputum, tooth trauma, severe wear and other serious tooth defects, bacteria and toxins invade the pulp through dentinal tubules or puncture points.

(2) After periodontal infection, bacteria and toxins pass through the periodontal pocket and penetrate the pulp through the apical foramen and the lateral accessory root canal.

(3) Blood source infection, bacteria and toxins entering the pulp through the blood is very rare, but it is not impossible.

Chemical stimulation (30%):

(1) Drug stimulation: Disinfection after the hole is made, such as phenols can cause the pulp to be stimulated.

(2) Filling stimulation: The deep hole directly uses the zinc phosphate cement bottom, and the composite resin directly fills and may stimulate the teeth.

Physical stimulation (30%):

(1) Temperature stimulation

If you use a gas turbine to make a hole, you must spray water to cool down, otherwise the pulp will be congested and the bleeding will cause inflammation.

(2) Current stimulation

If there are two kinds of different metal restorations in the mouth, the potential difference can be generated by saliva, which has certain stimulation to the pulp.

(3) Influence of pressure change

In high-altitude aircraft or deep-water snorkeling, changes in air pressure can lead to an acute onset of pulp disease.

(4) trauma

For example, diabetes can cause degeneration of the pulp, and the tumor can also spread to the pulp. The pulp disease caused by blood-borne infection is extremely rare.

Endodontic prevention

(-) pay attention to oral hygiene

From the perspective of the incidence factors, the incidence rate in rural areas is high, and the oral cavity is the main cause. People who pay attention to oral hygiene and have better protection can have less or no disease, even after illness, early treatment. Good results have been achieved, and the curative effect is stable. Therefore, strengthening public health education, efforts to improve people's oral hygiene habits, and universal treatment of unclean gingivitis can play a preventive role.

(two) to avoid foreign body damage

Many periodontal diseases are caused by long-term food intrusion, trauma, etc., and should be brought to the attention of patients and dentists, and should be corrected in time. In particular, periodontal diseases such as fillings should be avoided due to poor quality of work. Or the wounds produced by the excessively high prosthesis, the contact points are poor and the food is caulking, and the instrument damages the epithelium at the bottom of the sulcus at the time of the treatment, so that the periodontal pocket is formed.

(three) early examination and early treatment

Early periodontal disease removes irritants such as tartar, and after the inflammation subsides, satisfactory results can be obtained. The effect of advanced treatment is very poor. Therefore, the screening of oral diseases should be carried out frequently so that it can be detected and treated as soon as possible.

(four) teeth should be scrubbed

Advocate brushing your teeth every night to remove dirt and protect your teeth. The hair of the toothbrush should not be too hard. Hard will damage the gums and damage the teeth. Brushing your teeth is the best way to clean your teeth and protect your teeth. Brush your teeth properly and clear your mouth. Soft white dirt, food residue and some dental plaque, and can prevent the production of some calculus, play a role in massaging the gums, thereby reducing the pathogenic factors of the mouth, promoting tissue health and enhancing its ability to resist disease.

(5) The tooth should be often

The caries both consolidate the roots and periodontal tissues, and excite the teeth, blood vessels and dental pulp cells. This is of great benefit to the health of the teeth. The common method of caries is: firstly, the teeth are 36 times. Under the forty-six teeth of the fangs, the teeth of the fangs are thirty-six times. Finally, the tongue is licked on Wednesday, and the five laps are over. It takes only two minutes every day to get good results of strong teeth.

(6) Small labor and physical strength

Labor can stretch the tendons, smooth blood, adjust the spirit, strengthen the body, especially the mental workers and the elderly, but also should often participate in some physical labor within the limits of their ability, so that the body can exercise, it is beneficial to the body and mind.

(7) There are festivals and festivals

Diet is one of the basic conditions for the human body to survive, and it has the closest relationship with the human body. For example, "Shou's Parents' New Book, Diet and Treatment" said: "The food is born to the people, the living is also the source, so the diet is in the valley. The gas is filled, the gas is full, the blood is strong, and the blood is strong, but the strength is strong." The health care workers in the past have attached great importance to the study of diet, and they should be light, such as Sun Sizhens "Thousands of Gold and Dao Lin Yang". It is advisable to eat light food; every food does not need heavy meat, it is easy to eat raw meat, and it is often necessary to eat less meat and eat more rice." Because the diet is light and natural, the benefits of replenishment are outstanding, thick and sweet, and the spicy food is easy to hurt the internal organs. Modern Medicine believes that the staple food rice, noodles, miscellaneous grains, and more acidic reactions in the body after eating; the non-feeding meat eggs also have an acidic reaction, only vegetables can be alkaline after digestion, more vegetables can neutralize acidity, maintain the body The acid-base balance, while the elderly should maintain a slightly alkaline blood, often cleans the stomach, reducing the absorption of toxins in the feces, so that the body can be healthy.

(8) Solid tooth unilateral

1 Mint, green salt, etc. at the end of the study, each morning with a little rubbing teeth, good effect.

2 antler powder, each serving 1.5 grams, can be strong teeth.

3 sheep scorpion ash a little, often rubbing the teeth, the teeth are used for sparse.

4 Xianling spleen is the last serving or fried soup frequency, can fix the teeth.

5 psoralen 60 grams, 15 grams of green salt, grinding teeth, can cure long-term toothache, solid teeth.

Endodontic complications Complications acute periapical periodontitis

Complications after treatment of endodontic diseases include remnant myelitis, periapical periodontitis, cellulitis, and tooth fracture.

Symptoms of endodontic diseases Common symptoms Interdental distance widened toothache Teeth with cold and heat Pain leukocytosis Enamel corrosion bite

1. Ask about the nature of toothache, the number of episodes and the duration of each pain, and the relationship between hot and cold, chewing food, whether the pain can be correctly positioned and released, regardless of body position, whether it affects sleep, teeth, adjacent teeth Or other nearby organs have recently been injured or have been treated, have a history of toothache in the past, and whether this pain is the same.

2. Check the position and depth of the cavity with or without cavities and holes, whether to wear the pulp, whether there is pain or pain, and the reaction to the heat and electric activity test. If there is no cavity, check whether there are other teeth. Hard tissue lesions, with or without periodontal pockets, whether the teeth are loose, if necessary, you can take X-ray films, open holes or open marrow examination, if no obvious lesions are found, other teeth or adjacent organs should be examined for lesions, and with trigeminal nerves Pain identification.

3. Classification of endodontic diseases

According to the course of disease can be divided into

(1) Acute pulpitis

Mostly caused by accidental trauma or recent tooth surgery, there are cold, heat-induced pain and spontaneous pain, mainly caused by severe spontaneous pain, the characteristics are as follows:

1 pain often sudden, early intermittent, generally lasts for several minutes, followed by several hours of intermittent period, the patient can still refer to the tooth, with the development of the disease, the attack period is prolonged, the intermittent period is shortened, and gradually changed into persistent severe pain, And along the ipsilateral three-branch distribution area (such as the teeth to the neck, the front of the ear, the cheeks; the lower teeth to the ears, the back of the ears, the lower jaw release), often can not clearly indicate the location of the teeth.

2 Pain is often more dramatic at night, especially when lying down.

3 early cold, thermal stimulation can stimulate or aggravate pain, with cold stimulation pain more obvious; late or suppuration, heat stimulation pain, cold stimulation can only temporarily relieve pain, late patients often contain cold water, or absorb cold air to alleviate Pain, this symptom is helpful for diagnosis.

4 examination often shows that the teeth are pierced, and the pain is obvious.

(2) Chronic pulpitis

Because most of the rickets are chronic lesions, there is a long-term continuous stimulation of the pulp, which can cause chronic inflammation of the pulp. During the development of chronic pulpitis, such as polymorphonuclear leukocytes, the released lysosomes The enzyme is also increased, and the inflammation is intensified, and the symptoms of acute attack can be clinically present.

Chronic injury to the teeth, periodontal disease, and dentin chemical stimulation can cause the pulp to undergo chronic inflammation.

Chronic pulpitis is clinically divided into three categories: chronic atresia pulpitis, chronic open pulpitis and chronic proliferative pulpitis, chronic open pulpitis, also known as chronic ulcer pulpitis, chronic hyperplasia. Pulpitis is also called pulp polyps.

Diagnosis of chronic pulpitis:

1 long-term irritative pain, X-ray photographs show that the pericardial cavity has widened and the hard plate is damaged.

2 has a history of spontaneous pain.

3 probing has been puncture, bleeding, severe pain.

4 There are deep, deep blind pockets or chronic damage to severe teeth.

(3) Chronic pulpitis in the acute attack period, there are chronic pulpitis symptoms, recent severe spontaneous pain, can not locate or have loose pain, hot and cold stimulation caused or aggravated pain.

(4) Partial necrosis of the pulp, in addition to the symptoms of pulpitis, and has been puncture, open the marrow to check the coronary pulp is not active, the root marrow is still active.

(5) All necrosis of the pulp, may have a history of pulpitis or trauma, piercing the marrow, but no pain, or periodontal disease, no response to the vitality test, open pulp to check the pulp without vitality.

Examination of endodontic disease

1. Check the position and depth of the affected teeth with or without cavities and holes, whether to wear the pulp, whether there is pain, pain, and reaction to the heat and electric activity test. If there is no cavity, check whether there are other hard tissue lesions, whether there are periodontal pockets, whether the teeth are loose, if necessary, you can take X-ray films, open holes or open the marrow. If no obvious lesions are found, other teeth or adjacent organs should be examined for signs and differentiated from trigeminal neuralgia.

2. Ask about the nature of toothache, the number of episodes and the duration of each pain, the relationship with hot and cold, chewing food, whether the pain can be correctly positioned and released, regardless of body position, whether it affects sleep. The affected tooth, adjacent tooth or other nearby organs have recently been injured or treated. In the past, there was no history of toothache, and whether it was the same as this pain.

Diagnosis and diagnosis of endodontic diseases

Differential diagnosis

1. Interdental mastoiditis: due to food embolism caused by mastoiditis, there is spontaneous pain, which is characterized by persistent pain, hot and cold irritating pain, examination of interdental mastoid congestion and edema, local gingiva marked tenderness, It is often seen that food is jammed in the adjacent gap.

2. Trigeminal neuralgia: Trigeminal neuralgia is characterized by sharp pain, sudden onset, severe pain like tearing, reflex pain, and distribution along the trigeminal nerve. The difference from acute pulpitis is that trigeminal neuralgia rarely occurs at night. More than because of washing the face, said to be active, each episode is short, lasting for a few seconds to 1, 2 minutes, rarely lasting more than 5 minutes, hot and cold stimulation does not cause pain, there is a pain joint called "board machine point", touch Here it causes an episode of pain.

3. Acute maxillary sinusitis: Patients with acute maxillary sinusitis often have a maxillary toothache. Because of the maxillary sinus floor of the maxillary posterior teeth, the maxillary posterior teeth are distributed in the maxillary sinus wall and the sinus floor before the root canal. Therefore, the infection in the maxillary sinus often causes neuralgia in the maxillary posterior teeth and reflects the pain in the head and face of the affected side, much like acute pulpitis, so it should be distinguished. It is characterized by acute pain of maxillary sinusitis and persistent pain. Can affect the maxillary canine, double canine, molar area, check for pain, patients often have headache, nasal obstruction and history of pus and nasal discharge, check the anterior wall of the maxillary sinus tenderness, if suppuration for paranasal sinus puncture, there may be pus out .

Chronic proliferative pulpitis is identified with the following diseases:

(1) Gingival polyps: multi-line adjacent to the jaws, the gingiva grows into the hole to form polyps, and the probe dials the polyp pedicle to connect with the gums.

(2) periodontal ligament polyps: due to the destruction of multiple caries, the perforation of the pulp, the root bifurcation, long-term chronic stimulation, causing periodontal ligament hyperplasia, penetrating into the hole to form periodontal ligament polyps, polyps pedicles and teeth The perimembranous membrane is connected, and the probe examination can be inserted into the pulp base to reach the root bifurcation, but the pain is not obvious.

Chronic atresia pulpitis and identification of the following diseases

(1) Squat: The affected teeth are painful to cold, hot and sour, no spontaneous pain, sensitive to deep sputum exploration, no pain, sensitive temperature test, normal electrical activity test.

(2) Endodontic congestion: The teeth are sensitive to cold and heat stimuli, especially cold stimuli are more sensitive, no spontaneous pain, the pain is sharp, no pain, and the electrical activity test reading is lower than normal.

It should be noted that the pulp polyps and the nipples grow into the occlusal cavity of the adjacent teeth, and the polyps of the long medullary perforation are differentiated, otherwise the consequences are serious.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.