Pulpitis Treatment in Ukraine

Inside the tooth, beneath the enamel and dentine, is a cavity containing the pulp, a soft tissue with blood vessels, nerves and the cells that build dentine. The pulp nourishes the tooth from within and is responsible for its sensitivity. Pulpitis is inflammation of the pulp, and it is almost always bacterial: caries gradually destroys the dentine, micro-organisms reach the pulp chamber, and the tissue inside the tooth responds with swelling.

The pulp is enclosed within rigid walls. The swollen tissue has nowhere to expand, so the pressure inside the chamber rises and acts on the nerve endings. This explains the pain: it comes in waves, gets worse when lying down (that is, at night) and often wakes you up. At first cold causes a sharp flare, while at later stages the pain builds from heat instead, and cold temporarily eases it.

Pulpitis is classed as reversible or irreversible, and the whole approach depends on this distinction. Reversible pulpitis is when the pulp is still able to recover: the pain is brief, lasts seconds after cold and goes away as soon as the trigger is removed, and there are no spontaneous attacks. Irreversible pulpitis is when the inflammation has gone deeper: the pain lasts minutes or hours, comes on by itself, radiates to the temple, the ear or neighbouring teeth, and it is often hard to say which tooth is hurting.

Treatment is needed in either case, and also when the dentist, while preparing a deep cavity, sees that the caries has reached the pulp. Another reason is an injury in which part of the crown has broken off and a pink spot of pulp is exposed: in the first hours the pulp can still be saved. Treatment also has limits. A tooth is not treated when it is broken down below the level of the bone, has a vertical root fracture or has become loose because of bone loss around it. In such cases it is more honest to discuss extraction and a replacement tooth than an attempt that will take several visits and end in extraction anyway.

MediUkraine is a treatment search and coordination service, not a clinic. For dental treatment we work with a partner clinic: Vidnova Dental Clinic in Lviv, 10 Ivana-Teodoziia Kurovtsia Street. We select a dentist with the right specialisation, arrange the date and support you throughout, including if you are travelling from abroad. The diagnosis and treatment approach are decided by the dentist after an in-person examination and an X-ray.

Inflammation of the pulp starts with caries and almost never appears suddenly. Bacteria destroy the enamel, then the dentine, and their toxins travel through the dentinal tubules to the pulp long before an opening into the chamber appears. The pulp first responds defensively: it builds reparative dentine and tries to wall itself off. When the bacterial load exceeds what it can cope with, the inflammation becomes persistent. Less often the cause is a crack in the enamel, an injury with part of the crown broken off, overheating during drilling without cooling, or a leaking filling under which bacteria have lived for years.

In reversible pulpitis the whole pulp can still be preserved. The pain is brief: cold causes a sharp flare that passes within a few seconds of the trigger being removed, there are no spontaneous attacks, and the tooth does not trouble you at night. Treatment consists of removing the cause: all the affected dentine is removed, in a deep cavity a thin layer of liner is left at the base, and the tooth is sealed tightly with a restoration. Within a few weeks the sensitivity usually fades, and the tooth keeps its vital pulp.

Irreversible pulpitis is a different situation. The pain comes on by itself, lasts from several minutes to hours, gets worse at night and when lying down, and radiates to the temple, the ear or neighbouring teeth. It is often hard to pinpoint the tooth responsible: the pulp has no position receptors, so the brain cannot localise the pain precisely. At this stage the pulp can no longer be preserved in full, and the only question is how much of it will have to be removed.

The dentist tells the two apart using several signs, not just one. The cold test is done with a chilled cotton pellet, looking not at whether there is a reaction but at how long it lasts after the trigger is removed. Percussion and the response to biting are added, which suggest whether the inflammation has spread beyond the root tip, along with electric pulp testing and a periapical X-ray, which shows the depth of the cavity and the condition of the bone around the root tip. The boundary between reversible and irreversible inflammation is not clear-cut, so the final decision is sometimes made only after the caries has been removed and the pulp itself has been seen.

Methods that preserve the pulp are known as vital pulp therapy. The gentlest option is indirect pulp capping: a thin layer of affected dentine is left over the pulp and covered with the capping material. Direct pulp capping is used when the pulp has been exposed at a single point during caries removal or after a recent injury. Partial pulpotomy removes 2–3 mm of the superficial pulp, and full pulpotomy removes the entire coronal pulp down to the canal openings. In each case, bleeding is controlled first: if it does not stop within a few minutes, the tissue is inflamed more deeply than it seemed, and the method is changed.

The material matters a great deal. Today, bioceramic calcium silicate cements such as MTA and similar products are placed on the cut surface of the pulp: they are alkaline, well tolerated by the tissue and promote the formation of a dentine bridge. Calcium hydroxide, which was used for decades, gives a less predictable seal, so it is used less often in this role. Equally important is a well-sealed restoration over the material, because bacteria getting back in undoes any pulp-preserving treatment.

A tooth with an incompletely formed root is a special case. In a teenager's permanent tooth the root goes on maturing for another 2–3 years after eruption, and it is the pulp that builds it: it thickens the walls and forms the root tip. If the pulp is removed completely from such a tooth, the root will stay short for good, with thin walls and a wide open tip; it is difficult to fill tightly, and the tooth itself is at risk of fracture for years. That is why, after an injury or exposure by caries in a young tooth, a partial pulpotomy is done, leaving the root pulp alive, and the root is given time to finish forming; this approach is called apexogenesis. In primary (baby) teeth, pulpotomy also remains the main method.

When there is nothing left to preserve, the pulp is removed completely and classic endodontics follows. The tooth is isolated with a rubber dam, the chamber is opened, the canal openings are located, the working length is measured with an apex locator and confirmed by an X-ray, the canals are shaped with nickel-titanium instruments and irrigated generously with sodium hypochlorite. The canals are then filled along their full length with gutta-percha and sealer, without voids, and a check X-ray is taken. A root-treated tooth becomes brittle, so on molars and premolars it is covered with a ceramic onlay or a crown rather than a filling alone.

The number of visits depends on the condition of the pulp, not on the patient's preference. Irreversible pulpitis with a vital pulp is often treated in one appointment: the canal is only lightly infected, and there is no point in dragging treatment out. Two or three visits are needed when the pulp has already died, a lesion has appeared at the root tip or there is marked exudation; in that case the canals are filled with calcium hydroxide for 7–14 days between appointments. A further visit is planned for the permanent restoration. A short emergency pain-relief appointment is a separate matter: the dentist numbs the tooth, opens it and relieves the pressure inside the chamber, and schedules full treatment for the next few days.

Anaesthesia in pulpitis is technically harder than with ordinary caries. Inflamed tissue is acidic, and ordinary infiltration anaesthesia works less well in it, so the dentist adds a nerve block, intraligamentary and sometimes intrapulpal injection, and checks sensitivity before starting work. Computer-controlled anaesthesia delivers the solution slowly and at controlled pressure, so the injection is felt less and the numbing is more even. A plain word on devitalising pastes: the arsenic-based products once used to "kill the nerve" over a few days cause necrosis of the gum and bone if left in too long, and the practice has been abandoned.

For the first few days after the appointment the tooth may be sensitive to biting. This is a normal reaction of the ligament that holds the root in place to instruments working near the root tip. The discomfort is usually most noticeable on the first day and eases within 2–5 days; if needed, the dentist recommends a non-steroidal anti-inflammatory painkiller at the usual dose. Avoid chewing on that side until the permanent restoration is in place.

If the pulp has been preserved, the tooth may respond to cold with brief sensitivity for a few more weeks. What matters is not the reaction itself but how it changes: it should get weaker from week to week. A reaction that instead gets stronger, appears at night or lasts longer than a few seconds means that the inflammation has progressed, and the tooth needs to be re-examined rather than waited out.

Some symptoms should not wait for a scheduled visit: pain that builds instead of easing, swelling of the cheek or gum, a raised temperature, an unpleasant taste from under the temporary filling, or the filling falling out. In these cases, contact the clinic the same day: early intervention is usually simpler than treatment put off for a week.

A temporary filling is designed to last weeks, not months: it wears away and begins to let saliva and bacteria back into the tooth. That is why the permanent restoration is planned within 2–4 weeks. The seal of the crown affects the long-term result as much as the quality of the work inside the tooth, and this applies equally to a preserved pulp and to filled canals.

The result is assessed at different times depending on what was done. After pulp preservation the tooth is checked at 3, 6 and 12 months: the response to cold, the absence of spontaneous pain and the condition of the bone around the root tip on the X-ray are reviewed. After complete removal of the pulp the tooth no longer responds to cold, so the only way to monitor it is an X-ray at 6 and 12 months: a lesion in the bone shrinks slowly, and it takes one to two years to disappear.

Clinical studies show a high success rate for partial pulpotomy in teeth with a vital pulp, and canal treatment carried out according to protocol leads to healing in about 85–90% of cases. These are statistics, not a promise: the prognosis for a particular tooth depends on the stage of inflammation, the number of canals and how much tissue has been preserved, and only a dentist can outline it after an examination and an X-ray.