Pulpectomy is a very painful procedure, which should not be undertaken without proper anesthesia. Routine procedures, including local infiltration or regional blocs, to be followed and, as a rule, is sufficient. However, pulp anesthesia sometimes fails and you find that the tissue can still be a very sensitive and cannot be touched, not causing intense pain, even if the injection was given properly. This complication is more common in the side of the lower jaw teeth, than in the maxillary teeth, where infiltration anesthesia, as a rule, are effective (65). This is a common clinical data, especially in patients with painful pulpitis that full anesthesia may be difficult to achieve. Provided that the injection properly and at the proper doses, several mechanisms may be prosecuted:
Pulpectomy, first of all, is aimed at preventing the development of destructive course inflammation of the pulp of the tooth, which may result in
root canal infection and associated painful events. This means that pulpectomy can be considered in any permanent teeth, where there are clinical signs of irreversible inflammatory changes in the flesh.
Materials other than calcium hydroxide may also permit the hard tissue repair of tooth pulp wounds. It gave strength to the theory that the adequate protection of the wound during the healing process can be as important as the choice of a specific packing materials. Accordingly, dentin bonding system is in favor of direct pulp floors, since the formation of a hybrid layer and subsequent recovery resin composite was considered that as a result of leakage-free tonic. Some animal studies, primarily in nonhuman primates have shown promising results dentin formation of a coating exposure site, similar results with calcium hydroxide (15, 48). Histological study on humans, however, was not able to confirm these findings and less than or only rare hard tissue found after the direct coverage of the pulp of the tooth with the help of these materials compared with calcium hydroxide.
Random pulp impact through the intact dentin occurring during cavity and crown preparation has the greatest potential for success. In this situation, the pulp can be healthy and bacterial contamination is limited, so is the primary precondition for the healing is optimal.
It is the most difficult task for the doctor, to defend the right treatment, when flesh is open or when clinical signs and symptoms suggest inflammatory participation. Conservative measures saves effort, time and money, while pulpectomy, especially in the posterior teeth, often technically complex and time-consuming procedure. That's why
direct pulp capping enjoys a certain popularity over the years to control the pulp expositions: this is a non-invasive, easy to carry and does not usually require complex
restoration of teeth after. However, pulpecto-my is the method of choice for the forecast of the tooth pulp survival is considered doubtful. If the flesh is expected to irreversible condition pulpectomy always preferable in a fully developed tooth.
Many harmful elements separately or in combination, can cause adverse reactions in the pulp of the tooth in a clinical setting. If not properly, they can cause:
- hurt pulpitis;
- pulp necrosis (pulp necrosis);
- root canal infection leading to periapical inflammatory lesions (apical periodontitis).
In the worst case, pulpitis can cause severe pain. On the other hand, are common clinical data suggest that a large number of teeth to develop a common pulp necrosis without pain and without symptoms (6). As described above, local mechanisms affecting nociceptor activation in the pulp and paper (10, 44, 48) and regulation of the transmission of impulses in the Central nervous system (55)have significant modulation effect on the development of a pain in the pulpit. The poor correlation between symptoms and the actual condition of the pulp in the inflamed teeth was created in histopathological studies (6, 52). With diagnostic point of view, the great change in symptoms in inflammation of the pulp of the tooth it is important to note.
Both structural and functional changes in the Central nervous system occur following peripheral nociceptor activation in response to
tissue damage and inflammation. These changes become more visible in prolonged pain and can lead to constant changes in those parts of pain pathways that are involved in the regulation of pain impulse transmission from the periphery to the higher centers of the brain. The results of psychophysiological research and neurophysiological experiments show that the Central regulation is also important in various dental pain conditions.
Dentin hypersensitivity pain condition that develops as a result of irradiation of the surface of the dentin. The condition is most often located in the cervical area of the tooth (6, 42, 50) and can be a significant clinical problem. As a rule, patients complain of a sharp or stabbing pain, which is caused by cold food or drinks, brushing your teeth or even a slight touch of exposed surface dentin (42, 50, 61). Pain symptoms can be very intense, continue throughout the year and, thus, have a large impact on the daily life of the patient. State and main features of sensitive dentin and hydrodynamic nerve activation mechanism as the basis for the sensitivity of the dentin, described in detail in the previous section on the sensitivity of the dentin.
Perplexing clinical conclusion that pulpitis can often lead to complete pulp necrosis without any symptoms. Recent studies have revealed a number of local mediators in peripheral tissues, which regulate the inflammatory processes and, consequently, the sensitivity of nociceptors (48, 56). In the pulp of the tooth, for example, peripheral endogenous opioids, somatostatin and norepinephrine it was suggested to have two consequences(10, 19, 44, 48). As mentioned another mediator sympathetic fibers seems to inhibit the release of CGRP and, thus, may lead to a slowdown of the inflammatory reaction and nociceptor activation (17, 20, 54).