Tooth removal – represents the removal of the pulp (popularly the removal of a nerve). Pulp is a bundle of blood vessels, lymphatic vessels, nerve endings and loose connective tissue that fill the tooth cavity and nourish it from the inside. Thanks to the pulp, the process of blood supply and mineralization of the tooth occurs. When the pulp is removed, these processes will not occur.
On average, a tooth with a nerve “lives” longer than a pulpless one. The dentist’s task is to save the pulp, if possible, because removing the nerve is a necessary measure of dental treatment. As an option, the patient is offered a more loyal solution - to preserve the nerve in the tooth and seal it, and in case of pain, depulpate it. Depulping a tooth allows you to save the tooth, but has some negative consequences:
- removal of the pulp deprives the tooth of mineralization and proper blood supply, which shortens its “life”;
- Tooth enamel becomes more fragile and fades, and the strength of the tooth decreases.
Depending on the damage to the pulp, the dentist decides on its complete or partial amputation. There are cases when you have to deal with advanced inflammatory processes that lead to severe destruction, when the nerve cannot be saved - the nerve must be removed.
Some patients try to avoid the depulpation procedure, preferring to endure the pain and/or take painkillers. This should not be done! In such cases, pulpitis can become chronic without any special manifestations - asymptomatic. And due to provoking factors, a purulent abscess may occur, which threatens the development of periodontitis.
Painless removal of a nerve from a tooth: how it goes and consequences
Many people are familiar with the procedure of removing a nerve from a tooth, which was accompanied by the mandatory placement of arsenic. Previously, this method took several days, during which the substance killed the nerve, after which the doctor removed the pulp and installed a filling or crown. Modern methods make it possible not to resort to arsenic, using more effective and painless methods. The pulp or neurovascular bundle performs important functions; it nourishes and protects tooth tissue from infection. Without it, the enamel changes color, hard tissues are destroyed faster, but in some situations, removal of the nerve is necessary.
What is the dental nerve called?
In dentistry, the dental nerve, or pulp, is a complex structure - an interweaving of nerves and vessels located inside the root and crown of the tooth and responding to external stimuli.
Depulpation allows you to save the damaged tooth, but has negative consequences:
- Since the pulp acts as a barrier to infections, removing the nerve deprives the tooth of the necessary level of blood supply and mineralization, which shortens its “life.”
- A tooth deprived of a nerve loses sensitivity, the enamel becomes more fragile and faded, and the strength of the tooth decreases.
Causes of dental pulp damage
The dentist is often visited because of caries - damage and destruction of enamel, which at the initial stage causes aesthetic discomfort.
Important: if the disease is started, the process affects the deeper layers of the tooth and pulpitis develops, that is, the neurovascular bundle becomes inflamed.
Pathologies arise due to the rapid proliferation of microbes, but in addition, the pulp can be damaged for the following reasons:
- gum disease, in which the neck of the tooth is exposed, the bone tissue is destroyed and harmful bacteria penetrate inside;
- trauma, as a result of which part of the tooth can break off, and then microbes enter the resulting cavity;
- mistake by the dentist who installed the filling or crown. If some actions were incorrect, then the nerve will make itself felt after a while.
These are the main causes of pulp damage. The symptoms of this condition will be acute. The pulp will begin to react to cold, hot, too spicy, sweet foods. Removing the nerve in such situations is a necessity, despite the fact that minerals and nutrients will stop flowing to the tooth.
Signs of tooth pulpitis
It is divided into acute and chronic phases.
The acute stage of pulpitis is characterized by:
- throbbing, sharp pain;
- External irritants can cause pain: temperature changes, cold or hot food, poor quality dental procedures, touching a sore tooth;
The chronic stage is characterized by:
moderate pain that occurs only with temperature changes, cold, or biting on a sore tooth. Increased tooth sensitivity occurs. Often a fistula also forms, with purulent contents that will periodically come out of the formed hole in the gum.
Other symptoms of the disease: headache, sleep disturbances, fever, loss of appetite.
It happens that the cause of tooth pain can be inflammation of the trigeminal nerve or facial nerve.
Why do you need to remove the pulp?
We talked about the main reasons why nerve inflammation occurs, but most often pulpitis becomes a consequence of advanced caries. Therefore, it is very important to visit a dentist, even if nothing bothers you. The decision to remove the pulp is made in the following situations:
- pulpitis has passed into the stage of periodontitis, when inflammation affects the whole complex of connective tissue in the tooth;
- large area of carious lesion;
- the infection spreads through the apex of the tooth root;
- the appearance of unbearable, prolonged pain;
- spread of infection under an artificial crown;
- consequences of improper treatment.
The nerve can be removed either completely or partially, it all depends on the degree of tissue damage. Depulpation will prevent the spread of the inflammatory process under the crown and preserve the natural tooth, which is a priority for endodontic therapy.
Indications for depulpation
When should a dental nerve be removed?
- Advanced caries;
- Pulpitis – including asymptomatic;
- Severe tooth trauma – partial destruction of the tooth and exposure of the nerve;
- Preparation for prosthetic crowns (at the discretion of the orthopedic dentist);
- Periodontitis;
- Consequences of unsuccessful treatment;
- Unbearable pain.
How does the pulp removal process work?
We mentioned the method using arsenic at the very beginning. Some dentists still use it. The disadvantages of this treatment include its duration and pain. Before administering arsenic, the doctor must widen the root canal and place the substance into it. He then seals the area with a temporary filling. After two days, the arsenic kills the nerve, then the dentist cleans the substance from the tooth cavity and removes the pulp.
Important! Arsenic should not remain longer than expected in the oral cavity, as it is a poison and can be destructive to tissue.
There are more modern ways of performing the procedure, which are both safer and more painless. Before any action, an x-ray is required, which shows the vitality of the pulp, the length of the canal and other features.
Pulp removal is carried out using the vital and devital method. The first option is used for patients of any age. Its stages are as follows:
- the tooth is exposed;
- the pulp is removed with a special tool - a pulp extractor;
- a filling is installed.
In some situations it may be temporary and after a few days it changes to permanent.
Note: all stages of treatment are performed under anesthesia, so they will not be painful or uncomfortable for the patient.
The devital method is similar to what was used ten or more years ago, only instead of arsenic, a non-toxic substance is installed in the tooth cavity. The main method of pulp removal in modern dentistry is the vital method, when in just 1 visit to the doctor you can undergo complete painless dental treatment.
Important: temporary pain after a dental procedure is considered normal, as tissue intervention has occurred. If severe pain does not go away within 3 days, you should consult a doctor.
Why can a tooth hurt after pulp removal?
This often happens: the nerve has already been removed, but the pain remains. Such manifestations are acceptable in the first 3-4 days as a natural reaction of the body (for example, to clenching the jaws or to temperature stimuli).
Other causes of toothache after pulp removal:
- Careless cleaning of the canals, preservation and intensification of the inflammatory process due to incomplete removal of tissue damaged by caries.
- Using during the procedure a pulp extractor that is not suitable for the size of the canal or improper handling of the instrument.
- Broken dental instrument, retention of its remains in the upper part of the root (such a medical error leads to the need to remove the tooth).
- The occurrence of a secondary inflammatory process in the treated canals (residual pulpitis) occurs against the background of an incompletely removed nerve.
- Allergic reaction of the patient to the filling material.
In what situations should a nerve not be removed?
We are talking not only about contraindications, but also about cases in which the pulp can be preserved. The procedure is not performed if the patient has:
- any infectious disease;
- one of the forms of stomatitis;
- psychoemotional disorders;
- acute pathologies of the heart and blood vessels;
- unsatisfactory condition of the oral cavity with suppuration and inflammation.
The nerve is preserved if it is not subject to inflammation due to caries or other pathologies and injuries. The dentist’s task is to save the pulp and remove it only in case of emergency.
Important: you cannot endure a toothache and hope that the pain in your nerve will stop. Inflammation can become chronic and show almost no effect, but any provoking factor will affect the development of a purulent abscess. In this case, the minimal consequence will be tooth loss, and the possible consequence will be the spread of infection to other tissues.
About dental anesthesia
Standard dental practice is an injection of anesthetic; Taking tablet analgesics before going to the dentist is not recommended, as it leads to a decrease in the effectiveness of anesthesia (usually the effect of an anesthetic injection is 45 minutes). For patients suffering from a fear of injections, it is possible to use paste anesthesia, which has a similar effect.
The choice of anesthesia is up to the dentist; Taking into account the individual pain sensitivity threshold of each patient, the standard dose is sometimes doubled or even tripled. With proper selection of an anesthetic, discomfort during the procedure for the patient is excluded.
Consequences of nerve removal
If the treatment was carried out by a professional and experienced dentist, then apart from slight pain the patient will not be bothered by anything. Otherwise, there may be such complications:
- a fragment of the instrument remains in the dental canal;
- the nerve was partially removed;
- incorrect or poor-quality filling of the canal;
- mechanical damage to the root or wall;
- rapid darkening of the enamel;
- suppuration due to poor disinfection.
Important! Depulpation at the Crystal clinic is carried out with the minimum possible complications, since all procedures are carried out by certified doctors with extensive experience using high-tech equipment and tools.
After depulpation, it is recommended not to eat for 2-3 hours, not to eat cold, hot, hard or other foods that irritate the mucous membrane. Your doctor will tell you in more detail about the necessary actions after removing the nerve.
Modern method of depulpation
Today, depulpation is carried out using a pulp extractor - a thin metal rod with teeth that can penetrate even remote areas of the root canals. The apex locator device helps determine the depth of the canal to reduce the risk of injury. After the procedure, a temporary filling is usually installed, but a permanent one can also be installed if the doctor does not see the risks of complications and has high-precision instruments on hand, for example, a dental microscope.
Contraindications
The dentist will refuse to perform depulpation if:
- history of acute respiratory viral infection, sore throat, influenza;
- Stomatitis, acute leukemia, and hepatitis of infectious origin were diagnosed.
Contraindications to manipulation are heart disease in the acute stage and inflammatory pathologies of the oral cavity.
Remember: women in the 1st and 3rd trimester of pregnancy cannot have the nerve removed! This is due to possible psycho-emotional outbursts and (in the absence of pain relief) the painfulness of the procedure. Anesthesia during these periods is undesirable.
How is the nerve removed?
There are several ways to remove a nerve. Which one is needed in each specific case is chosen by the doctor in accordance with the clinical picture. The choice of treatment method depends on how damaged the tooth is and how deep the inflammatory process has penetrated.
Based on the results of the examination and examination, the dentist decides what kind of removal is needed: complete or partial. If the removal is partial, then the nerve is removed only in the crown part of the tooth, and the root is not affected. Partial removal of the nerve is used quite rarely; most often the dentist is forced to perform an operation to completely remove the nerve.
