What Is Periapical Periodontitis and How Is It Cured?

Periapical periodontitis (or apical periodontitis) is an inflammatory lesion of the soft gum tissue surrounding the tooth’s root (periodontium). It is usually the result of neglected cavities, dental trauma, faulty root canal work, pulpitis, or drug abuse, you can check here for details.

The body’s response to invading bacteria and a necrotic pulp include pain, tenderness, throbbing or palpitations, purulency, swelling, fever, and lymphadenopathy. Naturally, an endodontic specialist is required to remedy the condition. 

Different Types of Periodontitis

Apical means the problem is directly related to the root tip; on the other hand, periapical implies that the infection is somewhere in the general area.

Acute apical periodontitis is the result of bacteria entering the apical (root tip) of a single tooth following the trauma. If the infection progresses, the pain worsens, and the periapical tissue proceeds to break down. 

There are four stages of acute periapical periodontitis: 

• Periodontal – the inflammation envelopes the tooth’s root and surrounding dental tissue as a result of damage or injury
• Intraosseous – an infection travels to the bone that’s surrounding the root. It becomes purulent or filled with pus, a thick yellowish or greenish opaque fluid made of microorganisms, microbes, white blood cells, tissue debris, and serum.
• Subperiosteal – pus finds its way to the periosteum, membranous layers that cover the surface of the bones, hindering bone resorption and growth.
• Submucosal – a periodontal abscess, a localized collection of pus, forms due to an accumulation of cells at the apex of a dead tooth.

Asymptomatic vs. Symptomatic Cases

Asymptomatic apical periodontitis (asymptomatic apical periodontitis) shows little to no signs or symptoms. It develops so gradually that only a dentist would spot any inflammation during a general check-up. Silently the infection becomes problematic and slowly destroys the tissue surrounding the teeth if not recognized and treated.

Symptomatic periapical periodontitis (symptomatic apical periodontitis), on the other hand, develops suddenly and quickly gets worse. It causes acute pain in your gums and teeth, especially while eating. 

Chronic periapical periodontitis (or chronic apical periodontitis) occurs when there is a chronic inflammation of the apical canal around the tip of the root. It is typically non-painful because the condition has been present for so long that drainage throughout the gums and oral cavity ran into the major nerve canals, causing numbness. This is generally the final stage of periodontitis.

What Causes Apical and Periapical Periodontitis?

The condition develops when a previous malaise with the gums or teeth has gone neglected or maltreated. It can also advance if an infection reaches the pulp. This jelly-like innermost layer contains nerves, blood vessels, connective tissue, and special cells. A living and healthy pulp feeds the tooth nutrients and keeps it functioning properly. Even slight injury can lead to periapical periodontitis.

What are the effects of Apical and Periapical Periodontitis?

Without effective treatment done by a professional dentist, periapical periodontitis will keep causing painful swelling, slack teeth, or the complete loss of a tooth, and serious infections of the gum and soft tissue of the face.

You might not notice any symptoms, so it is vital to see your dentist at least every six months, especially if you have a history of cavities or oral infections. Regular check-ups will make it possible for a professional to catch any signs and asymptomatic inflammation in order to provide adequate treatment. It is the only sure way to prevent permanent damage to periapical tissue.

Treatments for Periapical Periodontitis 

During your visit, if the dentist notices any inflammation in your gums, they will most likely refer you for endodontic treatment. Endodontics is the field of study that practices the diagnosis, prevention, and treatment of diseases and injuries of the pulp and periradicular (concerning the root) regions. 

During a clinical examination, a root canal dentist will collect the patient’s medical and dental history and then perform a thorough inspection of the mouth. The presence of a visible periapical bone lesion is a clear indicator of disease. However, sometimes even if the pain is present, the tooth is asymptomatic of disease, requiring an X-ray for assessment.

Endodontic Therapy Options

Root Canal Treatment is necessary when a dental X-ray shows that the pulp has been inundated by an infection. An endodontist will administer anesthesia and remove any bacteria, sick tissue, and necrotic pulp before the contamination spreads. 

The orifice is filled with a rubbery substance called gutta-percha. A crown, or porcelain prosthetic, which looks and feels like your natural teeth, is then placed as a cover to protect and restore its original function. With modern advances, the procedure is moderately painless. Expect some minor discomfort during healing. The patient can return to activities of regular life after a few hours.

An apicoectomy is an outpatient surgical procedure, also called a root-end resection. This common procedure is utilized when a root canal doesn’t heal well and becomes reinfected. Afflicted gum tissue and root is removed, leaving the top or apex in place. A filling and crown are subsequently placed as a sealant. 

Extraction or the complete removal of a sick tooth is the last resort and might be the only option, if it cannot be saved.

Further Tips

Note that antibiotics are not effective for clearing root canal infections. They can be prescribed to treat an infection that spreads beyond the root and to prevent post-operation contagion.

During the final stages of periapical periodontitis, the symptoms gradually dissipate as the pulp dies. Your tooth may appear healed, as the pain disappears when the infection has actually spread and numbed the root. 

For that reason, it is vital to see your dentist as soon as possible if you develop swelling or persistent toothache. If your tooth is septic, the pulp cannot heal itself. 

A proper oral hygiene routine, including daily brushing and flossing, can help to prevent gum disease. Remember, regular oral health checks and cleaning by a hygienist will protect your teeth for a lifetime.