What is Periapical Periodontitis?

Taking care of your teeth is a highly important part of living a comfortable life. Dental problems, like periapical periodontitis, can often spiral out of control if not treated. In this article, we’re going to look at what exactly is this form of periodontitis is, what causes it, its symptoms and what treatment options are available.

Many people might confuse periapical periodontitis with periodontitis. The latter is the advanced stage of gum disease, but periapical periodontitis is something different.

So, what exactly is periapical periodontitis? Periapical periodontitis (more commonly referred to as apical periodontitis) most often develops as a complication of untreated caries, pulpitis, dental trauma, inadequate root canal treatment or drug impairment. This is when there’s some inflammation of the soft tissue that surrounds your tooth’s root (the periodontium) due to bacteria in the tooth pulp. This inflammation is generally located right at the tip of your tooth’s root and can cause severe pain in your gums if not treated.

Types of Periodontitis

There are several types of periapical periodontitis that might start troubling you. Apical is used to describe a problem originating at the tooth’s root tip while periapical implies that it began somewhere around the root tip.

The inflammatory response is dependent on the severity of the bacterial infection around the tooth root apex. Problems travelling beyond the apex of the root surface and into the root canal system can become chronic.

Acute apical periodontitis

Acute periapical periodontitis (also known as periradicular periodontitis) is a condition that develops when bacteria enter the apical portion of a tooth’s tip, usually occurring after trauma or infection. This causes a single tooth and surrounding gums to become inflamed with a feeling of weight, discomfort and tension on the side of the affected tooth. When the infection progresses, the pain intensifies and becomes pulsating as the periapical lesions (tissue) break down.

Acute purulent periapical periodontitis goes through four phases, depending on where the pus is located:

1.  Periodontal – the inflammation has covered the area around the tooth’s root apex and surrounding tissues.
2. Intraosseous – the inflammation (pus) progresses to the bone surrounding the tooth root.
3. Subperiosteal – the pus passes through bone and reaches the periosteum (this is the most painful phase), stopping bone resorption.
4. Submucosal – it becomes a periodontal abscess that forms when inflammatory cells accumulate at the apex of a dead tooth.

Asymptomatic Periapical Periodontitis

Asymptomatic periapical periodontitis develops gradually over time, but without showing any signs or symptoms. Eventually, it will cause some inflammation of the tissue surrounding your teeth, which leads to that tissue’s destruction if not treated. Generally, a dentist can detect this in a general check-up before it gets too serious – which is why it’s important to regularly get your teeth checked out.

Symptomatic Periapical Periodontitis

Symptomatic periapical periodontitis is different. With this type of disease, you’ll feel acute pain in your gums and tooth if you bite down. It develops suddenly, and without treatment, gets worse rapidly.

Chronic periapical periodontitis

Chronic apical periodontitis is most likely the final stage of periodontitis that a person will experience. It is generally a non-painful condition that is in the apical portion of the apical canal around the tip of the tooth root causing chronic inflammation.

As this type of periapical periodontitis has been present for a significant length of time there may be drainage through the gums from around the tooth’s root and oral cavity. Drainage into a major nerve canal can lead to numbness, which is generally temporary and resolves following successful treatment of the condition.

Clinical Symptoms

Clinical symptoms of periapical periodontitis include:

• Pain
• Tenderness
• Percussion or palpation
• Swelling

What Causes Periapical Periodontitis?

Generally, this condition develops only after there has been another problem with a tooth. For example, a cavity that has redeveloped after a failed treatment outcome or an infection in the pulp of the tooth.

At other times, it can develop if you have an infection in the pulpal origin of your tooth, or if that pulp has died. Sometimes even just injuries or simple trauma to a tooth can lead to a case of periapical periodontitis.

The Effects of Periapical Periodontitis?

Without effective treatment from a dentist, periapical periodontitis will continue to cause painful swelling of the gums, loose teeth, complete loss of a tooth (which can then lead to the need for dental implants), and severe infections of the gum and soft tissue.

What to do if you think you have Periapical Periodontitis?

As we mentioned above, depending on whether your periapical periodontitis is asymptomatic or symptomatic, you might not notice any symptoms. If you notice pain in a tooth when you bite down or put pressure on it, you should book an appointment with your dentist to prevent permanent damage to periapical tissue.

Routine inspections

For those of you who have a history of cavities or infections in your teeth, regular check-ups at the dentist are key. During a routine inspection, a dentist should be able to see any cases of asymptomatic inflammation and refer you for further treatment, like root filling, to take care of any problems.

Treatments For Periapical Periodontitis

Assessment

A dentist who specialises in the cause, diagnosis and treatment of diseases of the teeth’s pulp are called endodontists. Endodontic treatment is used to treat apical periodontitis that has advanced quite quickly. You might need to book a special appointment with one of these dentists to treat apical periodontitis

Root Canal Treatment

If you’re lucky, a simple root canal will be all that’s needed to treat the periapical periodontitis and minimise the inflamed periapical granuloma. This is when a dentist cleans away the inflamed or infected granulation tissue around the root canals of a tooth. The tooth root canal filling (or crown) is then placed on the tooth to protect and restore it to its original function.

They’re no longer as scary as their reputation – today, it’s a modern procedure that’s simple and effective for the treatment of gum diseases and removing the necrotic pulp.

Apicoectomy

If you’ve already had a root canal and the inflammation persists or crops up again, then you might need to have a treatment known as an apicoectomy. This is a little bit more involved than your regular root canal.

The dentist (or endodontist) will remove the inflamed and infected tissue surrounding the tooth-like in a root canal, but then continue and completely remove the root tip of your tooth as well to real the pulp chamber floor. Afterwards, a filling will be placed to seal the end of the root.

Tooth removal

As a last resort and for very serious cases of periapical periodontitis, a dentist might decide to completely remove the tooth that’s causing the problem.

Nonsurgical Retreatment

You might also be wondering why antibiotics aren’t used to treat periapical periodontitis. So far, studies haven’t come up with evidence that treating periapical periodontitis with antibiotics is effective. One study conducted found only very low-quality evidence regarding the treatment of the disease with systemic antibiotics – insufficient to determine whether it has any effect or not.

FAQs

Can I have periapical periodontitis and pulpal necrosis?

Yes. Pulp necrosis by itself does not cause periapical periodontitis unless the canal is infected. Some teeth may be nonresponsive to pulp testing due to calcification, or recent history of trauma.

What is the difference between periapical lesions and chronic lesions?

The main difference is that a chronic lesion is a permanently abnormal area inside the mouth while a periapical lesion is the last line of defence that your mouth and teeth have against inflammation and infections.

Make an appointment

If you believe something is going wrong with your teeth or gums, the best thing to do is book an appointment with the friendly team at NS Periodontics before jumping to any conclusions. They’ll be able to inspect any potential problems and recommend further treatment if necessary.