Treatment of tooth nerve inflammation

The tooth nerve is a neurovascular bundle consisting of nerve fibers, blood vessels, and connective tissue. The crown (visible part) of the tooth contains three main layers:

• enamel — the strongest and hardest tissue that has no nerve endings and serves to protect other tooth tissues from damage;
• dentin — a softer tissue compared to enamel that contains nerve canals and can be sensitive;
• pulp — the soft tissue that occupies the central cavity of the crown and fills the canals (roots); it is in the pulp where the tooth nerve is located.

Tooth nerves and the pulp as a whole perform a number of important functions:

• Sensitivity.

The main function of the tooth nerve is to provide sensitivity. Nerve endings in the pulp respond to stimuli such as cold, heat, or pressure. It is thanks to the nerve that we feel pain when a tooth is damaged (for example, with cavities). However, sensitivity is needed not only to signal the development of a disease. It is also thanks to sensitivity that overloading and damage to teeth during chewing do not occur. In addition, temperature regulation also occurs thanks to sensitivity.

• Trophism (nutrition).

Blood vessels located in the pulp supply the tooth with necessary nutrients and oxygen.

• Restoration.

The pulp plays an important role in the regeneration of tooth tissues, helping to restore dentin in case of minor damage.

• Protection.

The pulp participates in the immune defense of the tooth. When infection enters the tooth through carious cavities or microcracks, the nerve tissue can initiate an inflammatory process (pulpitis) to prevent further spread of infection.

Various diseases can develop in the area of the tooth nerve and surrounding tissues:

• Pulp gangrene — death of the tooth nerve.
• Periodontitis — inflammation of tissues around the tooth root that can affect the nerve.
• Pulp necrosis — complete death of the tooth nerve without the possibility of recovery.
• Pulp abscess — purulent inflammation of the pulp.

However, the most common disease is pulpitis — inflammation of the tooth nerve and surrounding tissues (pulp).

Tooth nerve inflammation cannot be asymptomatic, which is already clear from the morphology of nerve tissue. However, pain is not the only symptom. Moreover, with pulpitis, an inflamed tooth nerve can provoke various painful sensations:

• Intense, throbbing pain that suddenly appears and worsens at night.
• Pain reaction to temperature exposure: cold and hot drinks, food, and even air.
• Pain reaction when pressing or biting.

An inflamed tooth nerve can also provoke the following symptoms:

• sensitivity to stimuli (reaction to sweet or sour food);
• swelling of the mucosa;
• increased temperature;
• headache;
• bad breath.

There is a fairly large number of clinical methods that help determine whether a tooth nerve is inflamed or not. These include:

• clinical examination;
• cold/heat test;
• palpation test (checking soft tissues around the tooth);
• percussion test (checking the tooth’s reaction to tapping);
• pulp sensitivity test, or EPT (checking the tooth’s reaction to electrical impulse);
• radiography.

The variety of diagnostic tools and the experience of doctors allow for highly accurate detection of pulpitis — understanding whether the tooth nerve is inflamed or the cause of complaints lies in something else.

There are several methods of pulpitis treatment that are applied according to indications. When it comes to treating the tooth nerve itself, conservative methods that allow preserving the nerve are implied.

Their application is possible in the case of reversible pulpitis, in other words — inflammation of the pulp at the first stage, when the root canals of the tooth are not affected and there is no pulp necrosis.

Symptoms of reversible pulpitis:

• the tooth nerve hurts only during exposure (pressing);
• no purulent formations;
• the X-ray shows that the roots are not affected;
• the pulp has not lost its elasticity.

In most cases of pulpitis, removal of the tooth nerve becomes inevitable. This is due to the fact that patients often postpone their visit to the dentist in the early stages of the disease. Pulpitis progresses quite quickly from reversible to irreversible, when tooth nerve removal is indicated.

Symptoms of irreversible pulpitis:

• severe, prolonged pain;
• reaction to hot (increased pain);
• no relief after the stimulus stops;
• throbbing or sharp pain;
• pain when pressing or chewing;
• pain radiation (radiating to other teeth, ear, temple);
• swelling and redness of the mucosa.

Available treatment methods

The cost of tooth nerve inflammation treatment in Kyiv may vary depending on the chosen method, the degree of tooth damage, and the level of the clinic.

The use of biological methods in the early stages of the disease will cost patients 2–3 thousand hryvnias. The price of pulpotomy is slightly higher — 3–3 thousand hryvnias. And finally, the prices for pulpectomy and endodontic treatment reach 6–10 thousand hryvnias; the cost also depends on the number of root canals in the tooth. In other regions of Ukraine, prices for similar services are on average 10–15% lower.