On the question of choosing the most valid methods for diagnostics of pulpal hyperemia

Abstract

The choice of the most optimal methods for the diagnosis and treatment of reversible forms of pulpitis is an urgent issue of modern practical endodontics. The dental pulp is unique in its histological structure, innervation and microcirculation. Reversible forms of pulpitis (including pulp hyperemia) are associated with a number of morphological and functional changes in the neurovascular bundle, which, at their early stages, are not fully detected during clinical examination, and require the inclusion of additional functional diagnostic methods, which include not only in the assessment of the nerve elements of the pulp (EOD), but also the study of the state of microcirculation (LDF), a change in which can become a predictor of the inflammatory response. In order to determine the most valid method for assessing the condition of the pulp in reversible forms of pulpitis, 43 young people with a diagnosis of K04.00 (pulp hyperemia) deep caries were examined and treated. Each patient was assessed carious and intact (symmetrical) teeth. At the same time, in addition to clinical diagnostic methods, EOD and LDF were used (M and σ were evaluated). Within two weeks, after the treatment, in 2 patients with the highest values of EOD (19 and 21 μA at the time of the initial examination) and LDF (M: 21.14 and 23.56 arb. units and σ: 0.82 and 0.85 conventional units) was diagnosed with irreversible pulpitis, which required a different treatment strategy. Therefore, when diagnosing reversible forms of pulpitis, it is necessary to be guided not only by the data of a clinical examination (which is undoubtedly the main and determining one), but also to assess the state of the vascular and nervous elements of the pulp, changes in which often anticipate the clinical manifestations of the pathology of the pulp of the tooth.