Ukoliko ste doživeli takav bol da niste sigurni koji zub vas boli – jer vas boli cela strana, i sinusi, i uho, i glava – velike su šanse da imate pulpnu zubobolju. Pulpa je najvitalniji deo zuba, to je meko tkivo u korenu zuba koje sadrži nerv, krvne sudove i vezivno tkivo. Kada dođe do njene infekcije ili oštećenja, stomatolog će preporučiti vadjenje živca i pokušati na taj način da zaustavi dalje propadanje zuba.
Iako zvuči zastrašujuće, vadjenje živca je zapravo bezbolna procedura kada je sprovode dobri stomatolozi. Krenimo, za početak od objašnjenja šta je to zubni živac, kada je neophodno njegovo vadjenje i kako se ono izvodi.
Šta je to živac zuba i gdje se nalazi?
Zubni živac je opšteprihvaćen naziv za zubnu pulpu, iako pored nerva pulpu čine još i limfni sudovi, krvni sudovi i vezivno tkivo. Ovo je najmekši i najvitalniji deo zuba, koji ne samo da čini njegovo jezgro, no čini i zub živim. U predelu krunice zuba ona se nalazi u komori pulpe, dok je u predelu korena u kanalu korena zuba.
Pulpu, sa svim krvnim sudovima, vezivnim vlaknima i nervom, od napada bakterija i infekcija štiti sloj dentina. Dentin je najveći deo zuba i kroz njega prolaze mali nervni završeci koji zapravo mogu dati signal – ukoliko dođe do razvoja karijesa na gleđi.
Gleđ je najtvrđi deo zuba i predstavlja ujedno i najtvrđe tkivo u čitavom ljudskom organizmu. Ipak do njenog propadanja i te kako može doći, ukoliko se oralna higijena ne sprovodi pravilno i redovno. Karijes može napredovati i dospeti do dentina. Dentin je mekše tkivo od gleđi, te je tako put kvara do zubne pulpe i nerva mnogo brži.
Jednom kad se inficira pulpa, pristupa se njenom lečenju. Lečenje kanala korena podrazumeva umrtljivanje i vadjenje živca, odnosno zubne pulpe.
Čemu služi zubni živac?
Iako je ključ vitalnosti zuba u zubnom živcu, istina je da zub može nesmetano obavljati svoju funkciju čak i kad nema nerv u sebi. U toku razvoja zuba i njegovog rasta, pulpa ima nemerljiv značaj. Ipak, jednom kad zub izbije kroz desni, značaj pulpe se u tom smislu smanjuje. Zapravo, zubni živac nakon toga igra uglavnom senzornu ulogu – ona obezbeđuje zubu osećaj toplog i hladnog.
Sa ili bez zubnog nerva, zub funkcioniše. Međutim, jednom kad se obavi vadjenje živca zub će biti manje održiv, krt i sklon lomljenju.
Kada je neophodno vadjenje živca iz zuba?
Lečenje kanala korena naziva se još i endodontskom terapijom, a podrazumeva uklanjanje infekcije iz zuba i vadjenje zubnog živca. Iako i na sam pomen vadjenje živca zvuči kao bolan proces, zahvaljujući anesteticima ovo je bezbolna terapija. Kada je neophodno da se njoj pristupi?
Inficiran zub i pulpa – duboki karijes
Kada se karijes proširi sa gleđi na dentin i stigne do pulpe, neophodno je da se infekcija zaustavi, te da se spreči njeno širenje na okolna tkiva, kao što je alveolarna kost, na primer. Tada se pristupa lečenju kanala korena zuba, gde se pulpa nalazi. Karijes koji je zahvatio sva zubna tkiva naziva se duboki karijes.
Gangrena zuba
Neretko se događa da iz straha od posete stomatologu osoba ignoriše bol u zubu ili kad je to nemoguće – uz pomoć analgetika umiri bolove. Zubobolja na taj način umine, bolovi prestanu, pa osoba misli da je rešila problem. Međutim, to ne može biti dalje od istine.
Proces koji je započeo u zubu neće se zaustaviti sam od sebe. Ukoliko se infekcija ne leči, dolazi do odumiranja pulpe, odnosno do gangrene zuba. Gangrenu, pored nesnosnog bola koji se navraća, prate upaljene desni i neprijatan zadah iz usta, a zub menja svoju boju. Lečenje je sporo, a ako se ne započne na vreme, može biti i bez uspeha, što za krajnji rezultat nažalost ima vađenje zuba. Više o gangreni pročitajte ovde.
“Mrtav zub”
Mrtav ili nevitalan zub je ništa drugo do zub čiji nerv je mrtav. Bez obzira na to šta je uzrokovalo odumiranje zubne pulpe, lečenju kanala korena se pristupa momentalno. Vadjenje živca zuba jedini je način da se spreči širenje bakterija na okolne zube i desni.
Trauma ili lom zuba
Ukoliko dođe do preloma zuba, može se desiti da se lom proširi duboko u zub i dostigne pulpu. U tom slučaju je neophodno obaviti vadjenje živca.
Takođe, kad dođe do neke traume, te se na zub izvrši veliki pritisak, postoji mogućnost da završetak nerva bude odsečen. To će za posledicu imati odumiranje nerva i indikacija je vadjenja živca. Ono što je neobično kod trauma i njihovog efekta na pulpu jeste da se odumiranje nerva može desiti odmah ili čak godinama pošto je došlo do povrede.
Resorpcija korena zuba
Jedna od reakcija na traumu ili presađivanje zuba može biti resporpcija korena, kada se rastvara struktura zuba. Ako oštećenje počinje sa spoljašnje strane korena i krene prema unutra, to se naziva spoljna resorpcija korena. Ako se zub rastvara iz sredine ili iznutra zuba i napreduje ka spolja, klasifikuje se kao unutrašnja resorpcija. U oba slučaja resorpcija može napasti kanal pulpe i vitalni nerv i krvne sudove koji se nalaze u njoj. Ako do toga dođe vadjenje živca je neophodno, i to pre nego što resorpcija uništi veću strukturu zuba.
Vadjenje živca zuba – postupak
Endodontska terapija podrazumeva lečenje u tri koraka, koji se stomatolog obavlja u jednoj do tri posete u zavisnosti od toga da li zub ima jedan ili više korijena.
#1 Čišćenje kanala korijena
Početak lečenja zahteva da se kanal korena očisti od infekcije, i upravo u ovoj fazi radi se i vadjenje živca. Stomatolog pravi mali otvor na površini zuba, čisti ga od karijesa i uklanja bolesno ili mrtvo pulpno tkivo. Ovaj postupak se obavlja pod anestezijom, te pacijent ne oseća bol.
#2 Punjenje kanala korijena
Nakon vadjenja pulpe od izuzetnog je značaja da se šupljina kanala korena dezinfikuje, što stomatolog radi ubrizgavanjem različitih rastvora. Nakon toga se kanal puni posebnim pastama i zatvara cementom.
#3 Dodavanje krunice ili njeno punjenje
Sada kada je zub „mrtav“, odnosno bez dotoka hranljivih materija biće skloniji lomljenju i trošenju. Krunica mora imati adekvatan ispun, te se nakon završetka prethodne faze pristupa plombiranju zuba. Jednom kad se ispuni zub, osoba ga može koristiti kao i pre. Tamo gde je krunica toliko propala radi se njena zamena.
Kod zakrivljenih kanala ili kod zuba sa dva ili tri korena, endodontsko lečenje zahtevaće još jednu do dve posete stomatologu.
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