Apical periodontitis is the term used to describe inflammation of the tooth root apex. It is one of the odontogenic infections.
What is apical periodontitis?
Apical periodontitis is a bacterial infection that occurs at the tip of the tooth root. It also goes by the names root tip inflammation, apical ostitis or apical periodontitis. It is classified as an odontogenic infection. Apical periodontitis occurs when harmful bacteria reach the root tip via an inflamed root canal. Similarly, the germs can penetrate deep into the tooth via gingival pockets and affect it. It is not uncommon for the pulp of the affected tooth to have already died. Dentists then speak of a dead or devitalized tooth. Apical periodontitis occurs both acutely and chronically.
Causes
Apical periodontitis is usually caused by tooth decay. The resulting tooth lesions provide access for bacteria into the tooth. Often, apical periodontitis is preceded by inflammation of the dental pulp (pulpitis). The affected person does not always feel pain in the process. Other reasons for the occurrence of apical periodontitis can be trauma caused by dental treatments or fractures of the tooth. Thus, in some cases, grinding of the tooth results in painful pulpitis. However, the inflammation can also take an almost painless course. As it progresses, the pulp gradually dies. In the process, the harmful germs spread further and further within the root canal system. Finally, they can penetrate into the neighboring jawbone. The immune system reacts by breaking down the poorly perfused bone and replacing it with granulation tissue, which has better blood circulation. In rare cases, the cause of apical periodontitis is not bacterial, but is caused by chemical irritation. Their originators are mostly medicinal root inserts or root fillings.
Symptoms, complaints and signs
The symptoms of apical periodontitis vary. For example, acute root tip inflammation often presents with symptoms such as pain when biting down or tapping the tooth. Similarly, concomitant inflammation of the pulp is possible, in which the patient mistakenly feels that the affected tooth is elongating. If the root apex inflammation takes a chronic course, it is referred to as primary chronic apical periodontitis. In most cases, there is no pain. However, there is a risk that the inflammation will change to a chronic form and then cause pain. Without appropriate treatment of apical periodontitis, it threatens to affect the jawbone. Dentists refer to this as apical granuloma or apical abscess. In some cases, a fistula also forms. Furthermore, an apical pressure dolence is conceivable, which is accompanied by swelling and redness. It is not uncommon for the tooth to be sensitive to the touch of the tongue. If a pulpomatous tooth is present, there is a risk that it may cause further diseases. These may be neuralgias, repeated inflammation of organs, rheumatic diseases or allergies.
Diagnosis and course
Apical periodontitis can be diagnosed with the help of an X-ray examination. However, the typical whitening, which is a sure sign of an inflamed root tip, can only be detected after several weeks. The first indication is a widened peridontal gap. Whether changes in bone density are present can only be determined from the X-rays when the bone has already lost 30 percent of its mineral content, but this takes a period of several days or weeks. If the symptoms are only mild and the x-ray does not provide sufficient information, another x-ray must be taken after three months. To diagnose a dead tooth, a vitality test is performed. If the tooth reacts to cold, this is considered an indication that the nerve has not yet died. In addition, a dead tooth may be overly sensitive to a tapping test. If there is not yet extensive loosening of the tooth, apical periodontitis usually takes a positive course after appropriate dental treatment. However, if the loosening is very pronounced, the tooth is lost.However, by performing an apicoectomy, the affected tooth can be preserved in most cases.
Complications
Because apical periodontitis is usually chronic, develops over many years, and is also painful only in rare cases, it often goes undetected for a long time. At some point, however, the teeth begin to wobble and fall out. Therefore, a good prognosis depends on early initiation of therapy. Even if the appropriate maintenance measures are started in time, one tenth of patients experience severe tissue loss and bone destruction. This is a refractory form in which mostly the molars are affected. In addition to subsequent tooth loss, other general medical conditions may develop. Abscesses develop and further increase the suffering. The risk of heart attack or damage to internal organs increases. People with serious pre-existing diseases are predestined for apical periodontitis. A negative interaction can be seen in diabetes mellitus and apical periodontitis. Diabetes mellitus can predispose to the development of periodontal disease. Periodontal disease, in turn, reduces the otherwise good prospects for a mild course of chronic elevation of blood glucose levels. Apical periodontitis can also become risky for pregnant women, increasing the likelihood of abortion or miscarriage.
When should you see a doctor?
If you experience severe tooth pain, especially when biting down or tapping on the tooth, you should see a dentist. Symptoms indicate a serious dental condition that needs immediate treatment. Whether it is apical periodontitis or another disease of the oral or dental cavity, the physician can determine by means of an X-ray examination and a medical history. In addition, he can detect swelling, redness and fistulas and thus conclude that apical periodontitis is present. Other warning signs that require medical clarification are teeth that are sensitive to touch and the feeling that the affected tooth has grown. Often, bad breath and abscesses are also present, which should be clarified on their own. In less severe cases, apical periodontitis progresses slowly and without major complications. If no symptoms have developed yet, the teeth must be examined every three months. The doctor can suggest treatment at the appropriate time and reliably prevent further complications of apical periodontitis.
Treatment and therapy
To effectively treat apical periodontitis, root canal treatment must be performed. Because pain also radiates to adjacent teeth, it is not always easy to determine the location of the causative tooth. In case there is pulpitis in addition to apical periodontitis, it is treated at the same time. As an alternative to root canal treatment, extraction of the tooth may also be considered. This is especially true if there is extensive marginal bone loss or if the tooth crown has been severely destroyed by caries. Sometimes apical periodontitis also appears in teeth that have undergone root canal treatment a long time ago. Then it requires a new root filling or a root tip resection (WSR). In this procedure, the dentist removes the tip of the tooth root. This often contains secondary canals that are not treatable due to their small size. Approximately one year after the root canal treatment, the dentist checks the healing of the root tip inflammation by X-ray examination. Without a successful healing process, a root tip resection must be performed.
Outlook and prognosis
Apical periodontitis has a progressive disease course without seeking medical care and dental treatment. This ultimately ends in the loss of the tooth. The general well-being is weakened and the bacteria can infect other teeth in the mouth. If the affected person does not seek medical treatment even then, further tooth loss and inflammatory processes in the mouth occur. The course of the disease is gradual and takes place over many years. However, it cannot be stopped by natural means and self-healing. With medical care, the patient has a good prognosis.Due to the current medical possibilities, depending on the severity of the disease, dental treatment with or without a subsequent tooth replacement takes place. In some patients, the affected region is treated with medicines and removal of the diseased part of the tooth takes place. If these are significant, the removed tooth is then rebuilt with replacement preparations. In addition, the spread of germs is stopped with medication. The patient can be discharged from treatment as cured within a short time. Subsequently, regular check-ups are carried out to prevent the recurrence of bacterial infections. If the patient adheres to these and contributes to the maintenance of his dental health through comprehensive daily dental hygiene, he will remain permanently free of complaints.
Prevention
Dental plaque is the cause of dental diseases such as caries and the resulting apical periodontitis. So to prevent discomfort in the first place, regular removal of plaque is exceedingly important. In addition, the teeth should be thoroughly cleaned several times a day.
Aftercare
Apical periodontitis is a disease whose treatment belongs in the hands of the dentist. Following the therapy, not only the dentist is responsible for the aftercare, which is realized through regular control appointments. The patient is also involved in the aftercare through active cooperation in everyday life. Oral and dental hygiene are very important in this context. Since apical periodontitis is a bacterially triggered disease, it is crucial not to provide a surface for the bacteria in the mouth to attack. Thus, tartar is to be avoided as well as soft plaque that allows periodontal processes to re-emerge. Brushing is consistently necessary and proper brushing techniques can be learned at the dentist. Professional teeth cleaning (PZR) at the dentist removes hard and soft plaque and can also be the right time for learning the correct brushing technique. A root-treated tooth is often very sensitive and can be spared from chewing for a few days. However, the most important thing in periodontal aftercare is to refrain from smoking. Nicotine and periodontitis are closely related to each other, which wants to be clearly proven. Nicotine even has the property of sometimes masking an existing periodontitis in its symptoms, which hinders early detection of the disease and thus delays timely treatment.
This is what you can do yourself
Apical periodontitis requires medical treatment in any case. However, the conventional medical methods can be optimized by some measures and self-help tips for everyday life. First of all, a change in diet is recommended. Since the teeth and the oral cavity can be extremely sensitive during the disease, particularly spicy, hot or irritating foods should be eliminated from the menu. The same applies to acidic and highly sugared foods as well as various stimulants and medications that could damage the jaw and teeth. Tooth-damaging products are best replaced by a healthy and balanced diet. During the acute phase, light soups, soft-cooked fruits and vegetables, and baby food are particularly suitable. To protect the teeth, regular and extensive dental care is also important. People with apical periodontitis should clean their teeth several times a day with a toothbrush and dental floss. Gentle care products should be used to avoid further irritation of the inflamed areas. In general, the above measures are best worked out together with the doctor. In this way, everyday measures can optimally complement conventional medical treatment without causing complications.