Toothache always causes a lot of discomfort, as it deprives a person of the ability to sleep, work and even eat normally. Apical periodontitis is one of the most complex and problematic diseases that must be treated.
general description
The presented pathology is an inflammatory process that is localized in the periodontal tissues at the apex 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 damage to the ligaments that fix the tooth in the alveolus. In addition, the integrity of the cortical plate of the bone is impaired, hard tissue grows, and painful cysts appear in the crown area.
Apical periodontitis is equally often diagnosed in men and women aged 20-60 years. With this disease, the focus of the inflammatory process is at the apex of the root. Moreover, the crown itself can be affected, as well as the soft tissues that are around.
Reasons for the development of pathology
Apical periodontitis can develop due to such factors:
- Overload of the dentition, injury or bruise of the crown.
- Sinusitis.
- Unskilled and improper treatment of dental disease.
- Osteomyelitis (bone pathology).
- The advanced stage of pulpitis. In this case, the dental nerve dies, and the periodontium becomes infected.
Pathology classification
Apical periodontitis can be divided into the following types:
- Traumatic. In this case, the pathology develops due to contusion, deformation and fracture of the crown, chronic tooth injury.
- Medication. The reason here is the highly toxic antiseptic that is used in dental treatment. The drug penetrates the periodontal tissue, after which the inflammatory process begins to develop.
- Infectious. This type of pathology is the result of lesions of staphylococcus or streptococcus tissue surrounding the tooth. Also, the cause of the development of infectious apical periodontitis is untreated pulpitis.
The disease can also be classified by the nature of the course:
- 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 very pronounced, but the patient exacerbates periodically. The chronic form can also be granulomatous, fibrous and granulating.
Symptoms of the disease
Before treating this disease, it is necessary to consider how it manifests itself. For an acute form of pathology, the following symptoms are characteristic:
- Pulsating pain . And she can give in whiskey, and on the forehead.
- In the area of the affected tooth, edema appears.
- Enlarged submandibular nodes.
- The mobility of the crown. In some cases, the patient may lose it.
- Headache is quite severe.
- Redness of the gums.
- Raising the temperature to 37-38 degrees.
- Painful reaction to hot and cold. Unpleasant sensations appear even with a light touch on the tooth.
Chronic apical periodontitis is characterized by the fact that the clinical picture is less pronounced. During remission, the disease is generally asymptomatic. Even if the patient periodically feels some discomfort, then it is insignificant. In addition, a person has a bad breath when eating.
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, a distinguishing feature is the release of a viscous, turbid liquid of a greenish tint, which has an unpleasant odor.
- Serous. A patient in the affected area appears almost transparent exudate, which is odorless.
Chronic periodontitis is manifested in such forms:
- Fibrous It is characterized by the presence of an unpleasant odor, since there is a carious cavity in the crown.
- Granulating. The patient has unpleasant pain when biting on the affected tooth, a feeling of fullness. A fistula with purulent contents forms inside.
- Granulomatous. A person feels constant discomfort in the area of the diseased crown. In addition, a granuloma is formed at the apex of the root. Moreover, it can acquire a fairly large size.
Phases of the course of acute pathology
Acute apical periodontitis of pulp origin or a disease that developed for another reason has only two stages of development:
- At the very beginning of the inflammatory process, a periodontium intoxication phase appears. At this stage, long aching pains occur. In this case, the affected tooth becomes excessively sensitive, which is felt when biting on it.
- At this stage, a pronounced exudative process is observed. In this case, pain is felt constantly. The pain appears even with a light touch on the tooth, and can radiate to other parts of the head.
Serous or purulent exudate is actively distributed, so 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 presented pathology, it is necessary to consult a dentist and undergo a thorough examination. Diagnosis of apical periodontitis is not difficult and includes such studies:
- Detailed fixation of patient complaints. This survey is carried out 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 a purulent fistula, swelling of the soft tissues and other visible signs of a pathological process.
- Mandatory and basic is the radiographic diagnosis of acute apical periodontitis. The images will show the extent of destruction of bone tissue, small expansion of the periapical gap. The borders of the affected area may be blurry or clear. With the help of radiography, a periodontal cyst can be detected (a clearly defined formation at the apex of the root). An x-ray will also help determine the type of periodontitis: fibrous, in which a significantly enlarged periodontal gap is visible, as well as granular (alveolar bone tissue is destroyed).
These methods of diagnosing apical periodontitis are basic. Usually no additional studies are required.
Features of the treatment of the disease
If a person has apical periodontitis, treatment is standard, regardless of the form of development. Therapy involves the following steps:
- Mechanical The affected area is prepared for further treatment. That is, the tooth in which the inflammatory process is observed is first opened. Next, the affected pulp is cleaned, as well as the surrounding tissues. The doctor performs all manipulations using local anesthesia.
- Antiseptic treatment . To do this, 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 oral cavity, rinses with herbal decoctions can be indicated.
- The final filling of the canals , which is carried out 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 a bone restoration procedure.
If acute apical periodontitis has been diagnosed, treatment should be done immediately. Otherwise, it will go into a chronic form, which is very difficult to treat.
Features of surgical treatment of the disease
Standard therapy in some cases may be ineffective. Therefore, quite often with a therapeutic purpose, surgical intervention is used:
- Apicoectomy - resection of the root apex. 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 neoplasm and a small part of the tooth. The procedure lasts from 30 minutes to an hour, while local anesthesia is used.
- Amputation of the tooth root. Such an intervention can be used if several roots are observed under the crown. In this case, part of the affected crown may also be removed.
- Coronary Radicular Separation. If a tooth has 2 roots, then 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 must be done only if the destruction of hard tissues is so strong that the crown is not able to fulfill its functional purpose.
Treatment prognosis and possible complications
In most cases, the therapy is successful and the diseased tooth is completely healed. In this matter, early diagnosis of the disease is very important, as well as the competent approach of the doctor. However, in some cases, periodontitis can cause complications:
- The formation of a fistula or cyst.
- Inflammatory process in the bone-jaw tissue.
- Odontogenic sinusitis.
- Sepsis.
Naturally, complications are not so common, but no one is safe from them.
Disease prevention
In order to avoid severe pain and other discomfort, as well as not to lose a healthy tooth, you need to follow simple preventative measures:
- We must not forget about oral hygiene: twice a day you need to brush your teeth, if necessary, use dental floss, as well as antiseptics, rinses. The paste should not contain large solid particles.
- Do not overload crowns too much. A large mechanical effect on the teeth should be ruled out. That is, you can not bite nuts or solid food.
- Twice a year, you should undergo a routine examination at the dentist. Although if there are symptoms of any dental disease, then you need to contact earlier.
- It is important to follow proper nutrition, which should be varied and healthy. It is better to limit the consumption of sweets, coffee, as well as sparkling water, which negatively affects the enamel.
- If a person has inflammatory diseases in the body, they must be cured in time to prevent the spread of infection.
Be that as it may, pathologies of the oral cavity can lead not only to tooth loss, but also to disruption of the intestines. Therefore, any dental disease should be treated quickly. Be healthy!