ACUTE PULPITIS

Acute pulpitis is an inflammation of the pulp caused by injury to the pulp, usually from dental caries or trauma. It is the most frequent cause of severe tooth pain. The pain is caused by the pressure of fluids building up inside the pulp chamber or root canal.

Symptoms

A patient with acute pulpitis may complain of the following:

Spontaneous, continuous, or intermittent pain that lingers

Piercing and pulsating pain in the affected area

Increased pain when lying down

Signs

Upon examination for acute pulpitis, you may observe one of the following signs:

A large carious lesion

A large carious lesion with a pulpal exposure

Blood or pus oozing from the pulpal exposure

A fractured tooth or missing restoration

Treatment

As part of the emergency treatment plan for acute pulpitis, you may need to perform some of the following procedures:

Perform emergency treatment guidelines.

Gently remove loose debris from the cavity.

Dry the cavity with cotton pellets.

Pack the cavity with a cotton pellet slightly moistened with eugenol.

Gently fill the cavity with a temporary filling material.

Check the occlusion.

Instruct the patient to return for definitive treatment.

PERIAPICAL ABSCESS

A periapical abscess (fig. 6-4) usually results from an infection of the pulpal tissue causing the pulp to become necrotic (die). This type of infection causes fluids and by-products to build up within the walls of the pulp chamber and root canal(s). The periapical abscess is formed when these materials escape through the apical foramen of the tooth. An area of pus and fluid accumulation forms in the bone surrounding the apex of the tooth. As the pressure builds up, a channel may form through the alveolar bone and the soft tissue. This channel is called a sinus tract. When the pus reaches the soft tissue, vestibular or facial swelling can occur. Extensive swelling is called cellulitis. Swelling that is confined to a small area at the site of a sinus tract is called a gumboil.

Symptoms

A patient with periapical abscess may complain of the following:

Constant, throbbing pain in the affected area.

Increased pain when chewing.

Increased pain when lying down.

Bad taste in the mouth.

A gumboil.

The tooth "feels longer" than the others.

Figure 6-4.\Periapical abscess.

Malaise. Tender lymph nodes.

Signs

When there is a periapical abscess, you may observe some of the following signs upon examination:

A severe pain reaction is experienced when light pressure is applied to the affected tooth.

A gumboil.

Facial swelling (general or localized).

Tooth mobility.

An elevated temperature.

Enlarged lymph nodes.

Treatment

To treat the periapical abscess, you should perform the following in the emergency treatment plan:

_Perform emergency treatment guidelines.

Expose a periapical radiograph of the affected tooth. The abscess will appear as a radiolucency around the apex of the tooth.

Drain the abscess. If the abcess is soft 'and pus is evident, drainage can be done without local anesthesia. Puncture the most raised portion of the abscess with an explorer.

If a carious lesion is present, gently excavate the cavity. NOTE: If drainage occurs through the cavity, the patient may experience a rapid relief from pain.

If drainage does not occur, have the patient rinse with warm saline solution for 10 minutes every 2 hours. This should help promote drainage.

NOTE: NEVER apply heat to the external surfaces of the face.

If drainage still does not occur, apply an ice pack to the affected area. This may reduce the patient's discomfort until the dentist can provide emergency treatment.

When drainage is established, give the patient instructions about home care and notify the dental officer to see if a prescription for antibiotics can be called in to the pharmacy.

Instruct the patient to return to the dental treatment facility (DTF) for definitive treatment as soon as possible.