Today we are exploring Pulpitis in Children. Many simply do not notice the first signs of the disease, and sometimes do not attach importance, believing that with the loss of temporary incisors, the problem will be solved by itself. However, this is a fundamentally wrong approach, since it can lead to the defeat of a new dentition. Therefore, it is extremely important to understand how acute pulpitis of milk and permanent teeth in children is treated, what it is in pediatric dentistry, and most importantly, how to properly help children with unpleasant symptoms.
Pulpitis Definition
The inflammatory process that affects the internal structure, which is a bundle of nerve, collagen, and elastin fibers, as well as connective tissue and blood vessels, can manifest itself not only in adults but also in babies, even at a fairly young age. Almost all doctors agree that in most cases it is provoked by caries, which destroys the upper, hard, and durable protective shell.
Parents often think that it is not at all necessary to treat such a problem because soon the milk teeth will fall out on their own. Dentists say that such negligence should never be allowed. Dangerous pathogenic microorganisms, destroying the surface, also cause the destruction of the pulp. The process can be as unpleasant and painful as in adults, and the risk of damage to permanent dentoalveolar elements increases quite strongly. The bottom row is most susceptible to this phenomenon, due to the peculiarities of the anatomical structure of the human body.
Characteristic features of pulpitis
Caries are even more dangerous in childhood than in adults, for which there are objective reasons. The structure of dentition in children has its own nuances, which leads to the rapid spread of the disease. The thing is that the enamel coating during this period has a small thickness, it is weakly mineralized, and the tubules in it are quite large and wide. Babies also experience:
- A thin layer of dentin.
- Low saturation with minerals.
- A large mass of internal tissues.
- Not fully formed immunity.
The infection simply penetrates into the internal cavity and affects the pulpitis. The superficial infection becomes deep. The coating becomes much softer, it can no longer protect the delicate filling, and therefore it collapses rather quickly, “passing” microorganisms and bacteria inside.
Causes and features of pulpitis in children
There are a number of significant prerequisites that lead to such phenomena. It is worth familiarizing yourself with them in advance in order to stop any attempts of the disease to penetrate the baby’s body in time.
- One of the most common is injury. Children often receive injuries that no one even notices: when falling, bruising, a small point impact, or biting something hard. Even with a minimal and insignificant loss of dentin integrity (crack), when the coronal part remains intact, inflammation can develop, as bacteria and viruses penetrate through fairly wide tubules in the coating. If the cavity is opened, then the soft tissues inside are affected in just a few hours.
- Caries are the most common cause. It develops due to improperly organized and untimely hygiene procedures, and excessively high microbial load. Most often, bacteria such as streptococci and staphylococci (Streptococcus, Staphylococcus) are involved in the process.
- Rough mechanical impact and burns that occur during improper or excessively diligent and prolonged sawing, preparation in the absence of water, and etching with phosphoric acid, which is usually performed before installing a filling, can also cause the development of an inflammatory process.
- Infection of the body, for example, with sepsis, various viruses, including influenza, can also lead to pulpitis.
It is believed that a genetic hereditary predisposition cannot cause such a problem, or is extremely unlikely, at least, the connection has not yet been identified by scientists. However, the resistance of a hard surface to caries is just capable of being transmitted from parents to children. Therefore, some prerequisites of this kind still exist, although they are of a rather indirect nature.
Pulpitis Symptoms
Pathology in babies can manifest itself in a wide variety of ways. This is directly related to the characteristics of the child’s body, its anatomical structure, and the stage at which the formation of roots is located.
Acute
The most characteristic symptom of the disease is severe, sharp, and extremely unpleasant pain. It can often radiate to the neck, ear, or head. Often occurs when biting and chewing something hard and hard, under the influence of temperature (hot-cold). However, these are not all options, as symptoms may appear:
- When the pulpitis chamber is opened, the kids complain of sharp pains that appear when air is inhaled, as well as during the consumption of water at room temperature.
- The child becomes restless, there may be outbreaks of irritability, and sleep and appetite are disturbed.
- Older people often feel pain in attacks, influxes, and relapses most often occurring at night.
- Enlargement of the lymph nodes is caused there and the body begins to actively fight the infection.
- In babies, body temperature may rise, children become whiny and capricious, and sleep problems appear.
The acute form can proceed almost imperceptibly, transforming into the next one, which will be discussed further.
Chronic
With this option, there are usually no complaints at all or there are very minor complaints. The child practically does not feel discomfort, although sometimes the teeth begin to hurt sharply, and everything passes quickly. However, sometimes you can detect the appearance of an unpleasant putrefactive odor from the mouth when the pulp begins to actively break down.
Most often, parents miss the moment, not noticing the problem, until it is found in all its glory during the examination at the dentist. By that time, there is already a full-fledged carious cavity with the remains of destroyed pulp and strongly softened dentin. Often, in order to recognize this form of pathology, the doctor prescribes a study using a probe, computed tomography (CT), and/or x-ray.
The mechanism of origin and development
Usually, inflammatory processes do not occur without a reason. There are a number of irritants that cause them. Distinguish the following pathogenesis of the disease and the stages of its course:
- Hyperemia or increased blood flow to the pulpitis tissues is considered the primary phase of the development of the problem. When irritation continues to be present, for example, if the broken shell was not treated in time, it grows faster. At the same time, a substance called exudate begins to be released from small blood vessels, which accompanies inflammation.
- This is followed by a serious process, a sharp increase in the amount of protein begins to be observed in the fluid. This, as well as the procedure we have previously described, is reversible. The lymphatic system is responsible for this, capable of suppressing the pathology if the irritant is eliminated in time.
- The level of leukocytes at the next stage increases dramatically, foci of purulent lesions may appear, and the walls of blood vessels suffer greatly.
- In milk and even permanent teeth of babies, the dentin is not fully formed, it is really low-mineralized, and the roots, if any, are weak and not fully developed. The tubules in the coating are quite wide, and infection very quickly passes from the surface phase into the internal cavity. Therefore, it manifests itself not only in the coronal but also in the root region.
At an early age, all processes in the body proceed faster, and this is why the problem spreads many times more actively.
Pulpitis in children: classification and stages
In 1990, the World Health Organization (WHO) adopted the International Statistical Classification of Diseases (IBC-10). This document, which is due to be changed in 2022, indicates that the pathology can be divided into several main subtypes:
- Unspecified;
- Reversible;
- Acute;
- Chronic;
- Irreversible.
All of the above can be manifested equally in both adults and children.
On temporary
The main symptom can be called rather sharp pains, which often make themselves felt in the evening and at night. At first, they can appear from the cold and subside from the warm, but over time, any irritant causes discomfort. Pathology is of different types:
- Serous;
- Purulent;
- Periodontitis;
- With the connection of regional lymph nodes.
Sometimes it seems to children that the tooth has moved out of its place, interferes, and sticks out, it hurts to touch it. Often, swelling of the soft tissues of the submandibular region develops, and mobile lymph nodes can react quite painfully.
On permanent
The same processes are developing. However, already on the formed roots, they can be partial and/or general. Moreover, the child can accurately indicate which tooth bothers him. Usually, everything happens very quickly, most often the attacks worsen at night or in the evening, accompanied by powerful impulse-like pain sensations that radiate to the neck, ear, or temple.
Chronic options
May develop against the background of exacerbated inflammation. Pulpitis Symptoms are basically the same as described above, however, the surface may change color, and it becomes dark, grayish, or yellowish. In this case, usually in one of the elements, during the examination, a carious cavity is found, inside which an open soft tissue is visible.
Possible Complications
There are no special differences in the processes that occur with such pathology in adults and children, they are in many ways similar. The main damage may be the development of irreversible periodontitis. This chronic process, which develops at the very base of the root, persists for a long time in the bone alveolus.
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In young children, it spreads much faster, getting inside the cavity, due to the wide apical opening. In some cases, complete removal of the milk element is required to get rid of the problem. However, there are other options for aggravating the situation:
- Periostitis or inflammation of the periosteum.
- A cyst is a cavity filled with fluid.
- Granuloma, that is, the environment of the diseased area with a kind of capsule.
- Osteomyelitis is expressed in the defeat of bone tissue.
Pulpitis Diagnostics
It is not easy for dentists to work with kids, they do not fully know how to express their thoughts and feelings, and sometimes they are afraid of doctors. Therefore, diagnostic procedures are often very difficult, and the doctor has to rely only on carrying out activities according to a clear scheme.
Stages Actions
- Questioning the patient, and his parents and collecting anamnesis
- Inspection with a mirror and probe
- Percussion, that is, tapping with a special instrument
- Carrying out thermal diagnostics (cold-heat tests)
- x-ray
- Computed tomography (CT)
Pulpitis Treatment
There are several main methods of therapy that are used in the development of such pathology in young children and adolescents.
Conservative
To keep the soft tissues inside intact, these methods are used. First of all, they consist in applying various compositions to the opened or sealed pulp:
- Antibacterial;
- Antiseptic;
- Anti-inflammatory.
Surgical
The endodontic method (extirpation) is recommended in a number of cases when the doctor sees no other way out:
- Prolonged bleeding;
- Irreversible processes;
- Tissue changes;
- Long roots.
This is a full-fledged surgical intervention, during which the pulp is truncated in whole or in part, followed by filling.
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For this, a therapy option called abiogenesis is specifically provided. This procedure is aimed at spurring the development of roots. Therefore, during excision, a part of the inner pulp is especially left.
Complete removal
This effect is scientifically called apexification. It is a mechanical cleaning of the canal and then filling it with a special paste. After that, after two days, the cavity is opened and sealed with gutta-percha.
Pulpitis Treatment Complications
The restlessness and anxiety of babies during therapy are the main difficulties for dentists, even those with extensive experience. Sometimes doctors have to be in a hurry, which is fraught with insufficiently clear movements. This can lead to some, sometimes even very significant consequences:
- Root perforation.
- Gum burns with paste, due to its incorrect application.
- Bleeding.
How to prepare your baby
Preparation is an extremely important stage of therapy because it will depend on the smallest patient and how well the problem can be eliminated.
- Talk to him about doctors, telling him only positive things.
- Play dentist at home using toys and involving other family members.
- To refuse deception, as if it would not hurt at all, to tell that quite strong unpleasant sensations are possible.
- Bring your favorite toys with you to the appointment.
- Do not rush, let’s get used to the doctor.
It is important not to frighten the child, not to blackmail or offer “bribes”. All this can lead to the opposite result and the therapy session will be disrupted.
Prevention
Usually, the prognosis with timely treatment is quite good. In the vast majority of cases, it is possible to completely stop the problem. However, it is much easier to prevent the disease than to treat it later. Therefore, attention should be paid to preventive measures:
- It is recommended to carry out preventive examinations at first every three months, and then, in the absence of problems, after six months.
- Maintain good hygiene by teaching your child how to properly brush their teeth and mouth.
- Register your child for special lessons, which are often held in kindergartens and schools.
The most important aspect, in this case, is the personal example of adults. When parents follow all these points and perform all the necessary tasks themselves, then the kids adopt their habits.
Summing up
Thus, we figured out what it is – pulpitis in a child, how the teeth look before and after treatment, and most importantly, what to do if any symptoms of such a lesion suddenly appear. In no case should you ignore the problem, and at the first suspicion you need to contact an experienced, competent specialist. This will prevent the pathology from developing to catastrophic irreversible proportions. If everything is done correctly and methodically, then oral health will not raise any questions for many years, and sometimes for a lifetime.