Apical periodontitis is an inflammation that develops in the space between the root of the tooth and the wall of the dental alveolus in the region of its apex. In this rather narrow space is the periodontal ligament, which normally provides a connection between the root and the bone. During inflammation, the periodontal tissue swells, exudate is released, which presses on the walls of the alveoli and causes severe pain.
Depending on the cause that caused it, acute periodontitis is divided into:
- infectious - occurs as a result of untreated pulpitis, when pathogenic microorganisms exit the root canal into the periodontium. This is the most common option;
- traumatic - develops as a result of a bruise or incomplete dislocation of the tooth. At the same time, a hematoma is formed in the periodontal space, and aseptic inflammation develops;
- drug - is the result of exposure to periodontal concentrated solutions for disinfection of root canals or prolonged exposure to the tooth cavity necrotizing arsenic paste.
Stages of periodontitis and its symptoms
Depending on the phase of the course, two types of acute periodontitis are distinguished: serous and purulent. Each stage is characterized by a certain symptomatology and has its own characteristics of treatment.
Acute serous periodontitis
At this stage, under the influence of toxins released by microorganisms, platelet lysis products or a chemical agent, local inflammatory mediators are released, which leads to edema and capillary dilation.
Serous periodontitis is manifested by constant aching pain, which is aggravated by biting on the causative tooth. The pain is relieved by simple analgesics, the general condition is not disturbed, the reaction of the periosteum and lymph nodes is absent.
Acute purulent periodontitis
Inflammatory mediators and microbial toxins attract blood cells responsible for the destruction of foreign agents, leukocytes, to the site of inflammation. The latter destroy bacteria by absorbing them, after which they themselves die. Fragments of bacterial cells and dead leukocytes form a purulent exudate. Accumulating in a confined space, it exerts strong pressure on the walls of the alveoli, which is the cause of pain.
Pain in purulent periodontitis is very strong, constant. Not like biting, just touching the tooth becomes unbearably painful. There is swelling of the gums in the area of the causative tooth and a painful increase in regional lymph nodes. Body temperature may rise.
Diagnosis and treatment of acute apical periodontitis
Diagnosis of periodontitis is based solely on the patient's complaints and clinical examination data. Radiography is performed in order to distinguish the primary acute process from the exacerbation of a chronic one. In the first case, no changes will be found on the image, and in the second case, a focus of bone tissue destruction in the region of the root apex will be visible.
Modern root canal treatment techniques and medications make it possible to save the tooth in almost all cases, unless, of course, its coronal part is so destroyed that it cannot serve as a support for an artificial crown.
The treatment is carried out only under anesthesia and includes the following steps:
- Evacuation of exudate. To do this, the doctor cleans the lumen of the root canal and expands it, destroying the apical ledge. In the treatment of serous periodontitis, after thorough washing of the canal, you can proceed to the next stage; in case of a purulent process, it is recommended to leave the tooth open for 1-2 days so that the pus comes out.
- Sterilization of canals and periodontal space, which is carried out using temporary filling with therapeutic antiseptic pastes, electrophoresis and depophoresis of copper-calcium. The purpose of this stage is the complete elimination of microorganisms from the focus of inflammation.
- Permanent filling of the canals and the crown of the tooth is carried out using special materials after the canal and periodontal space are completely cleaned.
- If necessary, the manufacture of an artificial crown. If the crown of the tooth is more than two-thirds destroyed, it will not be possible to compensate for the defect with a conventional filling, this will lead to the fact that the rest of the tooth will break off. In this case, an artificial crown is made.
What happens if acute periodontitis is not treated?
If the root canal is not completely closed by the remnants of dead pulp and outflow through it is possible, acute inflammation can become chronic. In this case, the pain and swelling will completely disappear, but the process inside the bone will continue. a cyst will form , and in this case complex surgical treatment will be required.
If the outflow of exudate is not ensured, the inflammatory process will progress: periostitis, lymphadenitis, abscess or phlegmon of the adjacent area will develop. One of the complications can be osteomyelitis, an infectious inflammation of the jawbone. To prevent this from happening, treatment should be started as early as possible, and it is better to carry it out in a planned manner based on the results of preventive examinations.
