Apical periodontitis: symptoms, diagnosis, treatment

Toothache always brings a lot of discomfort, as it deprives a person of the opportunity to sleep, work and even eat. Apical periodontitis is one of the most complex and problematic diseases that must be treated.

general description

Present pathology is an inflammatory process that is localized in the tissues of periodontal disease at the tip of the tooth root. It extends to other parts of the crown: dentin and cement. In some cases, even the alveolar bone is affected.

A characteristic of the disease is the damage to the ligaments that fix the tooth in the alveolus. In addition, the integrity of the cortical bone plate is disrupted, the hard tissue grows, painful cysts appear in the area of the crown.

Apical periodontitis is equally often diagnosed in men and women aged 20-60 years. In this disease, the focus of the inflammatory process is at the apex of the root. And the crown itself can be amazed, as well as the soft tissues that are around.

Causes of pathology development

Apical periodontitis can develop due to such factors:

1. Overload of the dentition, injury or injury to the crown.
2. Sinusitis.
3. Unqualified and improper treatment of a dental disease.
4. Osteomyelitis (pathology of bones).
5. Launched the pulpitis stage. At the same time the dental nerve dies off, and the periodontitis becomes infected.

Classification of pathology

Apical periodontitis can be divided into these types:

• Traumatic. In this case, the pathology develops due to a bruise, deformation and fracture of the crown, chronic tooth trauma.
• Medicated. The reason for this is a highly toxic antiseptic, which is used in the treatment of teeth. The drug penetrates into periodontal tissues, after which the inflammatory process begins to develop.
• Infectious. This type of pathology is the result of a lesion of staphylococcus or streptococcus surrounding the tooth tissues. Also, the cause of the development of infectious apical periodontitis is untreated pulpitis.

Classify the disease can also be on the nature of the flow:

• Acute apical periodontitis. It is characterized by a high intensity of symptoms. It develops quickly and sharply. This type of disease can also be divided into purulent and serous.
• Chronic apical periodontitis. In this case, the symptoms are not expressed very much, but the patient periodically exacerbates. The chronic form can also be granulomatous, fibrous and granulating.

Symptomatic of the disease

Before treating this disease, it is necessary to consider how it manifests itself. For the acute form of pathology, the following symptoms are typical:

1. Pain of a pulsating nature. And she can give and whiskey, and forehead.
2. In the area of the affected tooth, there is swelling.
3. Enlargement of submandibular nodes.
4. Mobility of the crown. In some cases, the patient may lose it.
5. Quite a strong headache.
6. Redness of the gums.
7. The temperature rises to 37-38 degrees.
8. Painful reaction to hot and cold. Unpleasant sensations appear even with a light touch to the tooth.

Chronic apical periodontitis is characterized by the fact that the clinical picture is less pronounced. During the period of remission, the disease generally occurs almost asymptomatically. Even if the patient periodically and feels some discomfort, then it is insignificant. In addition, during eating, a bad breath comes from the person.

Features of the course of the disease

It all depends on the type of pathology. If it is acute, it can manifest itself in such forms:

• Purulent. Here, the distinguishing feature is the allocation of a viscous turbid liquid of a greenish hue, which has an unpleasant odor.
• Serous. The patient in the affected area appears almost transparent exudate, which is odorless.

Chronic periodontitis manifests itself in such forms:

• Fibrous. It is characterized by the presence of an unpleasant odor, since the crown has a carious cavity.
• Granulating. At the patient there are unpleasant painful sensations at nakusyvanii on the amazed tooth, feeling of raspiranija. Inside a fistula with purulent contents is formed.
• Granulomatous. The person feels constant discomfort in the area of the patient crown. In addition, the top of the root forms a granuloma. And it can acquire a fairly large size.

Phases of acute course of pathology

Acute apical periodontitis of a pulpal origin or a disease that has developed for another reason has only two stages of development:

1. At the very beginning of the inflammatory process, a phase of periodontal intoxication appears. At this stage there are long pains of noisy character. In this case, the affected tooth becomes unnecessarily sensitive, which is felt when biting it.
2. At this stage, a pronounced exudative process is observed. In this case, the pain sensations are felt constantly. The pain appears even with a slight touch to the tooth, and can irradiate to other parts of the head.

Serous or purulent exudate is actively spreading, therefore, soft tissue edema appears in the affected area. In addition, there is an increase in regional lymph nodes.

Diagnostic Features

In order to cure the pathology presented, it is necessary to consult a dentist and undergo a thorough examination. Diagnosis of apical periodontitis is not difficult and involves such studies:

• Detailed fixation of patient complaints. This survey is made only in the presence of an acute form, since chronic pathology has a less pronounced clinical picture.
• External examination of the patient. The doctor can see purulent fistula, puffiness of soft tissues and other visible signs of the pathological process.
• Mandatory and basic is the radiographic diagnosis of acute apical periodontitis. The pictures will show the extent of destruction of bone tissue, small extensions of the periapical cleft. The boundaries of the affected area can be blurred or clear. With the help of X-ray, you can find a periodontal cyst (a clearly defined formation at the tip of the root). X-ray also helps to determine the type of periodontitis: fibrous, which shows a significantly enlarged periodontal gap, as well as granular (destruction of the alveolar bone tissue).

These methods of diagnosis of apical periodontitis are basic. Usually, additional research is not required.

Features of treatment of the disease

If a person has an apical periodontitis, treatment is standard, regardless of the form of development. Therapy provides for such stages:

1. Mechanical . Produced preparation of the affected area for further treatment. That is, first the tooth is opened, in which the inflammatory process is observed. Next, the affected pulp is cleaned, as well as surrounding tissues. All the manipulations the doctor makes using local anesthesia.
2. Antiseptic treatment . For this, it is necessary to first increase and disinfect the root canals using ultrasound. In addition, anti-inflammatory and antibacterial pastes are used to destroy the pathogenic microflora. To improve the condition of the mouth, rinses can be shown by herbal decoctions.
3. Final filling of the canals , which is performed with subsequent X-ray control. If the tooth is badly damaged, then a crown is put on it.

If the patient has an abscess, then it is necessary to ensure the outflow of exudate. After the mechanical cleaning is carried out, it will be necessary to perform the procedure of bone restoration.

If acute apical periodontitis was diagnosed, treatment should be performed immediately. Otherwise, it will pass into a chronic form, which is very difficult to treat.

Features of surgical treatment of the disease

In some cases, standard therapy may be ineffective. Therefore, surgical intervention is often used with a therapeutic purpose:

1. Apicoectomy is a resection of the root tip. Most often this procedure is indicated for patients with a chronic form of the disease, in which a granuloma or cyst is formed. The purpose of the operation is to remove the tumor and a small part of the tooth. The procedure lasts from 30 minutes to an hour, while using local anesthesia.
2. Amputation of the dental root. You can apply such an intervention in the event that several roots are observed under the crown. This may also remove part of the affected crown.
3. Coronary-radicular separation. If the tooth has 2 roots, it is divided into two parts, each of which is treated separately.

In extreme cases, the entire tooth is removed along with the root. This should be done only if the destruction of hard tissues is so strong that the crown is not able to fulfill its functional purpose.

Prognosis of treatment and possible complications

In most cases, the therapy is successful, and the sick tooth is cured completely. In this case, the early diagnosis of the disease, as well as the competent approach of the doctor, is very important. However, in some cases, periodontitis can give complications:

• Fistula formation or cyst.
• Inflammatory process in the osteo-jaw tissue.
• Odontogenic sinusitis.
• Sepsis.

Naturally, the complications are not so often, but no one is immune to them.

Prevention of disease

To avoid strong pain and other discomfort, and not to lose a healthy tooth, you need to follow simple preventive measures:

1. Do not forget about oral hygiene: twice a day you need to brush your teeth, if necessary, use dental floss, as well as antiseptic rinse. The paste should not contain solid coarse particles.
2. Do not overload the crowns too much. A large mechanical effect on the teeth should be avoided. That is, you can not crack nuts or solid foods.
3. Twice a year you should undergo a preventive examination at the dentist. Although if you have any symptoms of a tooth disease, then you need to contact before.
4. It is important to observe proper nutrition, which should be varied and useful. It is better to limit the consumption of sweets, coffee, and also sparkling water, which adversely affects the enamel.
5. If a person has inflammatory diseases in the body, they must be cured in time to prevent the spread of the infection.

Whatever the case, the pathology of the oral cavity can lead not only to loss of teeth, but also to disruption of the intestine. Therefore, any dental disease should be treated quickly. Be healthy!