Granuloma of the tooth: symptoms, treatment or tooth extraction
Granuloma of the tooth is a serious and dangerous consequence of the development of periodontitis. Is formed for a long time and does not manifest itself before a certain time. The first signs, forcing the patient to contact the physician identified in the form of discomfort when biting, change tooth color, the appearance of the tissue defect. On receiving the diagnosis to be confirmed by the conduct of basic and additional methods of examination. The treatment is carried out with the use of conservative and surgical interventions. In the absence of treatment over time, the process may be complicated by fracture of the tooth.
Granuloma of the tooth what is it? This kind of education is referred to the radius of the tooth root in the form of capsules with purulent contents. Outside education the normal one is not noted, the main changes of the bone occur under the gums.
The main causes of the origin is considered to be an infection. Routes of entry can be from the cavity of the tooth or through the blood and lymph. Microflora can enter the canal of the tooth through the cavity when the disease of hard tissues: caries and its complications (pulpitis and periodontitis). Inner path of penetration of microorganisms through the blood and lymph vessels due to the presence of infectious diseases in different body systems.
The stage of formation of granuloma:
- Penetration of the infection in the apical region;
- Activation of the immune system: there is focal inflammation specific cells;
- Delimitation of the place of inflammation in the connective tissue capsule: the formation of the granuloma, cavity filled with pus, with the presence of dead cells, bacterial particles;
- Further growth of the tumor, with progressive destruction of bone.
As can be seen from stages a granuloma on the root of the tooth cannot remain static, and over time, increasing in size, may cause serious disorders in the maxillofacial region.
Dental granuloma formation is characterized by prolonged and sometimes for the patient can in no way be celebrated. The signs of the disease are identified by hypothermia, stress, colds, or other processes that can cause the failure of the immune system. The symptoms of granuloma patient will depend on the topography of the inflammatory process and the extent of its spread in the bone or in the direction of periodontal recesses.
The patient notes pain when biting, which may be referred to a discomfort of varying intensity. Often marked by aesthetic dissatisfaction. In the tooth there is a cavity filled with necrotic particles and remnants of food. It is noted the change of color of dental hard tissues. During long-term course of the pathology renders the patient on the gums swelling in the projection of apex of root or bifurcation. A granuloma of the gum is indicated by a swelling and soreness in the feeling.
With time against the background of an intoxication of an organism products of disintegration of microbes and distribution process in the bone tissue arises the deterioration of health. This is indicated by the rise in temperature, headache, weakness, sleep disturbance and appetite.
During exacerbation of the inflammatory process all of the above symptoms will appear in greater severity, as well as with enlargement and tenderness of regional lymph nodes, there could be a slight asymmetry of the face.
Diagnosis granuloma dentist begins with the collection of complaints and drawing up anamnesis cards (anamnesis of life and disease).
There is a characteristic of periodontitis clinical picture:
- Early treated tooth or a tooth with a large cavity;
- The pain of whining character, aggravated by biting;
- Change the color of teeth;
- Sensing the existing cavity painlessly;
- Tapping on the tooth causes severe pain;
- The temperature test was negative;
- Palpation in the projection of the root apex, as a rule, sensitive;
- The mucous membrane in the radius of the apex or in the separation zone of the roots is visualized bulging, painful on palpation.
The main method of diagnosis and clarification of the forms of chronic periodontitis is an x-ray. Is sighting radiography, reflecting the state 2_3 teeth and underlying bone.
On x-ray in chronic granulomatous periodontitis to be rendered granuloma in the apical region of the root. A granuloma is indicated in the picture in the form of darkening round shape with clear boundaries. The boundary darkening is a connective-tissue capsule. A cavity in a formation filled with pus.
There is a gradation of dimensions and the corresponding processes:
- 0.5 cm granuloma;
- 0,5_0,8 cm cystogranulomas;
- Greater than 0.8 cm cyst.
On the topography klassificeret granuloma:
The following extension method of diagnosis will be to conduct electrogoniometry. The PDE – method of determining threshold for pain polovoy tissue to electrical current. Since all chronic forms of periodontitis are characterized by the presence nekrotizirovanne fabric, performance EDI will be more than 100 µa.
Treatment is medical or surgical tactics. Treat conservative way possible with the patency of the canals of the tooth root presented. When the granuloma on the root of the tooth in treatment is important to achieve a sterility of channels and closing the created space with the creation of the seal.
Complex therapy includes:
- The gradual blocking of inflammation: antimicrobial therapy for all structures (main canal, its branching (dentinal tubules), periodontitis);
- Stimulation of regeneration of the periapical tissues;
- The obstacle of re-infection of the canal: closure of the lumen of the root filling;
- The reconstruction of the coronal portion of the tooth: restoration events or orthopedic design.
In the treatment phase of escalation is recommended to first remove pain, by setting the injection with the anesthetic drug, which is optimal in this situation method (application, infiltration, conduction methods). It is desirable to remove dental plaque to reduce microbial contamination of the oral cavity.
In the first visit the treatment of granuloma extraction is carried out with the creation of access. Perform the preparation of implementation completion and disclosure of the tooth cavity. In the presence of the seal produce a full lifting from the surface. You need to perform regular antiseptic treatment of the working space of the tooth. Next, you primary cleansing of the canal system from detritus or re (if you have a history of endodontic intervention and visualization of root fillings). In the course of therapy is sufficient antiseptic treatment of canals and zone apex (sodium hypochlorite 3-5 %, chlorhexidine digluconate 2%).
To increase the antiseptic effect on periodontitis applied physiotherapy: electrophoresis antiseptics, molecules in suspension which emit strongly polarized ions (potassium iodide); phonophoresis – enter the antiseptic in small tubules under the influence of ultrasound; laser under the effect of radiation are indicated simultaneously two processes: the creation of the sterility of the canal in the background bactericidal effect of the laser selection of atomic oxidizing agents (oxygen or chlorine) which is determined by the decay of more complex molecules under the influence of radiation.
Next, make the introduction of anti-inflammatory substrates on turundas and perform the setting of the temporary filling. In addition to the ongoing intervention prescribed broad-spectrum antibiotics (Metronidazol, tsiprolet), antihistamines (diazolin, claritin), analgetic drugs (ketorol).
After 2_3 days continue treatment:
- Perform the removal of the temporary filling;
- Carry out cleaning and remediation of system of root channels;
- Close the lumen of the canal at the apical area a therapeutic substance for the period from 2 to 6 months depending on the clinical situation (CellCept, Metapex). A granuloma in the area of the apex leads to destruction of bone. To create recovery used calcium drugs. Calcium as a major component of medical pastes and starts the function of bone cells (osteoblasts), leading to the emergence of the bone again.
After it was designed, the necessary exposure time control is performed based, endodontic intervention is performed in the system of the root channels, the lumen of the root is closed with gutta-percha.
Further tactics in the recovery of the crown will be determined by the value IOPS (index destruction occlusal surface of the tooth):
- Up to 40% of destruction is reduced by sealing;
- 40_60% tab using metal, porcelain or composite;
- 60_80% of: crowns;
- More than 80%: cultivee pin design (KSHV) combined with crowns.
For a more complete impact on the inflammatory process in granuloma applied physiotherapy: electrophoresis, phonophoresis, UHF, UHF — therapy, laser, magnet.
Such an approach is necessary when it is impossible to perform an effective cleaning of the channels with the use of endodontic instruments. Basically perform tooth-preserving manipulations:
- Amputation – the implementation of the removal of the tooth with a granuloma to koronkowa-root transition (in multirooted teeth);
- Hemisection – is removed the affected root with to be to him a crown;
- Cystotomy – layer-by-layer cutting of the cyst, to provide output pus. When the operation is carried out antiseptic treatment. Place of introduction is closed mucoperiosteal flap;
- Cystectomy – removal of cyst in one visit, with subsequent histological examination;
- Resection of the root at the initial stage of tooth granuloma treatment is done conservative, filling 2/3 of the root. Do control x-ray radiography. Then through access from the gums produces the removal of the apical portion of the tooth to be a granuloma.
Interventions for single rooted and multirooted teeth. In celebration of patient with chronic diseases of other systems, it is necessary to perform a series of tests (blood, urine, ECG) and obtain permission from a specialist, who is sick.
In addition to surgical intervention is prescribed desensibiliziruyuschee, relieve swelling remedies, analgesics, immunomodulators and vitamins. If the tooth cannot be kept, it is necessary to perform the extraction.
At the time not carried out the diagnosis and the intervention in the root canals of the tooth, the inflammatory process begins to spread to underlying bone tissue. Some time the body tries to maintain the integrity of the connective tissue capsule, however, prolonged and aggressive for the reproduction of bacteria, producing pus. All this leads to the increase in the volume content of the cavity and thereby the compression of the bone. Against this background, the bone begins to break down. A granuloma is gradually becoming cystogranulomas and then into the cyst. With a significant size of the cyst and a random effect of traumatic factor it may lead to the appearance of the fracture. And complication is the development of granulating form of chronic periodontitis and the spread of infectious flora through the blood and lymph for the rest of the body systems that can lead ultimately to septicopyemia and death in absence of treatment.