Apical Periodontitis - Symptoms, Treatment, Forms, Stages, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Apical periodontitis

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Symptoms
4. Diagnostics
5. Treatment
6. Possible complications and consequences
7. Forecast
8. Prevention

Apical periodontitis is an inflammatory process localized in the area of the apex of the tooth root (periodontium). This is one of the most common dental pathologies. It is diagnosed in every third patient between the ages of 20 and 60 who visits the dentist.

Apical periodontitis - inflammation in the periodontal area

Causes and risk factors

In most cases, the cause of the development of apical periodontitis is the penetration of pathogenic microflora (staphylococci, streptococci, aerobic bacteria) from the dental canal through the apical opening into the tissue of the periodontal ligament. This usually happens against the background of a neglected form of pulpitis, in which the death of the dental neurovascular bundle (the so-called dental nerve) occurs.

Apical periodontitis can also appear as a result of mechanical trauma to the tooth (bruise, root fracture) or the ingress of irritating potent drugs into the periodontal tissue, which is observed with incorrect pulpitis therapy. These factors trigger aseptic inflammation in the periodontium, which quickly turns into an infectious form.

The onset of apical periodontitis

Infection can also enter the periodontium from the maxillary sinus with sinusitis.

Forms of the disease

Depending on the cause that caused the development of the infectious and inflammatory process, there are three forms of apical periodontitis:

• infectious;
• traumatic;
• medication.

In accordance with the routes of infection, the following forms of the disease are distinguished:

• intradental (the infection penetrates through the apical canal of the problem tooth);
• retrograde (the infection penetrates from the gingival margin);
• extradental (the infection enters the periodontium from another site of inflammation).

According to the activity of the inflammatory process, apical periodontitis can be acute and chronic. Acute forms of the disease, in turn, are subdivided into serous and purulent. Chronic apical periodontitis is:

• fibrous;
• granulomatous;
• granulating.

Symptoms

The first symptom of acute apical periodontitis is aching pain at the site of the lesion, aggravated by thermal or mechanical exposure. After a short period of time, the intensity of the pain increases, it acquires a pulsating character and can radiate to other parts of the face. These signs indicate the beginning of purulent fusion of periodontal tissues. Other symptoms of acute apical periodontitis are:

• an increase in body temperature to febrile values;
• deterioration in general health;
• headache;
• the mobility of a diseased tooth;
• enlargement of the submandibular lymph nodes;
• swelling of soft tissues in the affected area.

The acute stage of the disease can last from 2 to 14 days. If adequate treatment is not started, the inflammation will either go into a chronic phase or spread to the surrounding tissues, which can cause severe purulent-inflammatory diseases (for example, phlegmon).

The clinical picture of apical periodontitis

Chronic apical periodontitis in the remission phase is almost asymptomatic. With an exacerbation of the disease, the clinical picture is characteristic of the acute period. Without an exacerbation, some patients may experience:

• bad breath;
• the appearance of fistulas on the gums;
• slight soreness of the problem tooth that occurs when biting on it.

The granulating form of chronic periodontitis is characterized by a feeling of fullness in the gums and occasional slight pain. Usually these symptoms precede the opening of a fistula through which pus is released. Then the fistula closes, and the unpleasant sensations also subside until a new exacerbation.

Chronic granulomatous periodontitis is almost asymptomatic, the only signs may be pain or discomfort in the affected tooth while eating.

In chronic fibrous periodontitis, the problem tooth does not respond to temperature changes or chewing load. There is usually a very deep carious cavity inside the tooth with completely dead pulp. A gangrenous odor often spreads from the cavity.

Diagnostics

Apical periodontitis is diagnosed by a dentist based on symptoms of the disease, X-ray and electrodontometry (EDI) data.

The acute form of the disease requires differential diagnosis with other diseases with a similar clinical picture:

• periostitis;
• osteomyelitis;
• diffuse purulent pulpitis;
• peri-root cyst;
• maxillary sinusitis.

Treatment

Treatment of both acute and chronic apical periodontitis consists of several stages:

1. Mechanical preparation. Under local anesthesia, the doctor opens the cavity of the diseased tooth and thoroughly cleans it from necrotic masses, processes and expands the lumen of the root canals, which makes it possible to create the necessary conditions for the outflow of exudate from the periodontium. At home, the patient should regularly rinse the mouth with antiseptic solutions. For this purpose, infusions of medicinal plants (eucalyptus leaves, chamomile flowers) are often used.
2. Antiseptic treatment. Antiseptic preparations in the form of pastes are placed in the cavity of the affected tooth. To stop the inflammatory process, antibacterial and anti-inflammatory drugs can be prescribed.
3. Canal filling. After complete relief of inflammation, the canals of the diseased tooth are sealed with mandatory X-ray control. Then the tooth cavity is closed with a permanent filling.

Apical periodontitis treatment process

Possible complications and consequences

With an untimely started or incorrectly carried out treatment, it is not possible to achieve a stable positive result with conservative treatment methods. In this case, the root apex of the diseased tooth is resected. If this intervention is unsuccessful, the tooth is removed.

The acute form of apical periodontitis can be complicated by the development of:

• periostitis;
• abscess;
• phlegmon;
• osteomyelitis;
• odontogenic sepsis.

A complication of chronic forms of apical periodontitis is the formation of granulomas and cysts that require surgical intervention, and sometimes the removal of a diseased tooth.

Forecast

Timely started therapy of apical periodontitis allows to achieve complete cure while preserving the tooth in 90% of cases.

Prevention

In order to prevent apical periodontitis, it is necessary:

• observe the rules of oral hygiene;
• visit the dentist every six months for a preventive examination;
• carry out active prevention of caries;
• treat teeth in a timely manner.

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Elena Minkina Doctor anesthesiologist-resuscitator About the author

Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!