Synonims: apical periodontitis or periradicular periodontitis
Periapical periodontitis develops most often as a complication of untreated caries, pulpitis, dental trauma or drug impairment. It is an inflammatory disease in which the bacteria from the oral cavity pass through the root canals into the periodontium (the tissue surrounding the tooth root) and there they cause inflammation which affects the bone surrounding the root apex.

It can be acute or chronic.

Acute periapical periodontitis develop when there is a large amount of bacteria and reduced defences of the organism, and it is characterized by the formation of pus. The tooth could have been treated endodontically previously or have a big hole. Feeling of weight, tension and discomfort on the side of the affected tooth can be experienced at first. The pain is localized in single tooth which feels taller than the rest. It is dull and constant. The painkillers have a short duration. In suppuration (acute purulent periapical periodontitis) the pains intensify and become pulsating and every touch of the teeth (with tongue or other teeth) is extremely painful. Eating is difficult or impossible. Pain intensifies with warm while cold temporarily calms it down. Acute purulent periapical periodontitis goes through four phases, depending on where the pus is located.

First phase (periodontal) – the inflammation has covered the area around the apex of a tooth root.
Second phase (intraosseous) – the inflammation (the pus) progresses to the bone around the tooth root.
Third phase (subperiosteal) – the pus passes through bone and reaches the periosteum (this is the most painful phase)
Fourth phase (submucosal) – it is periodontal abscess.

Sometimes the phases of periapical periodontitis pass quickly, and diagnosis is made once it has extended over the whole periodontium (end of second and beginning of third phase). In acute condition there is an increase in the submandibular lymph nodes, fatigue, fever and malaise. An untimely treatment could lead to endodontic abscess.

Chronic periapical periodontitis are slow progressing and long-term inflammatory reactions. They develop as complications of pulpitis, acute periapical periodontitis or injuries. As a result of chronic bacterial irritation in the root canals, a granulation tissue is formed in the damaged areas of the periodontium. This can occur with a smaller amount of bacteria and with a stronger immune system in which the body successfully fights the infection. Granulation tissue (granuloma) is a soft tissue which looks like wreath, which forms around the top of the root. It is formed by the human organism in order to prevent bacteria entering through the tooth root to be disseminated into bone. The longer the root canal is open and bacteria enter freely, the greater becomes granuloma, as its expansion is at the expense of slowly melting of the bone.In most cases the process takes place without any symptoms. It is usually discovered with a X-ray picture made accidentally during the treatment of a nearby tooth. The X-ray picture shows a dark circular or elliptical formation around the tip of the tooth root. In some patients there is sensation and discomfort when chewing solid food. As a result of general illness (influenza, scarlet fever, cold) and reduced immune defences the symptoms could increase and the periapical periodontitis may flare up (the granuloma can form pus and severe pain and fistula can appear).

Upon dental check, the presence of untreated caries and secret-releasing fistula (bone passage through which pus from the area of the root apex has reached the oral mucosa), could be discovered. Fistula is protruded and located in the projection of the roots of the inflamed tooth, while the patient may have mild pain in the tooth.

Depending on the condition of the root canal, the general condition of the patient, patent’s age and the virulence of the infection, the method of treatment is selected.

In early diagnosis and proper treatment the tooth could be preserved and healing occurs. In severe cases extraction – removal of the tooth could be necessary. If left untreated the granuloma becomes a cyst over time.

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