Toothache always brings a lot of discomfort, as it deprives a person of the opportunity 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 periodontal tissues at the top of the tooth root. It extends to other parts of the crown: dentin and cementum. In some cases, even the alveolar bone is affected.
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 disrupted, the hard tissue grows, and painful cysts appear in the area of the crown.
Apical periodontitis is equally common in men and women aged 20-60. In this disease, the focus of the inflammatory process is located at the top of the root. Moreover, the crown itself, as well as the soft tissues around it, can be affected.
Causes for the development of pathology
Apical periodontitis can develop due to the following factors:
- Overloading of the dentition, trauma or bruising 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.
Classification of pathology
Apical periodontitis can be divided into the following types:
- Traumatic. In this case, the pathology develops as a result of a bruise, deformation and fracture of the crown, chronic tooth injury.
- Medical. The reason for this is a highly toxic antiseptic that is used in dentistry. The drug penetrates into periodontal tissues, after which the inflammatory process begins to develop.
- Infectious. This type of pathology is the result of staphylococcus or streptococcus damage to the tissues surrounding the tooth. Also, the cause of the development of infectious apical periodontitis is untreated pulpitis.
The disease can also be classified according to 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 periodically has an exacerbation. 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. Moreover, she can give both in whiskey and in the forehead.
- Swelling appears in the area of the affected tooth.
- Increased submandibular nodes.
- Mobility of the crown. In some cases, the patient may lose it.
- Sufficient headache.
- Redden gums.
- The temperature rises 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 the period of remission, the disease generally proceeds almost asymptomatically. Even if the patient periodically feels some kind of discomfort, then it is insignificant. In addition, while eating, a person develops bad breath.
Features of the course of the disease
It all depends on the type of pathology. If it has an acute character, it can manifest itself in the following forms:
- Purulent. Here, a distinctive feature is the release of a viscous cloudy liquid of a greenish hue, which has an unpleasant odor.
- Serous. The patient has an almost transparent exudate in the affected area, which is odorless.
Chronic periodontitis manifests itself in the following forms:
- Fibrous. Forit is characterized by the presence of an unpleasant odor, since there is a carious cavity in the crown.
- Granulating. The patient has unpleasant painful sensations when biting on the affected tooth, a feeling of fullness. A fistula with purulent contents is formed inside.
- Granulomatous. A person feels constant discomfort in the area of the diseased crown. In addition, a granuloma is formed at the root apex. Moreover, it can become quite large.
Phases of the course of an acute form of pathology
Acute apical periodontitis of pulpal origin or a disease that has developed for another reason has only two stages of development:
- At the very beginning of the inflammatory process, a phase of periodontal intoxication appears. At this stage, there are long aching pains. In this case, the affected tooth becomes overly sensitive, which is felt when biting on it.
- At this stage, there is a pronounced exudative process. In this case, pain is felt constantly. The pain appears even with a light touch on the tooth, and may radiate to other parts of the head.
Serous or purulent exudate is actively spreading, 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 applysee a dentist for a thorough examination. Diagnosis of apical periodontitis is not difficult and includes the following studies:
- Detailed recording of the patient's complaints. This survey is performed 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, soft tissue swelling and other visible signs of the pathological process.
- Mandatory and basic is the radiographic diagnosis of acute apical periodontitis. The images will show the extent of bone tissue destruction, small expansions of the periapical fissure. The boundaries of the affected area may be blurred or clear. An x-ray can detect a periodontal cyst (a well-defined formation at the root apex). X-rays will also help determine the type of periodontitis: fibrous, in which a significantly enlarged periodontal gap is visible, and granular (alveolar bone tissue is destroyed).
These methods of diagnosing apical periodontitis are the main ones. Usually no further research is required.
Features of the treatment of the disease
If a person has apical periodontitis, its treatment is standard, regardless of the form of development. The therapy includes the following steps:
- Mechanical. The affected area is being prepared for further treatment. That is, first the tooth in which the inflammatory is observed is opened.process. Next, the affected pulp is cleaned, as well as the tissues surrounding it. The doctor performs all manipulations using local anesthesia.
- Antiseptic treatment. To do this, it is necessary to first enlarge and disinfect the root canals using ultrasound. In addition, anti-inflammatory and antibacterial pastes are used to destroy pathogenic microflora. To improve the condition of the oral cavity, rinsing with herbal decoctions may be indicated.
- Final canal filling, which is performed with subsequent X-ray control. If the tooth is severely damaged, then a crown is put on it.
If an abscess was found in a patient, then it is necessary to ensure the outflow of exudate. After mechanical cleaning has been 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 turn into a chronic form, which is very difficult to treat.
Features of surgical treatment of the disease
Standard therapy may not be effective in some cases. Therefore, surgical intervention is often used for therapeutic purposes:
- Apicoectomy - 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 neoplasm and a small part of the tooth. The procedure lasts from 30 minutes to an hour, whilelocal anesthesia is used.
- Amputation of the tooth root. Such an intervention can be used if several roots are observed under the crown. This may also remove part of the affected crown.
- Coronary-radicular separation. If the 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 should only be done 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 cured. In this case, early diagnosis of the disease is very important, as well as a competent approach of the doctor. However, in some cases, periodontitis can lead to complications:
- Formation of a fistula or cyst.
- Inflammatory process in the bone and jaw tissue.
- Odontogenic sinusitis.
- Sepsis.
Of course, complications are not so common, but no one is immune from them.
Disease prevention
To avoid severe pain and other discomfort, as well as not to lose a he althy tooth, you need to follow simple preventive measures:
- Don't forget about oral hygiene: brush your teeth twice a day, if necessary, use dental floss, as well as antiseptic rinses. The paste should not contain solid large particles.
- Notit is worth loading the crowns too much. Large mechanical impact on the teeth should be excluded. That is, you can not crack nuts or solid food.
- Twice a year you should have a preventive check-up at the dentist. Although if there are symptoms of any dental disease, then you need to contact earlier.
- It is important to observe proper nutrition, which should be varied and he althy. It is better to limit the consumption of sweets, coffee, as well as carbonated 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 loss of teeth, but also to disruption of the intestines. Therefore, any dental disease should be treated quickly. Stay he althy!
