Inflammation of the tooth root | Root Cancer

Inflammation of the tooth root

It is not the root of the tooth directly that is inflamed, but the surrounding tissue, called periodontium, that becomes inflamed. Untreated periodontitis, with its destruction of the periodontium, penetrates deeper and deeper towards the tip of the tooth root and causes an inflammation of the surrounding tissue. If the periodontal membrane is inflamed due to bacterial influences and the periodontium is destroyed, toothache occurs and the tooth becomes loose.

Such an inflammation can be present in both living and market dead teeth. Every touch, both in horizontal and vertical direction, causes pain. Bacteria can also get from this inflammation into the whole organism and cause infections there.

An inflammation of the root of a tooth at the root tip alone (apical ostitis) can be painless for a long time. It only occurs in a tooth whose pulp has died and which has not received any root treatment. But even teeth with a root filling can get an inflammation at the root tip.

Unfortunately, the root canal is branched like a delta at its end and therefore it is not possible to reach all branches with the root filling. As a result, remnants of the bacteria can still remain in these angles. Antibacterial root fillings provide some protection, but not in all cases.

The consequence is that the bacteria can escape into the bone and a reaction of the body. A chronic suppurative focus forms, which is shielded by the body’s own defense with a wall of connective tissue. The bacteria continue to multiply and the focus expands. This leads to an inflammation of the tooth root and bone loss. Bacteria can enter the bloodstream from this focus and thus attack other organs, mainly the heart.

Treatment of root canal inflammation

The only way to preserve a root-infected tooth is to perform a

  • Root canal treatment
  • And, if necessary, a root tip resection.

The most common treatment method is root canal treatment with subsequent root canal filling. In advance, the dentist will take an X-ray of the affected tooth and carry out a so-called vitality test. During the vitality test, the tooth is exposed to a cold stimulus and it is checked whether the patient generally feels this cold, whether pain occurs or whether the stimulus no longer triggers any reaction.

If the tooth is dead, the vitality test will be negative. During the root canal treatment, the affected tooth is “drilled out” and the pulp and nerve fibres are removed with the help of root files of varying thickness (Reamer, Hedstrom or K-files). In this way, the dentist removes the inflamed tissue and tries to repair the inflammation of the tooth root.

Subsequently, an alternating rinsing with different solutions is performed. The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite. In many cases, it is possible to connect an immediate root canal filling to a tooth that was already dead before the treatment began.

However, if the inflammation is very advanced, the dentist will probably first place a medication in the root canals and let the tooth rest for a few days.In a separate session (about 3 – 5 days later) the drainage and filling of the tooth roots begins. As soon as the tooth roots are sterile and dry, they are filled with so-called guttapercha points and a dense cement. The guttapercha points are rubber-like material that fills and seals the hollow tooth roots.

As a rule, an X-ray control image is then used to check whether the root is filled to the tip (apex) and the tooth is then sealed. Sometimes, however, such a root canal treatment is not sufficient to free the diseased tooth from the inflammation. The dentist then has the possibility to perform an apicoectomy.

In apicoectomy, the root tip of an inflamed tooth is removed. The chance of saving the tooth in this way is 90 – 97%. During the operation, the gum in the area of the diseased tooth is opened first and then the jaw bone is opened with the help of a so-called ball cutter (osteotomy).

This gives the doctor a good overview of the tissue to be treated and allows him to separate and remove the inflamed tip of the tooth root. A so-called retrograde root filling is then performed. Retrograde means that the filling of the root canals does not start from the crown of the tooth, as is usually the case.

The insertion of the guttapercha points is done starting from the separated root tip. This has the advantage that the root canal filling starts exactly at the end of the tooth roots. Then the gum is sutured with about 2 – 3 stitches.

During a surgical apicoectomy the nerves can be damaged, which is manifested in the patient by loss of sensitivity in the lip area (numbness). In addition, as with any operation, bleeding and/or wound healing disorders may occur. The patient is therefore strongly advised to avoid alcohol and nicotine after the operation, as alcohol can also cause toothache.

Home remedies such as clove oil or rosemary leaves cannot reach the source of the inflammation as rinses. They merely calm the inflamed gums. Therefore, household remedies should never be used as the sole therapeutic measure to treat an inflammation of the tooth root, as they do not solve the problem.

In general, the use of home remedies should be discussed with the dentist. In general, cooling always helps with swelling if a few rules are followed. It is advisable to use a cooling compress which is wrapped in a towel.

This cooling compress can then be held in the affected area. It is important that this cooling process lasts for a maximum of 10 minutes and that a period of at least one hour is then observed until the next cooling process takes place. This is particularly important, as a permanent cooling process is damaging.

Due to the permanent cooling, the blood vessels contract and the area is poorly supplied with blood. At this point the body senses the state of freezing and steers against it. The blood pressure and heart rate rise and the affected area warms up again.

This in turn provides the perfect environment for bacteria, as they multiply particularly quickly and in many different ways when it is warm and the inflammation spreads even faster. With targeted cooling, this does not happen and the swelling spreads more slowly because the bacteria do not prefer cold. However, only time can be gained, the abscess does not regress through pure cooling.

The abscess, which is the result of an inflammation of the root of the tooth, is usually caused by a tooth. If the pus in the swelling has been drained by a dentist through a relief incision, the tooth must also be removed. (Tooth extraction)The nerve inside the tooth has died and due to the massive inflammation it is usually not possible to save it by a root canal treatment.

The bacteria have started to metabolize the nerve and the surrounding bone tissue and the tooth is no longer well anchored in its original bone compartment. It has loosened. Once the tooth has been removed, once the wound has healed completely (about 2-3 weeks), it can be planned how and in what form the resulting tooth gap will be closed.

In implant planning, it is often necessary to wait 6 – 12 weeks after extraction until the bone has completely regenerated. In the case of a bridge restoration, this can be achieved more quickly, since only complete soft tissue regeneration is required.In addition to surgical therapy, in which a relief incision of the abscess is made and the tooth is extracted, the dentist also prescribes an antibiotic. The antibiotic works in such a way that it either destroys the bacteria themselves or prevents them from multiplying and thus achieves that the body is freed from the bacterial load much faster.

According to this spectrum of action, antibiotics can be divided into a bactericidal or a bacteriostatic group. The bactericidal ones kill the bacteria and destroy them, the bacteriostatic ones prevent their reproduction. It is important that the patient strictly adheres to the antibiotic medication prescribed by the dentist and finishes the preparation so that no resistances can develop.

If the intake is not followed at the right intervals or not long enough, it is possible that bacteria may survive and adapt against themselves against this antibiotic. They form a resistance and in case of secondary diseases the antibiotic is no longer effective. Usually the penicillin preparation Amoxicillin is prescribed, in case of allergies Clindamycin is used.

If an inflammation of the tooth root remains untreated or if the affected tissue is not completely removed by the treating dentist, this has further consequences:

  • In such cases, the inflammation will most likely spread to the structures surrounding the tooth and damage them as well.
  • Frequently, after attacking the root and tip of the tooth, the inflammatory processes attack the root skin and then spread to the jawbone.
  • Further expansion can then lead to the development of an abscess and/or gum fistula.
  • Bacteria can enter the body’s circulation in untreated dental root inflammation and attack other organs, including the heart. The danger of heart valve inflammation then exists. (endocarditis)