Sometimes dental granulomas can form at the tip of the root or in the area of the gum pockets after a tooth or gum infection.
What are dental granulomas?
Dental granulomas should definitely be examined by a dentist, otherwise severe pain and inflammation may occur. Dental granulomas are usually caused by chronic irritation or inflammation of the teeth or gums. Dental granulomas are small nodules that can sometimes be felt in the jaw, especially around the gums. The area is sensitive to pressure pain, and dental granulomas in the gum area may also bleed. No matter where they are located, dental granulomas are usually associated with pain. So, dental granulomas is the term used to describe a nodule-like tissue in the area of the teeth or gums. As you can see from the name dental granulomas, they are granulated structures made of various cells, mostly lymphocytes, blood vessels and connective tissue cells. Dental granulomas can develop in response to persistent inflammation, infection or allergy. There are several types of dental granulomas. They can occur in the gum area or at the root tip of teeth.
Causes
The different dental granulomas can have different causes:
There are fungus-shaped dental granulomas called epulis. These dental granulomas are usually caused by inflammation to which the surrounding tissues of the tooth respond. Such inflammation may form in a gum pocket and then expand. Epulis can also result from prolonged irritation caused by filling margins, crowns or pressing dentures. A special form of these dental granulomas occurs during pregnancy (epulis gravidarum). Root tip granuloma is usually caused by progressive caries, which leads to inflammation inside the tooth and spreads to the area of the root and jawbone. This inflammation forms dental granulomas, which encapsulate and form a focus on the root tip of the tooth. Foreign body granulomas can occur in the area of the teeth or in other parts of the body when a foreign body penetrates the tissue and causes persistent inflammation, where it encapsulates to form a granuloma. Foreign bodies can be metal particles, wood chips or thread.
Symptoms, complaints, and signs
The typical symptoms of dental granulomas include more or less severe pain. These are the same complaints that occur with all inflammations in the dental area. Dental granulomas can be hidden at the root of the tooth or visible as a protrusion of the gums (epulis). While the so-called apical granulomas (root tip granulomas) are primarily characterized by pain, an epulis can also bleed easily. However, dental granulomas can also remain painless for a long time. Therefore, invisible granulomas are sometimes discovered late. Apical granulomas usually cause discomfort when biting or eating cold as well as hot food. In these cases, severe toothache occurs even though the tooth in question is already dead. However, there is granulation tissue at the root of the tooth, which is inflamed and presses on the jawbone under mechanical stress. The epulis, in turn, represents a mushroom-shaped or hemispherical structure that sits on the gum line. It is a pinkish protrusion of the gums. Epulis often occurs during pregnancy. However, it can also occur due to constant irritation caused by ill-fitting dentures, crowns or disturbing filling margins, as well as insufficient oral hygiene. In rare cases, so-called internal dental granulomas are also observed, which form as a result of chronic dental neuritis. Since the tooth is poorly supplied by the granulation tissue, tooth fractures often occur.
Diagnosis and course
Dental granulomas usually become noticeable through persistent tooth pain, which forces the patient to visit a dentist. The dentist first has the patient describe his or her complaints – usually a throbbing toothache – and then examines the oral cavity more closely. He can easily diagnose epulis because these dental granulomas occur in the area of the gums, often bleed and are already easily visible to the naked eye. The dentist palpates them and then decides how to treat the dental granulomas.Root tip and foreign body granulomas, however, cannot be seen with the naked eye; an X-ray of the jaw must be taken to diagnose these dental granulomas. If dental granulomas are completely removed along with the infected tissue, the focus of inflammation can heal well. However, dental granulomas may form again in the same place if the dental granuloma tissue is not completely removed. If the inflammation persists for a long time, dental granulomas can form jaw cysts that can damage the jawbone.
Complications
When dental granulomas displace adjacent tissues due to their growth, serious complications can occur. Parallel protrusions and, at times, pain occur, which, because of their chronic nature, represent a significant psychological burden. The granuloma form epulis can cause small nodules on the gums, resulting in further pain and sometimes bleeding. Furthermore, dental granulomas can form recurrences, i.e. new ones can develop after successful treatment. If the inflammation persists over a long period of time, cysts may form, which in turn can damage the jawbone. Jaw cysts can also cause infection and tissue damage. Pronounced growths occasionally cause sensory disturbances and numbness in the affected area. Therapeutic treatment of a dental granuloma does not pose any major risks. However, local anesthesia may cause side effects such as temporary confusion, memory impairment and panic attacks. Surgical intervention occasionally results in wound healing disorders or the formation of scars. Because of the location of dental granulomas, healing can be complicated. Concomitantly prescribed medications also carry risks and side effects, which can develop into serious complications in the presence of pre-existing conditions or combination therapy with other medications.
When should you see a doctor?
If inflammation of the gums is persistent or chronic, a doctor should be consulted. If there is discomfort when eating, toothache or swelling in the area of the mouth, a doctor should be consulted during a check-up. If there is an unusual taste in the mouth, irregularities in wearing braces or a denture, or if there are abnormalities in speech, a doctor is needed. Discoloration of the gums or deformities in the area of the face are considered to be warning signals of the organism. They should be examined by a doctor so that a diagnosis can be made. Irritability in the mouth area, general malaise, loss of appetite or refusal to eat are signs of health impairment. A physician is needed so that measures can be taken to alleviate the symptoms. Since pregnant women are at increased risk of developing dental granulomas, special vigilance is required, especially in their case. Any changes that occur should be discussed immediately with a physician. If fractures of the teeth occur, medical attention should be sought immediately. Consultation with a physician or medical professional is always recommended before taking any analgesic medication. Side effects may occur, causing an increase in discomfort. If teeth become loose or dentures slip, a check-up with a doctor is also necessary.
Treatment and therapy
Dental granulomas cause pain for a long time in most cases if left untreated. One can remove the dental granulomas under local anesthesia. In addition, the dentist must also treat the root and inflamed tissue that caused the dental granulomas. If areas of the bone are affected, they must also be removed. In the case of a severely decayed tooth, the dentist will opt to extract that tooth because of the risk of re-inflammation. In the case of root tip granuloma, the dentist will need to remove part of the tooth root and the infected tissue around it through a root tip resection . Beyond surgical procedures, the tooth, root and jaw area are treated with medication to heal the inflammation.
Prevention
There is no direct prevention against dental granulomas, but much can be done by practicing good oral hygiene through regular cleaning of the teeth and interdental spaces, which together prevent tooth decay and gum inflammation.Because dental granulomas mostly occur on inflamed teeth, caries prophylaxis is also prophylaxis against dental granulomas.
Follow-up care
Follow-up care for dental granulomas should extend beyond the end of the healing phase, with limited measures available. The defect is openly followed up by tamponade and dressing plate. The focus is on ongoing examinations and accompanying diagnostics so that deterioration or further complaints can be ruled out as far as possible. Thus, it is important to consult the physician at an early stage in case of any change. If the doctor can intervene, the course of the disease can be positively influenced. This is usually done by medicinal treatment using ointments and tablets. The course of therapy depends on whether the medication can already be discontinued. In some cases, however, medical interventions in the patient’s mouth are also necessary. As part of aftercare, patients can also do a few things themselves that have a positive effect on the course of the disease. Improving oral hygiene is fundamental. Regular oral care is absolutely necessary to prevent the formation of further dental granulomas. This includes brushing the teeth and rinsing with an antibacterial mouthwash. When taking medications and applying ointments, it is imperative to follow the prescribed regularity.
This is what you can do yourself
Irritation of the teeth or gums should be avoided to minimize any increase in adverse health effects. For this purpose, the intake of food should be checked and optimized if possible. The intake of acidic foods, alcohol or nicotine should be avoided. Worn or inserted braces as well as existing dentures should be checked for the effect of pressure in the mouth area. Pressure points can intensify existing complaints or lead to disturbances in the healing process. As soon as they appear, a doctor should be consulted so that they can be checked. Independent action is not advisable in these cases. Dental granulomas are usually associated with the occurrence of pain. Nevertheless, the consumption of painkillers is not recommended under any circumstances without a doctor’s consultation. Complications and side effects may occur, which can lead to serious disorders. In everyday life, existing physical as well as mental stressors should be reduced to a minimum. Persistent mental overload has a negative influence on the course of recovery and should therefore be reduced as quickly as possible and on a sustained basis. To prevent the spread of existing health irregularities, daily tooth and mouth cleaning is necessary despite the complaints. The cleaning processes in the mouth and throat should be adapted to the health possibilities, but should under no circumstances be completely discontinued. In addition, the jaw should not be subjected to excessive stress.
