UNIVERSITATEA DE MEDICIN I FARMACIE

NICOLAE TESTEMI ANU

Catedra de Chirurgie OMF Pediatric Ped!d!" ie i Ort!d!" ie
REFERAT
Pu#$ite#e di"%i#!r $er&a"e"%i #a c!$ii' C#a(i)icare'
Particu#arit%i#e e*!#u%iei c#i"ice a )!r&e#!r acute +i cr!"ice
e,acer-ate a $u#$ite#!r di"%i#!r $er&a"e"%i de di)erite *.r(te'
C!!rd!"at!r/
C!")' u"i*' V#'P'Se&i"!*ici

Re0ide"t gru$a 1/
P!$!* 2e!rgeta
Chi+i"u 1345
Di"te#e $er&a"e"t t."r 6i&atur7 (e caracteri0ea0 $ri"tr8! rdci" i"c!&$#et )!r&at i
u" a$e, de(chi(' A-(e" a $ar!d!" iu#ui a$ica# ." 0!"a ter&i"a# a rdci"ii 6(tructuri care (u"t
(u-(tituite 9de u" !rga" )!r&ati* 7 "e !-#ig ca ." (itua ia a)ectrii $u#$are (au $u#$!8
$arad!"ta#e a ace(t!r di" i ( a$#ic& a#te teh"ici e"d!d!"tice di)erite de ce#e a$#icate #a di" ii
$er&a"e" i &aturi'
Fact!rii eti!#!gici ."cri&i"a i ." eti!$at!ge"ia $u#$!$atii#!r di" i#!r $er&a"e" i ti"eri
(u"t (i&i#ari cu cei care i"ter*i" ." ca0u# di" i#!r &aturi di" $articu#arit i#e a"at!&ice a#e
di" i#!r i&aturi 6ca&era $u#$ar *!#u&i"!a( de"ti" de gr!(i&e re#ati* redu( i
$er&ea-i#itate cre(cut7 .i )ac $e ace tia &ai *u#"era-i#i #a ac iu"ea )act!ri#!r agre(i*i'
T!t!dat di"te#e $er&a"e"t t."r e(te caracteri0at $ri"tr8! ca$acitate -i!#!gic cre(cut
dat!rit "u&er!a(e#!r e#e&e"te ce#u#are i *a(u#ari0a iei -!gate' Ace tia c!"(tituie )act!ri
)a*!ra-i#i re*er(i-i#it ii )e"!&e"e#!r i")#a&at!rii i *i"decrii'
Ce#e trei cau0e $ri"ci$a#e care ge"erea0 &!di)icri $u#$are (u"t caria de"tar "etratat
&a"!$ere#e tera$eutice i trau&ati(&e#e' :" ge"era# &!di)icri#e ce (e $!t $r!duce ."
(tructuri#e $u#$are (u"t de ti$ i")#a&at!r i dege"erati*' ;4<
Clasificarea pulpopatiilor
De8a #u"gu# a"i#!r au )!(t e#a-!rate i )!#!(ite &ai &u#te c#a(i)icri'
Ce#e &ai i&$!rta"te (u"t/
A' C#a(i)icarea tradi i!"a# a #ui Euler, Meyer care )!#!(i"d dre$t criteriu &!di)icri#e
a"at!&!8c#i"ice 6(i&$t!&e i e*!#u ie7 i ce#e hi(t!$at!#!gice de #a "i*e#u# $u#$ei
$re0i"t ur&t!are#e )!r&e c#i"ice/ ;4<
4' Pu#$ite acute/
Ser!a(e/ $ar ia#e
t!ta#e
Puru#e"te/ $ar ia#e
t!ta#e
1' Pu#$ite cr!"ice/
."chi(e
de(chi(e/ u#cer!a(e
gra"u#!&at!a(e 6$!#i$7
5' Necr!0a $u#$ar/
a(e$tic
(e$tic
=' Knzel c#a(i)ic a)ec iu"i#e $u#$are ."/ ;4<
>i$ere&ie $u#$ar 6t!ate carii#e $r!)u"de7
Pu#$ite a(i&$t!&atice (au re*er(i-i#e
Pu#$ite (i&$t!&atice (au ire*er(i-i#e
Pu#$ite (i&u#ta" (i&$t!&atice i a(i&$t!&atice 6$ar ia# recu$era-i#e7'
C' Ingle i Glick c#a(i)ic $u#$!$atii#e a(t)e#/ ;1<
I' Pu#$a#gie hi$erreacti* II' Pu#$a#gii acute
a7 >i$er(e"0iti*itate de"ti"ar a7 I"ci$ie"te
-7 >i$ere&ie -7 M!derate
c7 A*a"(ate
III' Pu#$a#gii cr!"ice
a7 =ar!d!"ta#gia
IV' Pu#$it hi$er$#a(tic
V' Pu#$ "ecr!tic
VI' Re(!r- ie i"ter"
VII' Oc#u0ie trau&atic
VIII' Fractur i"c!&$#et'
D' Du$ Grossman/;1<
I' Pu#$ite
a7 Pu#$ite re*er(i-i#e
8 Si&$t!&atice 6acute7
8 A(i&$t!&atice 6cr!"ice7
-7 Pu#$ite ire*er(i-i#e
47 Acute
8 r($u"( a"!r&a# #a rece
8 r($u"( a"!r&a# #a ca#d
17 Cr!"ice
8 de(chi(e a(i&$t!&atice
8 $u#$ite hi$er$#a(tice
8 re(!r- ie i"ter"
II' Dege"erare $u#$ar
a7 Ca#ci)icat 6c!")ir&at de dig"!(ticu# radi!gra)ic7
-7 A#te#e/ )i-r!a( atr!)ic 6c!")ir&ate de dig"!(ticu# hi(t!$at!#!gic7
III' Necr!0 (au ga"gre" $u#$ar
E' C#a(i)icarea &!der" rec!&a"dat de Seltzer i Bender ."cadrea0 a)ec iu"i#e $u#$are
." d!u &ari c#a(e/;4<
4' re*er(i-i#e 6trata-i#e7/
$u#$ i"tact "ei")#a&at?
$u#$it $ar ia#8 acut (au cr!"ic )r "ecr!0?
1' ire*er(i-i#e
$u#$ita $ar ia# cr!"ic cu "ecr!0 $ar ia#?
$u#$ita cr!"ic t!ta#?
"ecr!0a $u#$ar t!ta#'
A*a"ta@u# ace(tei c#a(i)icri e(te c (ugerea0 (!#u ia tera$eutic ." )u"c ie de (tadiu# de
e*!#u ie deci gradu# de a)ectare a# !rga"u#ui $u#$ar'
F' C#a(i)icarea du$ . !"#$%!&$';5<
4' Pu#$ite acute/ 1' Pu#$ite cr!"ice/
a7 (er!a(e $ar ia#e? a7 (i&$#e?
-7 (er!a(e t!ta#e? -7 $r!#i)erati*e?
c7 $uru#e"te $ar ia#e? c7 $r!#i)erati*e hi$ertr!)ice?
d7 $uru#e"te t!ta#e' d7 ga"gre"!a(e'
Particularit ile evolu iei pulpitelor din ilor permanen i n
diferite etape de dezvoltare la copii
1. Perioada de formare e rdcinii
Pulpitele acute. :" e*!#u ia c#i"ic a $r!ce(u#ui i")#a&at!r (er!( acut ." acea(t $eri!ad
#i$(e te ta-#!u# c#i"ic !-i "uit ace(tei )!r&e'
La $u#$ita acut (er!a( c!$iii acu0 a$ari ia ($!"ta" a u"ei dureri (#a-e' Acce(e#e ti$ice
$e"tru $u#$ita acut #i$(e(c' Acea(t durere de !-icei "u (e re$et ($!"ta" ci u#teri!r e(te
$r!*!cat de irita" i &eca"ici (au ter&ici' A(e&e"ea e*!#u ie $!ate )i e,$#icat $ri"
$!(i-i#itatea (curgerii e,udatu#ui $ri" ca"a#icu#e#e de"ti"are #argi ." ca*itatea cari!a( i $ri"
!ri)iciu# a$ica# #arg ." e(utu# $eria$ica#'
La u"ii c!$ii $r!ce(u# de-utea0 acut/ )e-r ce)a#ee !-!(ea# (#a-iciu"e dereg#ri a#e
(!&"u#ui tahicardie etc'
La $u#$ita acut di)u0 a$are u" acce( de dureri i"te"(i*e care ($re (ear (au "!a$tea (e
re$et i (e a&$#i)ic' C!$iii au i"a$ete" (u"t irita i au re($ira ie )rec*e"t tahicardie' :"
0iua ur&t!are durata dureri#!r (e &re te $." de*i"e $er&a"e"t i $!ate iradia #a t.&$#'
:" regiu"ea !cci$ita# (au (u-!r-ita# ." ureche' A"a#getice#e au ac iu"e (#a-' Ca*itatea
cari!a( are de"ti"a ra&!#it e(te (#a- $ig&e"tat' S!"darea $#a" eu#ui ca*it ii e(te
durer!a(' Date#e EOM "u (u"t c!"c#ude"te'
Pu#$ita acut $uru#e"t ."tr8u" di"te cu rdci"a i"c!&$#et )!r&at (e caracteri0ea0 $ri"
dureri acute $u#(ati#e care iradia0' Pu#$ita )!arte )rec*e"t (e a(!cia0 cu ede& c!#atera#
hi$ere&ie hi$ere(te0ie a $ie#ii di" regiu"ea a)ectat'
2a"g#i!"ii #i&)atici (u"t &ri i #a $a#$a ie (#a- durer! i' :" di"te #a -!#"a* (e de$i(tea0
i ca*itate cari!a( $r!)u"d (au !-tura ie' A#i&e"te#e )ier-i" i duc #a i"te"(i)icarea durerii iar
ce#e reci #e &ic !rea0'
Pulpitele cronice. Pu#$ite#e cr!"ice c#i"ic (e &a"i)e(t (#a- ."( $!t )i (e"0a ii "e$#cute
6de greutate7 ." di"te' La trecerea di"tr8! ."c$ere ca#d ." u"a rece a$ar dureri "e."(e&"ate'
Di" a"a&"e0 $!t )i (ta-i#ite dureri acute ." di"te' La e,a&i"are (e !-(er* $ierderea #uciu#ui
(&a# u#ui di"te#e (e ."tu"ec$!ate )i ! ca*itate $r!)u"d cu de(chidere (au "u a ca&erei
$u#$are $u#$a e(te ce"u ie #a, durer!a( #a (!"dare' Date#e EOM "u (u"t c!"c#ude"te'
Pulpitele cronice exacerbate. Se caracteri0ea0 $ri"tr8! e*!#u ie #e"t recidi*e re$etate
de dureri acute' Di" a"a&"e0 (e c!"(tat c di"te#e reac i!"ea0 #a age" i ter&ici ."(
durerea "u era i"te"(i*' Peri!ade#e de re&i(iu"e $!t dura #a u"ii c!$ii ti&$ ."de#u"gat'
C!$iii acu0 dureri acute (). iet!are cu caracter $u#(ati# care $!t iradia' Reac ia
$ar!d!"ta# e(te )!arte )rec*e"t' ;5<
Peri!ada cu rdci"i )!r&ate/ C#i"ic "u (e de!(e-e te de &a"i)e(tri#e $u#$ite#!r di" i#!r
$er&a"e" i #a &aturi';5<
Forme clinice
Inflama iile pulpei din ilor imaturi
De!arece #a di" ii $er&a"e" i ti"eri &ai de( (u"t ."t.#"ite i")#a&a ii#e $u#$are ire*er(i-i#e
tre-uie ( cu"!a te& c $u#$ita ire*er(i-i# re$re0i"t ! i")#a&a ie di)u0 care cu$ri"de at.t
$u#$a c!r!"ar c.t i cea radicu#ar':" ace(t ca0 (u"t $uter"ic acce"tuate (chi&-ri $r!gre(i*e
i regre(i*e (u- )!r& de )!care de "ecr!0 care a$ar ." $artea ce"tra# a i")i#tratu#ui ." ace(te
c!"di ii i")#a&a ia de*i"e ire*er(i-i#';1<
Cauze: Ce# &ai de( i")#a&a ii#e ire*er(i-i#e a$ar ca i re0u#tat a# $r!ce(e#!r cari!a(e
"etratate #a ti&$ (au ca ur&are a trau&ei &eca"ice' A*."d ." *edere (i&$t!&at!#!gia
di)ere" iat i")#a&a ii#e ire*er(i-i#e (e .&$art ." $u#$ite ire*er(i-i#e ."chi(e 6)r de(chiderea
ca&erei $u#$are7 i de(chi(e 6cu de(chiderea ca&erei $u#$are7';1<
Examenul histopatoloic re#e* u" ta-#!u &u#tidi)ere" iaat'
:" ca0u# $u#$ite#!r ire*er(i-i#e ."chi(e $!t )i !-(er*ate i")#a&a ii $u#$are acute $uru#e"te
(au cr!"ice reacuti0ate ."(! ite de a-ce('
:" ca0u# $u#$ite#!r ire*er(i-i#e de(chi(e (e $!t de0*!#ta i")#a&a ii $u#$are/ cr!"ice
$r!#i)erati*e u#cer!a(e $uru#e"te (au $u#$ite cr!"ice )i-r!a(e c!&$#icate adic cu i")i#trat
$uru#e"t';1<
Di" ce#e re#atate ." e#ege& c $artic#arit i#e &!r)!)u"c i!"a#e a#e !rga"u#ui $u#$ar t."r
6"u&er!a(e ce#u#e *a(e i $u i"e )i-re7 duce #a (e#ec i!"area cu $redi#ec ie a a"u&it!r )!r&e
c#i"ice'
A(t)e# &ai )rec*e"te (u"t formele acute care re)#ect ! -u" a$rare a !rga"u#ui $u#$ar'
Di"tre $u#$ite#e acute &ai de( ."t.#"ite (u"t ce#e (er!a(e i ." ($ecia# $u#$ita (er!a( $ar ia#'
Formele cronice! dat!rit ace#!ra i $articu#arit i au )rec*e" &ai &are #a c!$ii dec.t #a
adu# i? )!r&a de pulpit cronic nchis (e ."regi(trea0 ." ($ecia# (u- !-tura ii *!#u&i"!a(e
iar pulpita cronic deschis e(te c!"(eci" a #e0iu"i#!r cari!a(e e*!#uti*e cu de(chiderea
ca&erei $u#$are e*!#u ie &ai ra$id #a di"te#e t."r dec.t #a di"te#e adu#t';4<
"ecroza i anrena pulpar
#ortificarea i infectarea pulpei din ilor permanen i n perioada de cre tere
constituie o posibilitate relativ frecvent la dintele tnr.
:" ra$!rt cu e,ti"derea $r!ce(u#ui i")ec i!( i cu (tadiu# de de0*!#tare a# di"te#ui (u"t
di)ere" iate ur&t!are#e )!r&e de ga"gre" $u#$ar/ ;4<
4' necroza pulpar A &!rti)icarea a(e$tic a !rga"u#ui $u#$ar?
1' anren par ial 8 "ecr!0a i i")ec ia $u#$ei e(te #!ca#i0at ." terit!riu# c!r!"ar i
#i&itat ." terit!riu# radicu#ar cu &e" i"erea *ita#it ii ." terit!riu# radicu#ar i cu
$(atrarea c!"di ii#!r de de0*!#tare a a$e,u#ui $ri" a$e,!ge"e0?
5' anrena total8 ." care "ecr!0a i i")ec ia cu$ri"de ."traga $u#$ e,i(t."d ."(
$!(i-i#itatea &e" i"erii u"!r re(turi $u#$are *ita#e ." 0!"a a$ica# ceea ce $er&ite
c!"ti"uarea de0*!#trii a$e,u#ui $ri" a$e,!ge"e0'
B' anrena complicat8 ." care $e #."g terit!riu# $u#$ar e(te i 0!"a $eria$ica#
6$ar!d!"tit a$ica# acut i cr!"ic7/ acti*itatea tecii >ertCig e(te !$rit
)e"!&e"e#e re$arat!rii (e de$#a(ea0 $eria$ica#? cre terea a$e,u#ui )ii"d ."#!cuit
$ri"tr8! -arier ca#ci)icat ce a(igur (igi#area a$e,u#ui' Sigi#area e(te re0u#tatu#
u"ei ca#ci)icri di(tr!)ice )!r&at ." i"teri!ru# e(utu#ui de gra"u#a ie ce a$are ca !
&a( c!&$act ce (e c!"ti"u cu $rede"ti" a(igur."d a(t)e# ."chiderea u"ui a$e,
#arg deci ! rdci" (curt "e)u"c i!"a#' ;4<
I"di)ere"t de a)ec iu"ea $u#$ar e,i(te"t 6$u#$ite re*er(i-i#eDire*er(i-i#e acuteDcr!"ice7 ."
ca0u# din ilor permanen i tineri obiectivul fina# .# re$re0i"t tratarea c.t &ai ti&$urie a
a)ec%iu"i#!r +i pstrarea interal sau par$ial a vitalit$ii oranului pulpar necesar
pentru dezvoltarea complet a rdcinii';4<
%ibliorafie
4' E' =ratu F' 2#*a"/ Practica pedodontic, Ediia a III-a,Ti&i+!ara 133E.
1' F' GHIHJKLMHN8OHPQRLMHN SQT IUTHMVWUX Y'F'ZQ[W\]J/
!" !##, ^KRQR 1344'
5' P'2!d!r!@a A' S$i"ei Iu' S$i"ei/ $to%ato&o'ie terape(tic pediatric, Chi i"u 1345'