A case of reversible pulp inflammation of difficult diagnosis, whose cause was occlusal contact in premolar guide disocclusion.
A patient sought care complaining of mild, cold-induced pain, declining rapidly, for about a month. She reported seeing two professionals, with no success in detecting the cause. On clinical examination, the pain was more exacerbated on the heat test on tooth 25. On radiographic examination, only a small radiolucent image distally on said tooth, apparently an infiltration or a small space between the restoration. After some attempts to find out the cause, it was noted that the patient was performing lateral disocclusion by the premolar.
Occlusal relief was then performed on this tooth and the patient was advised to see a professional for re-establishment of a canine guide. The patient reported remission of pain after the procedure.
Reversible pulp inflammation In: Machado, Ricardo. Endodontics: Biological and Technical Principles. Available at: GEN Group, GEN Group, 2022:
Definition
The word "inflammation" has its origin in the Latin inflammatione, which comes from the verb inflammare and means "to light or set on fire". It can be defined as a reaction to an injury to the tissues, through the blood microcirculation, with extravasation of vascular elements, such as fluids, cells, and molecules from the intra- to the extravascular space.
Inflammation represents the process by which the vascularized tissues of the body react to an aggression. The inflammatory process occurs regardless of the nature or type of aggressor agent, and is characterized by its nonspecificity. Depending on its degree of effectiveness and frequency, inflammation can be considered physiological or pathological. In daily practice, the dental surgeon must be able to determine the diagnosis, treatment, and prognosis for each case. The patient's immune response and inflammation represent the body's main form of defense against the action of aggressive agents and the occurrence of lesions and neoplasms.
It is extremely important that the professional has sufficient knowledge about the inflammatory process, because it is closely associated with the development of signs and symptoms of various pathologies of the stomatognathic system. In pulpal and periradicular diseases, inflammation acts as an etiological factor and is related to defense and repair mechanisms. During an endodontic treatment, the professional may encounter an inflammatory process at diagnosis, during treatment, and during proservation. Tissue repair represents the final stage of inflammation.
Pulpal pain is a consequence of an inflammatory response to vascular alterations with distinct characteristics, such as vasodilation, increased permeability, and release of chemical mediators capable of maintaining inflammation and stimulating pain.
Several diseases trigger inflammatory reactions as a result of the action of antigens and/or the release of their toxins. Physical agents such as trauma, radiation, or chemical processes can also give rise to inflammatory processes. Proper diagnosis and treatment are crucial because of the various causes of orofacial pain, which are sometimes difficult to elucidate. All information is relevant and must be properly collected and included in the patient's clinical history, as well as the results obtained through the different tests and examinations necessary for diagnosis.
Reversible pulp inflammation
