What is popularly called the dental nerve, in reality, is a neurovascular bundle, which has a rather complex structure and is properly called pulp. Thanks to this tissue, located inside the crown and root of the tooth, it is able to respond to external influences: for example, to feel hot and cold food. Pulp is also a kind of barrier to the further penetration of bacteria.
The photo below shows the nerve removed from the tooth:
Removing a nerve from a tooth leads to the fact that it becomes “dead” and loses the ability to perceive almost all types of stimuli (cold, sweet, sour, salty). But a tooth is called a dead one, first of all, for the reason that it loses its blood supply, the rate of mineralization processes significantly decreases in it - in other words, with time it becomes fragile, and the enamel becomes dull.
But why then do dentists so often remove a nerve from a tooth, thereby effectively depriving it of a very important internal component? What consequences can these prevent and is it really necessary to remove a nerve from a tooth?
Next, we will try to consider these issues in more detail, as well as get acquainted with the patient's feedback on “unforgettable” impressions at the dentist and see how the nerve removal procedure can occur at all and in which cases it is sometimes accompanied by very, very unpleasant feelings ...
When you have to remove a nerve from a tooth
During initial tooth decay by caries the nerve is not affected yet but with deepening carious process bacteria eventually penetrate the pulp chamber, causing inflammation here - pulpitis. In this case, a person may experience severe pain, often aggravated at night.
Pulpitis (inflammation of the dental “nerve”) is a disease that almost always requires partially or completely removing the affected pulp from the tooth in order to avoid further spread of the infection beyond the root, which could lead to serious complications.
Sometimes there are cases when the removal of the nerve is required after a severe trauma of the tooth, most often - the front. Traumatic pulpitis it is not as common as infectious pulpitis of carious origin, but it will still be necessary to remove the nerve from the tooth.
There are also cases when the infection penetrates into the tooth not through the carious cavity, but through the so-called retrograde pathway, that is, through the hole at the top of the root. At this stage of the inflammatory process in the pulp pass on the same principle as with classical pulpitis.
In rare cases, the pulp is damaged by stones or "stones", sometimes under certain conditions appearing in the root canals and compressing the delicate tissues of the neurovascular bundle, causing their irritation. This may cause traumatic damage to the pulp with a subsequent inflammatory reaction, which leads to the need to urgently remove the nerve from the tooth, which visually often looks completely healthy.
It is interesting: “Is it necessary to remove a nerve from a tooth before prosthetics with crowns?”
Depending on the clinical situation,An orthopedic dentist may, before dissecting a tooth under the crown, refer a patient for depulpation to a dentist-therapist who removes nerves from the tooth, cleans the canals and seals them to the top. In the case of a heavily damaged tooth under the crown, the nerves are necessarily removed, and in cases of prosthetics with metal-ceramic, this depends on the doctor’s tactics.
There are two schools or two approaches to prosthetics with metal-ceramic: either leave the pulp in the tooth, or else remove it completely. And if the orthopedic surgeon chooses the last option - this does not mean that he is a bad doctor. The fact is that most of the tooth is “cut down” under the metal ceramics, and the probability of overheating of the nerve or its damage during this procedure is extremely high. Therefore, in proportion to the risks, the dentist can decide not to endanger future prosthetics and eliminate uncertainty: Will the tooth ache under the crown or not.
A school that preserves the pulp in the channels during prosthetics with metal-ceramic adheres to another opinion. But this requires a high level of professionalism of the doctor (backed up by a special preparation technique), as well as the availability of certain equipment,allowing to grind the tooth on all sides during grinding.
How painful is it to remove the pulp from the tooth?
Modern dentistry has techniques that reliably relieve the tooth, so that the removal of the dental nerve is painless. However, although this may seem strange, not all physicians are fluent in pain management techniques and not all clinics have effective anesthetics for local anesthesia. In some free clinics, the situation with this can be especially pitiable.
That is why there are still reviews, disturbing the consciousness of those people who are preparing for the first time to depulp a tooth (nerve removal, followed by filling the canals).
“10 years ago I was treating the lower chewing tooth in the clinic at the place of residence (free of charge, which I regretted). I already had experience when a nerve was removed from a tooth. I thought the doctor would put arsenic and all that. And he just drilled a tooth. Then he stuck something into it (as much as a spark from his eyes) and took out a nerve. Without any anesthesia! Horror, in general. "
It is the panic fear of the upcoming nerve removal procedure that causes some people to take risks by contacting clinics where they are treated under general anesthesia, that is, with a complete blackout.However, sometimes no argument that most people get absolutely painless help in the treatment of pulpitis under local anesthesia (that is, in the mind) does not help. Even the increased cost of removing a nerve from a tooth under anesthesia is not an obstacle in such cases.
However, besides the desire to go to the “operating table” at your own risk and remove nerves from one or several diseased teeth in a dream, there are strict indications for anesthesia that a competent dentist must take into account when choosing methods and means of anesthesia.
“I don’t know why people are so afraid to go to the dentist to remove their nerves, but I personally removed them more than once and there was no severe pain. There is no pain at all! For the thirty minutes that the doctor picks there, it may prick a couple of times, but it’s not even a pain to call it. Simply, there is a feeling that something is being done in the tooth, and there is no pain during the removal of the nerve. ”
The main steps of the nerve removal procedure
Having decided on why a nerve is removed from a tooth at all (and that this is not always painful), we proceed to the next question: how does this procedure actually take place?What exactly can you expect in the dentist's office?
Generally speaking, depending on the nature and depth of damage to the pulp tissue, the doctor may decide on the partial removal of the nerve (the so-called amputation) or on its complete removal (extirpation). During amputation of the nerve, only the coronal portion of the nerve is cut off, which is located in the pulp chamber, and the root portion is preserved. However, this technique is not common, so most often resort to the complete extraction of the dental nerve from the canal system. And the more of these channels, the higher will be the price of treatment.
In the photo below, the root canals are clearly visible - each of them must be thoroughly cleaned of pulp residues, otherwise the infection remaining in them can lead to serious consequences in the future:
For interesting details of the treatment of pulpitis in teeth with several channels, see a separate article: About the treatment of pulpitis three-channel teeth and prices for this procedure.
Let us consider the main stages of preliminary preparation for the procedure of nerve extraction from a tooth:
- X-ray of the tooth. It is used, for example, in case of any doubts of the doctor at the stage of diagnosis.If there are suspicions that the nerve in the canals has died, then intraoral contact radiography, or a snapshot on a viziograph, which is safer than the first variant, is more often done.
- Anesthesia. Local anesthesia is usually used, but, as noted above, with certain indications or wishes on the part of the patient, treatment can be carried out under general anesthesia with a total loss of consciousness (especially anesthesia is required for the treatment of young children). In the case of local anesthesia, techniques and anesthetics are used to remove the nerve, which allow you to reliably and permanently freeze the tooth, almost completely turning off its sensitivity for a while.
- Insulation of the working field. In expensive private clinics, before the treatment of a tooth, cofferdam is applied — a special latex film that protects the aching tooth from saliva from the oral cavity and, moreover, creates more comfortable conditions for the doctor’s work.
- Processing of carious tissues of the tooth with simultaneous air-water cooling, creating convenient access to the pulp chamber, its opening and the formation of smooth sheer walls.
After a high-quality preparation, the nerve itself is removed from the tooth, which is performed by a pulpoextractor, a special disposable tool. The structure of the pulpoextractor allows the capture of the neurovascular bundle and extract it from the tooth canal after turning the tool along the axis at an angle of 90-180 degrees.
With a wide enough channel, it is often necessary to introduce more than one pulpoextractor to capture the pulp.
It is interesting
The usual string from the piano served as the prototype of the first pulpoextractor.
Currently, there is a technique for removing a dental nerve without pulpoextractor. A number of dentists are of the opinion that in some clinical situations the pulpoextractor extracts the nerve too roughly, creating its traumatic breakdown together with the periodontal tissues, which can in rare cases lead to certain negative consequences.
Therefore, universal files are used - tools for the passage and expansion of the root canals, which allow to carefully and controlledly cut the pulp at a given length without disturbing the root tissue that is sensitive to endodontic treatment.Control of nerve removal in this way can be carried out according to x-ray images, as well as special instruments for measuring channels, tables, etc.
To the note: "Is it possible to remove the nerve at home and if so, how to do it?"
Unfortunately, the question that concerns many people can only be answered negatively.
As practice shows, there are a lot of "craftsmen" who, when acute pain independently try to kill the nerve in the tooth at home, and if possible, get rid of it altogether. For example, there are cases when people “burned” their dental nerve. garlic, liquid ammonia, acids, alkalis on a cotton wool embedded in the "hollow", tried to cauterize the nerve with a hot needle and even a spark from a car ignition system.
However, all these methods can not be called safe for health. And even if you get somewhere arsenic paste, which is intended only for professional use, at best it will not remove the nerve, but will cause its necrosis (death), and at worst - even more pain with the safety of a living nerve, or will burn the gum around the patient and healthy neighboring teeth.
If the canal treatment of the tooth ended immediately after the removal of the nerve, it would greatly simplify the life of both the doctors and their patients. However, everything is somewhat more complicated.
In order to save the tooth for the rest of its life, immediately after removing the pulp from all canals, the dentist passes and expands them over a given length of roots, thoroughly rinses active antiseptics (from the remnants of infection and pulp) at these stages, seals it, and then makes a control picture .
A permanent filling per tooth is placed on the first or (more often) next visit.
(Clearly, some procedures for endodontic tooth treatment can be viewed on the video at the end of this article).
Possible medical errors and their consequences
The removal of the dental nerve is an event that is responsible in every sense, on which the fate of an already dead tooth depends. Under certain circumstances (lack of professionalism or fatigue of the doctor, outdated equipment and instruments), medical errors can occur during the removal of the nerve, which sometimes lead to tragic consequences for the tooth.
Most often during the extraction of the pulp there are two complications:
- break off the tool in the channel;
- severe bleeding from the canal.
The photo below shows an example of a broken dental instrument in the canal:
However, if a tool can be called a classic mistake of a doctor, then bleeding from the canal can sometimes be difficult to foresee - for example, the pulp can be pulled off while extracting the pulpoextractor may occur too deep. That is why a number of dentists do not consider it appropriate to risk removing the nerve from the tooth with a pulpoextractor, and prefer another method: cut off the soft tissue gradually with files with abundant stage-by-stage washing of the canal with antiseptics.
Breakdown of the pulpoextractor in the channel occurs due to the violation of the technique of working with it (its excessive torsion in the channel), or when using unsuitable (defective) tools.
If bleeding from the canal of the tooth is most often stopped quickly and without serious consequences, then removing the left piece of pulpoextractor is a complicated procedure, which requires the appropriate skills and specific equipment from the doctor.Leaving the “dirty” residue of the pulpoextractor in the untreated canal means tooth extraction, and it is only a matter of time.
Another possible complication of the doctor’s fault is the reappearance of pain, which is a consequence of incomplete extraction of the nerve from the dental canals. Unfortunately, even nowadays there are cases when a doctor, due to haste, negligence or fear of hurting a person, may accidentally or specifically leave a part of the dental nerve in the canals not removed.
It is not by chance that there is even a diagnosis in the clinic - residual pulpitis, when an exacerbation of the re-inflammatory process in a collapsing nerve residue in one or several channels begins. After incomplete removal of the nerve, the tooth first aches, and then it can become acutely acute with a further spread of infection into the surrounding root tissue and the development of a more serious periodontitis disease (patients may feel that the tooth pulses after pain removal from the nerve).
With the development of residual pulpitis, it is necessary to urgently re-treat the poorly processed canals anew, since completely not removed infected nerve creates the threat of serious complications, leading at best to tooth extraction.
Question to the dentist: “Why does my tooth darken after a nerve is removed?”
After high-quality canal treatment, the tooth usually does not darken over the years, but only fades, that is, it loses its natural luster, which is not a deviation from the norm. If the tooth turned black or yellowed some time after the nerve had been removed, the cause should be sought either in the preparation of the tooth cavity under the filling (in low-quality excision of carious tissues), or in poor instrumental processing of the canals while leaving nerve residues and bacterial infection in them.
In addition, often a serious change in the color of the tooth crown is associated with the material used for sealing the canals. For example, some dentists, by mistake, still continue to fill the canals of the front teeth after nerve removal with Endometasone, due to which, after a few years, the teeth may become very yellow, which is even indicated in the instructions for the material.
All shades of pink can appear on a dead tooth after canal filling using resorcin-formalin paste. Unfortunately, on a budget intake, this harmful in every sense paste is still being used, especially after the removal of nerves from milk teeth.
How much can a tooth treatment cost with nerve removal?
The price for the removal of a nerve from a tooth is based on each stage of the procedure and its complexity. Ah, if only the cost of nerve extraction and anesthesia were recorded in the receipt for the services performed, the treatment would be worth a penny ...
In fact, in the final list of services provided by the dentist, as a rule, at least 5-6 points of the price list appear: from anesthesia and passage of each canal with its filling to the cost of the final filling.
Here is a photo with an example of a price list for services for the treatment of pulpitis (caries complication):
A person who is not familiar with dentistry, usually can not clearly understand how much it will cost to cure a tooth with the removal of the nerve and the production of permanent fillings. And even often the clinic administrator, who does not know the nuances of endodontics, can only very roughly suggest the price.
Therefore, most often the patient is informed of the minimum possible amount. As a rule, this is a single-channel pulpitis, the treatment of which should take place without force majeure (without narrow and curved channels, without the use of additional drugs and x-rays).
On a note
When a consultant tells you a price, for example, “from 3,000 rubles,” and after treatment a receipt consists of 8-10 items with a final amount of 10,000 rubles, then friends, you should not immediately suspect the clinic staff of cheating. It is possible that you should be offended only at your sixth upper tooth with five narrow channels, which the doctor had to spend more than 2 hours to expand and wash with ultrasound activation, constantly take intermediate pictures on the visiograph, and in the end - fill them with the Termafil »And install a high-quality" light "seal, which has a 5-year warranty.
Fortunately, there are clinics and highly qualified doctors who discuss the cost of treatment with patients in advance, based on free time and more consultation and diagnosis. In such cases, a fixed price is not set, but a not too blurred range of deviation from the final cost is given, for example, from 8 to 9 thousand rubles for the complete treatment of the upper sixth tooth after diagnosing the maximum of possible nuances (surprises) for the future.
Interesting video: close-up removal of the dental nerve
And here you can see all the stages of treatment of pulpitis single-channel tooth.