Dental care has come a long way in the recent years. Awareness about dental health has also increased a lot. However, dental problems are very common and affect almost every age group even in developed countries. Dental problems may result from poor dental hygiene but there could be other reasons as well. If proper oral hygiene is not maintained, tooth decay and pain can result. Brushing twice a day, flossing regularly and using a medicated mouthwash can significantly reduce the chances of developing cavities and gum disease.
Dental cavities, if not treated on time, can affect the pulp i.e. the soft center of the teeth. The pulp contains nerves and blood results of the teeth. It also nourishes the surrounding dentin through specialized cells known as odontoblasts. These cells also transmit sensory information. This is why injury to the pulp causes pain. If left untreated, pulp diseases can eventually lead to loss of teeth.
Symptoms of dental pulp diseases
There are several types of dental pulp diseases. Depending on the type of the disease, symptoms will vary. Common symptoms include:
- Tooth pain, especially when you eat something sweet, hot or cold
- Mouth infections
Types of dental pulp diseases
There are several types of pulp diseases. They include:
Reversible pulpitis: Reversible pulpitis is characterized by mild inflammation of the pulp. It can be easily cured. Symptoms include pain when taking sweet, hot or cold foods. If it is not treated, the inflammation can result in the formation of a dental abscess. Following proper oral hygiene can treat reversible pulpitis. However, in some cases dental fillings may be necessary. Pulpitis can also result if the teeth are broken, chipped or injured.
Irreversible pulpitis: Irreversible pulpitis is characterized by severe inflammation of the pulp that cannot be cured. Symptoms include intense and continuous pain. If it is not treated, serious gum and connective tissue infections can result. Root canal treatment is the mainstay treatment option for irreversible pulpitis. If it is not successful, extraction of the affected tooth may be necessary.
Dental pulp calcification: Dental pulp calcification is also known as ‘dental pulp stones’. In this condition, the pulp becomes hard or calcified. This results in the compression of the nerves present in the pulp, leading to extreme sensitivity and pain. Root canal treatment to remove the hardened tissue is the main treatment approach used to treat pulp calcification.
Dental pulp exposure: When the external covering of a tooth is damaged due to cavities or injury, the internal pulp gets exposed to bacteria and food particles. This causes pain and sensitivity.
The dentist will diagnose pulp diseases on the basis of the description of the symptoms experienced by you. The severity and nature of the pain provide clues about the extent of damage to the pulp. Your dentist will also examine your mouth for cracked or discolored teeth. He/she may expose your teeth to heat or cold to check if the nerve is still alive.
Your dentist may also inject a local anesthetic at the base of the tooth that is suspected to be infected. If you stop experiencing pain, it means that tooth was the right one. If you still experience pain, he/she will repeat the procedure with the next tooth. This way he/she can identify the exact teeth having pulp infection.
Pulpitis cannot be identified easily using an X-ray scan. This is because pulpitis affects the bone only at very advanced stages.
Treatment options for dental pulp diseases
Once dental pulp disease is diagnosed, the dentist will take measures to prevent the infection from spreading and to save the tooth. The treatment procedure will depend on the extent of the infection. The following treatment options are usually followed.
Root canal treatment
Root canal treatment preserves the tooth and keeps you from having it removed. In root canal treatment, the infected pulp tissue is removed and the chamber is sealed off to prevent the infection from spreading. Root canal treatment usually takes 2 to 3 visits to the dentist’s office.
First visit: In the first visit, the dentist will inject an anesthetic and isolate the tooth with a rubber dam. The dentist will then drill a hole through the top of the tooth and remove the pulp. He/she will then clean the root canal, remove bacteria, tooth fragments and tissue, and shape the root canal. The dentist will then inject antiseptic and antibiotics into the pulp chamber to kill the bacteria. The root canal is then allowed to dry and then temporary filling material is placed in it. Finally, a temporary restoration is placed in the access hole of the tooth. Sometimes, this procedure may be performed over two visits.
Second visit: In the second visit, the dentist will remove the temporary filling and fill the chamber with a permanent filling to prevent reinfection. Sometimes, a plastic or metal post may also be inserted into the root canal to provide extra support.
Third visit: In the third visit, a permanent restoration is placed on the tooth. The material used for restoration will depend on the size of the access hole. Your dentist may use an amalgam or composite restoration, a crown or both depending on the requirements. Premolars and molars are usually crowned after root canal treatment to prevent breakage.
Pulpotomy is the removal of the damaged pulp from the crown portion of a tooth. The procedure leaves the pulp portion present in the root intact. This procedure is usually performed in children and young adults as it allows the root to grow. Pulpotomy is suitable only if the inflammation is mild. Root canal treatment may be required at a subsequent date after pulpotomy is performed.
If the infection has spread through the dentin, the dentist may coat it with a layer of medication to allow it to heal on its own before placing a permanent filling. This is known as pulp capping.