Chronic forms of pulpitis Chronic forms of pulpitis • Significant duration is a general sign of all chronic forms of pulpitis (it is from several weeks about to several months and years). The combination and discrepancy of slight manifestation of subjective symptoms (for example, pain) and hard tissue sewere damage. • Pain is typically presents in all forms of chronic inflammation of the pulp, it connected with the action of irritants. But pain, unlike in caries, does not subside after the elimination of pain cause. Long discomfort in an oral cavity is typical of the chronic forms of pulpitis. Nagging toothache when reception of eating, inhaling of cold air, coming in a warm room after cold. Chronic fibrous pulpitis • The patient complains of paroxysmal tooth pains from various irritants: temperature, mechanical, and chemical. Anamnesis shows, that the tooth was painful earlier. Spontaneous pains arise rarely, can be absolutely absent. Reflex pains arise with delayed reaction only from strong irritants (cold water). • An examination with a probe of the floor of a carious cavity the communication between the carious and crown cavities is found more often. The examination with a probe of the pulp is painful, the pulp bleeds. In some cases chronic fibrous pulpitis can develop without the communication of carious cavities with the cavity of a tooth. X-ray in 30 % of cases shows the expansion of periodontal fissure or the centers of under pressure of bone tissue at a root apex. Differential diagnostics • It is necessary to differentiate chronic fibrous pulpitis from deep caries, acute local pulpitis, chronic gangrenous pulpitis. 1) In chronic fibrous pulpitis and deep caries there is painful reaction to all types of irritants. But if in deep caries the pain subsides quickly after the elimination of irritants, but in chronic pulpitis pain persists during some time. 2) the case history shows • that the chronic fibrous pulpitis lasts much longer during this period the process can repeatedly become exacerbated. Acute local pulpitis lasts only 1-2 days. Its course is characterized by the absence attacks of spontaneous pains. 3) In chronic gangrenous pulpitis the painful reaction occurs from strong irritants, first of all, from hot food. The tooth cavity is widely open in most cases; the examination with a probe of the crown pulp causes not severe pain or may be painless. Pain of pulp can be determined on deep examination with a probe by root needle in tooth root canals. Chronic hypertrophic pulpitis • The patient complains of nagging pain of which is caused by various irritants. The patient frequently complains of growth of «wild meat» which easily bleeds. Hemorrhage can be in full absence of pain. The pain can be observed only at chewing. Examination of the carious cavity is reveals a growing tissue. • This growing tissue can be dense or of granulation type, easily hemorrhage even at the easiest touch. Sometimes there is slight pain there. Dense tumour of lightly pink color is found on the generated polyp of the pulp in a carious cavity. The examination with the probe does not cause hemorrhage and is slightly painful. The reaction to temperature irritations is not expressed. As a rule, the changes in periapical areas of X-ray examination are not found. Differential diagnostics • It is necessary to differentiate chronic hypertrophyc pulpitis from growth gum or granulating tissue of periodontium, bifurcation (trifurcation) roots. The growth of gum papilla occurs as a result of its trauma of sharp edges of a carious cavity • For the specification of diagnosis we can use the probe which pushes aside the growing gum papilla, on external edge of a carious cavity. If periodontium was a source of a growth of granulating tissue, the deep introduction of probe is painless. There can be severe hemorrhage and perforation of the floor of tooth crown cavities. The X-ray shows the bone rarefaction in bifurcation area.
