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Pain symptoms and pulpal diagnosis

In the worst case, pulpitis can cause severe pain. On the other hand, are common clinical data suggest that a large number of teeth to develop a common pulp necrosis without pain and without symptoms (6). As described above, local mechanisms affecting nociceptor activation in the pulp and paper (10, 44, 48) and regulation of the transmission of impulses in the Central nervous system (55)have significant modulation effect on the development of a pain in the pulpit. The poor correlation between symptoms and the actual condition of the pulp in the inflamed teeth was created in histopathological studies (6, 52). With diagnostic point of view, the great change in symptoms in inflammation of the pulp of the tooth it is important to note.

The nerve fibers of cellulose can maintain their structural identity even in developed pulpitis where there is considerable destruction of other components pulp tissue (57). It is not known if other axons are capable of momentum transfer in such circumstances, but clinical experience shows that pain can be caused due to endodontic treatment of teeth, where the majority of necrotic pulp.

Comparison of electric thresholds of one intradental nerve fibers and the teeth of man also indicates that the activation of only a few intradental axons enough to cause prepain or pain sensations in human teeth (39, 43). With pulp diagnosis such results are significant because they indicate that the few survivors of the nerve fibers of cellulose with the advanced tissue necrosis may give a positive sensory response dental stimulation. Thus, caused a sensation in response to electrical stimulation with pulp tester does not necessarily mean that the pulp is healthy. In fact, dentin can be sensitive, despite significant tissue damage in the base pulp tissue (6). All these results indicate that the correlation between treatment sensory reactions and conditions of the pulp poor. Accordingly, it should be noted that the painful symptoms are not a reliable basis for the production of pulp diagnostics. With inflammatory lesions, mediators, such as histamine, bradykinin activated fiber (40, 43). After the decrease of the tooth pulp blood flow to the periapical injections of adrenaline, they retain their ability to function better than fiber (35), where the momentum is blocked, probably due to hypoxia in the pulp and paper tissues. This means that during the implementation of pulpitis, the pulp of a tooth with fiber can keep their opportunities for a nerve impulse longer than fiber. In fact, they may become even more active in the closing stages of inflammation of the pulp of the tooth because of their susceptibility to inflammation mediators and lowered pH (21). Functional properties of two of the nerve fibers of cellulose groups can explain changes in the quality of painful symptoms for pulpitis: from rather sharp or shooting and quite well localized, dull and protracted. Thus, the type and duration of symptoms in patients with inflammation of the pulp of the tooth diagnostic value, and may give some indication of the pulp condition. However, it should be emphasized again that the correlation between symptoms and histopatho-logical changes in pulpitis is poor and determining the type and extent of inflammatory changes on the basis of symptoms is inaccurate. ..
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