[Overview]

Acute pulpitis is characterized by acute attack and characteristic severe pain. Clinically, it belongs to acute attack of chronic pulpitis, especially caries. Simple acute pulpitis is rare in clinic, which is mostly caused by physical injury and chemical stimulation.

[Diagnostic Points]

1. Patients have typical pain symptoms: spontaneous, paroxysmal, sporadic sharp pain or jumping pain, aggravated at night, aggravated by cold and hot stimulation, and the pain cannot be located.

2. Dental lesions, such as deep caries, can be found in the affected teeth.

3. Dental cavity exploration often has severe pain, and sometimes small pith holes can be detected, and a little pus can be seen. Late teeth have knocking pain.

4. The pulp vitality test, especially the temperature diagnosis, is helpful for the qualitative location of the teeth. The temperature diagnosis reaction is extremely sensitive or obviously painful. After the stimulation is eliminated, the pain will last for a while. It can also be expressed as "big heat and slow cooling".

[Differential diagnosis and its basis]

1. Trigeminal neuralgia has a painful "trigger point", and every time the patient touches this point, it will induce pain; Trigeminal neuralgia rarely occurs at night; Temperature stimulation will not cause pain.

2. The nature of gingivitis pain is persistent swelling pain; The reaction to temperature test is only sensitive and generally does not cause irritation and pain; The patient can locate the pain; Suffering from swelling and tenderness of gums.

3. The pain of acute maxillary sinusitis is persistent swelling pain; The affected maxillary premolars and molars can be involved at the same time and both have pain, but there is no dental tissue disease that causes pulpitis. There is tenderness in the anterior wall of maxillary sinus, and patients may also have symptoms of upper respiratory tract infection such as headache, stuffy nose and purulent nose.

[therapeutic principle]

1. The vital pulp of young permanent teeth with early pulpitis can be preserved by pulp capping or vital pulp amputation as appropriate in clinic, and the whole pulp or root pulp can be preserved as much as possible.

2. Save your teeth. For those who are not suitable for preserving vital pulp, or those who fail to preserve vital pulp, clinical methods such as pulp drying, root canal therapy and pulp plasticization can be used as appropriate to preserve teeth.

3. Strictly follow the principle of aseptic and painless. In the acute phase, emergency treatment should be carried out first to alleviate the symptoms and the suffering of patients.

4. Try to preserve tooth tissue and restore the shape, beauty and function of teeth.

[Case study]

Patient, male, 48 years old. Self-reported spontaneous pain in the left lower posterior tooth for 3 days, which suddenly worsened last night. Now I go to see a doctor because of the unbearable pain.

Examination: The left lower 6 adjacent surfaces are deeply caries and close to the pulp, and there is a large amount of softened dentin at the bottom of the cavity, with obvious probing pain and percussion (-). The pain of cold and hot diagnosis is severe and lasts for a long time. I want to ask about its diagnosis, treatment and treatment precautions.

1. Diagnosis of left lower acute pulpitis 6.

Diagnostic basis: Teeth have typical symptoms of acute pulpitis, such as spontaneous pain, paroxysmal pain and nocturnal aggravation. The temperature test is positive and the knock is negative.

stand treat

(1) Emergency treatment begins with pulp drainage to relieve the acute symptoms of teeth.

(2) After the acute symptoms are relieved, the pulp plasticization treatment is performed.

In addition, if root canal conditions permit, pulp can also be removed directly.

3. Precautions This case is acute pulpitis caused by deep caries infection near the pulp, and most of them are acute attacks of chronic pulpitis. Therefore, when selecting the treatment method, pulp drying is not suitable.