Chronic apical periodontitis: what is the treatment

The diagnosis of chronic apical periodontitis is dental professional often enough. This is the most common pathology of the periodontium. However, to identify it at an early stage is difficult because the clinical picture is not pronounced. The patient seeks help, when the disease gives a complication of a fistula or cyst. In this article we will talk about the causes of periodontal disease, its symptoms, diagnosis and treatment.

As apical periodontitis becomes chronic

The periodontium is type of connective tissue located between the tooth root and the alveolar plate. The function of the periodontium:

  1. to protect the body from pathogenic microorganisms;
  2. to provide the tooth necessary nutrients;
  3. depreciation, that is, to reduce the pressure on the jaw bone.

In pathology of microorganisms seep into the tissues of the periodontium, causing inflammation. Inflammation leads to swelling, which is called periodontitis.

Apical or apical periodontitis — a disease in which inflamed tissue surrounding the root tip of the tooth, resulting in destruction of the periodontium.

Apical periodontitis is diagnosed more often than other inflammation of the periodontium. «Apical» indicates that the beginning of the process is localized in the root apex. Infection occurs by vertical polyarnoi from the affected camera.

Chronic apical periodontitis is the result of the lack of treatment in the acute phase of illness or prolonged moderate the effect of traumatic factor of periodontal tissue, for example, over the remaining teeth, fillings that are just above the dentition or mistakes made by the dentist in the treatment. Stages are separated by clinical presentation and transformation of the periodontium and bone.

Causes of apical periodontium

Depending on the etiology of the inflammation are the following factors influencing the development of apical periodontitis:

  1. Traumatic. The cause of the disease is trauma, which was received:
  • once, for example, a fall or blow to the tooth. Injuries provoke periodontal changes in the apical part of the tooth;
  • as a result of factor for a long time. High fillings and improperly fitted prosthetic design lead to swelling of the pulp and its necrotization;
  • as a result of medical intervention. For example, excessive pressure when closing the root filling or for cleaning of the channel of strong pressure can lead to the ingress of the working region in the periodontium.
  1. Infectious. The penetration of pathogenic microorganisms in periodontitis is carried out through:
  • destroyed by a caries cavity. The result is pulpitis (inflammation of the connective tissue inside the tooth) and tooth nerve dies. Bacteria — streptococci, staphylococci and anaerobic — fall into the periodontal ligament at apicalnam hole, resulting inflammation of the root apex;
  • through the marginal region of the periodontium. Teeth due to diseases, age or injury become mobile and move away from the gums, through these cracks and penetrates the bacteria.

Inflammation can be due to iatrogenic factors, i.e., improper conduct of antidecalogue treatment.

Infection can occur as intradental (inside the tooth), and extramental when bacteria enter from the surrounding tissue, for example due to sinusitis or osteomyelitis. In the apical region occurs lymphatic or vascular relief of infection when it is the long accumulation in the body.

  1. Medication. Caused in most cases an incorrect treatment of the pulp, in which the periodontium got potent drugs or irritants (pasta with arsenic, phenol, formalin pins). During the rehabilitation solutions of the root scope, when errors in machining the top of the tooth, may be antiseptic, what causes burn tissue and bone. This should include periodontitis, which was caused by an allergic reaction.

In children the disease most often occurs as a result of infection from the inflamed rotting pulp. The most common infectious form that appears when untreated pulpitis. Traumatic and medical form often and quickly transformirovalsya in infectious diseases.

What are the symptoms of the disease is expressed

Signs of the acute form of disease is a constant aching pain that increases with increasing pressure on the tooth, for example, during meals. Observed pain upon contact with hot or cold stimuli. Inflamed submandibular lymph nodes. The patient noted mild swelling of the tissues in the area of the affected tooth. The pain gradually increases and becomes pulsating in character, affecting the surrounding area of the mouth or goes into the nearest anatomical land — whiskey, eyes, ears, nose. Observed symptoms of intoxication. This is explained by a transition serous purulent stage. The body temperature rises to 38⁰С or worse overall health, a headache.
There are two stages of acute periodontitis:

  • Stage 1. Infection of the periodontal bacteria that cause inflammation. Is characterized by prolonged pain and hypersensitivity of the tooth. The mucous membrane in the area changes were observed;
  • Stage 2. The sensitivity of the tooth to excessive, intense pain is not. The gum swells. The decomposition of the pulp, a symptom of which is lack of response to thermal or electric stimuli.

Is the acute phase of illness for a few days, but can continue for up to two weeks.

In the absence of qualified treatment, the disease spills over into the chronic form, which formed granulomas, cysts, fistula, and there is the chance of developing periodontitis, oculoselective abscess, sepsis, phlegmon, osteomyelitis of the jaw.

In the chronic form of the disease specific complaints in the period of remission the patient does not show, because the pain is negligible and can occur only when pressure on the tooth. Concerned about patient putrid smell from the mouth. Tooth can be sealed or intact, but often there is a hole into its cavity. The gums are formed fistulae or granulomas, the mobility of the tooth. Bloating of the tooth increases, which may indicate the spread of pus in the bone of the apical region, or the lack of access to exudate (fluid that is produced during inflammation and is released from small blood vessels).

Types of chronic apical periodontitis

Fibrous periodontitis. Characterized by the presence of the cavity is destroyed by caries and unpleasant putrid odor from the mouth. There is a gradual replacement by fibrous tissue fibers that anatomically are not suitable for this area and prevent adequate blood supply as a result of the ligaments lose their function.
Granulating periodontitis. Is characterized by pain when the load on the tooth, feeling of fullness. Is formed under the tissue of the alveoli sinus, filled with pus. If the fistula is the pus flowing into the mouth, which reduces pain. In this pathology destroys the alveolar bone, which threatens complete loss of the tooth.
Granulomatous periodontitis. Formed a cyst putting pressure on the alveolar process, thereby destroying it. This increases the risk of osteomyelitis or fracture of the tooth root. Through cystogranulomas the body gets infection that affects internal organs.

Symptoms of acute exacerbation of chronic apical periodontitis

Often exacerbated granulomatous or granulomatous periodontitis, significantly less fibrous. The exacerbation begins in the result of destructive changes of the periodontium. Pain when the load on the tooth is strong, although less than in acute purulent periodontitis. Appear such symptoms as:

  • enlargement and inflammation of the lymph nodes;
  • not passing pain;
  • soft tissue swelling near the affected tooth;
  • visible cavity, destroyed by caries;
  • no pain sensing;
  • the tapping of the tooth top and with the edge causes severe pain;
  • tooth color changed to yellow-grey;
  • the tooth becomes mobile;
  • the tooth does not respond to temperature stimuli.


The diagnosis is made based on dental examination and in interview. Specify whether the patient is trauma or medical intervention, and the presence of the transferred earlier diseases such as the oral cavity, and systemic. During the inspection noted facial symmetry, skin and mucous integument without change. The tooth is as open cavities and healed, but there is a putrid odor and color changes. The sensing cavity is not perceived as painful in contrast to the tapping of the vertical (increasing the load on the pus in the apical part of the periodontal). When tapping the side pain responds granulomatous and granulomatous form of periodontitis, because there was a gap of marginal cords. Touching the mucosa in the affected area also gives pain.


At diagnosis is electrogoniometry (to test the reaction of the pulp to the electric current — when tissue necrosis any reaction is absent), and x-rays. The initial changes in the acute period of the disease x-ray shows no changes, and chronic forms, on the contrary, give a picture for diagnosis. Fibrous periodontitis is characterized by the extension of the periodontium in the absence of bone resorption walls of the alveoli. Granulating is characterized by a darkening of irregular shape with indistinct edges, as the area is filled with purulent secretions visible area of rarefaction of bone tissue. Granulomatous periodontitis looks like darkening round shape with clear contours. The examinee must also pass a General analysis of blood. It will show inflammation in the body, that is, the increase in white blood cells and increase in ESR.


The aim of the treatment is to stop the inflammation in the oral cavity and the body systems. Includes therapeutic interventions, and if necessary, surgical and orthopedic.

The treatment is as follows:

  1. Mechanical preparation. Under anesthesia revealed a bad tooth and mechanically clean and / or medication from the cavity of the anesthetized pulp and tissues affected by caries. Then expanded and processed the root canal, thereby providing release of fluid;
  2. Antiseptic treatment of. For the destruction of pathogenic microorganisms in the channels of the used ultrasound. Then in the root of the tooth is placed antiseptic and anti-inflammatory paste. I advise you to rinse your mouth decoctions of herbs chamomile and oak bark, eucalyptus;
  3. Filling the canals. After the inflammation is thorough sealing of root canals and installed a permanent filling.

Surgical treatments involve an incision in the gums to give the opportunity to enter the exudate. Your doctor may recommend analgesics, antibiotics or antihistamines. When the aggravation is removed can undergo physiotherapy: laser, magnetotherapy.

With timely medical intervention in 85% of cases, this type of periodontitis can be cured completely. Chronic forms of the disease in the absence of proper treatment can lead to the development of complications such as granulomas, cysts, sepsis, abscess, which lead to tooth extraction.

Preventive measures is hygiene of the oral cavity, preventing the development of caries or timely treatment, periodic visits to the dentist for examination and professional teeth cleaning.

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