Tooth caries

1. APICAL PERIODONTITIS
BY
JAVISHA ROSHAN J

2. DEFINITION
 PERIODONTITIS refers to an inflammation of the gingival tissues in
association with some loss of both the attachment of periodontal ligament
and bony support
 APICAL PERIODONTITIS is the inflammation of the periodontal ligament
around the root apex
 It characteristically causes tenderness of the tooth in its socket
 Apical periodontitis can be Acute and Chronic

3. ETIOLOGY
 Infection
 Trauma
 Chemical irritation
 When a tooth experiences trauma, like a
strong blow, it can damage the blood
vessels at the root apex, causing the pulp
(the nerve tissue inside the tooth) to die;
this necrotic pulp then becomes
susceptible to bacterial infection from the
gums, leading to inflammation and
infection in the surrounding bone tissue, a
condition known as apical periodontitis.

4. ACUTE APICAL PERIODONTITIS
 Clinical features
 Pain due to previous pulpitis
 Due to the collection of imflammatory oedema in the periodontal
ligament, the tooth is slightly elevated in its socket
 A large carious cavity or filling in the affected tooth, or it may be
discoloured due to death of the pulp earlier
 Gingiva over the root is red and tender
 There is no swelling while inflammation is confined within the bone
 Pain of apical periodontitis is accurately localised

5. Radiographic features
Radiographic appearance is
essentially normal at this stage
Immediately round the apex, the lamina
dura may appear slightly hazy
The periodontal space may be slightly
widened

6. Treatments
1. Conservative Management (If No Pulpal Involvement)
2. Endodontic Treatment (If Pulp is Infected/Necrotic)
3. Antibiotic Therapy (If Systemic Involvement)
4. Surgical Management (If Required)

7. CHRONIC APICAL PERIODONTITIS
 Clinical features
 Chronic periodontitis is a low grade infection
 Present over long time of period
 It may follow an acute infection that has been inadequately drained and
ncompletely resolved
 The tooth is non-vital and may be slightly tender to percussion
 Symptoms may be minimal
 Chronic periodontitis is first recognised as a round area of radiolucency at
the apex of a tooth (‘apical granuloma’)in a routine radiograph

8. COMPLICATIONS
 Periapical granuloma:A periapical granuloma, also known as a radicular or
apical granuloma, is a chronic inflammatory mass of bacteria and granulation
tissue that develops at the tip of a tooth’s root. It’s a common growth that forms
in response to dead tissue in the tooth’s pulp chamber. Periapical granulomas
can be a diagnostic marker for chronic apical periodontitis. If left untreated,
they can cause fistulas and more pain.
 Radicitar cyst:A periapical cyst, also known as a dental or radicular cyst, is a
fluid-filled sac that forms at the tip of a nonviable tooth’s root. It’s the most
common odontogenic cyst and is caused by dental pulp necrosis, which
reduces blood, oxygen, and nutrient supply to the soft tissue beneath the
tooth’s hardest layer. Symptoms include pain, tenderness, swelling, and
drainage. If left untreated, chronic inflammation from the cyst can lead to bone
loss around the tooth.

9. Radiographic feature
➤ Radiographically, diffuse or demarcated radiolucency
around the apex of the tooth
➤ Root resorption
➤ A thin radiopaque line representing a zone of sclerotic
bone may sometimes be seen outlining the lesion

10. • RCT is the first-line treatment.
• Surgical options are considered if RCT fails.
• Extraction is done only if the tooth cannot be saved.
Treatments

11. ACUTE APICAL PERIODONTITIS
 Acute onset
 Spontaneous intense and throbbing pain
 Tender on percussion
 Pus formation
 Previous history of pulpitis
 Thermal changes do not induce pain
 Tooth is elevated from the socket

12. 1. Gradual onset with mild or no symptoms.
2. Mild pain or discomfort on biting or chewing (may be asymptomatic).
3. Slight tenderness to percussion (may not always be present).
4. Tooth is non-vital (no response to vitality tests).
5. May have a sinus tract with intermittent pus discharge (if chronic abscess
develops).
6. Radiographic features: Well-defined periapical radiolucency.
7. Sequelae of pulpitis or acute apical periodontitis.
8. Can progress to:Periapical granuloma (chronic inflammatory response).Periapical
cyst (if epithelial proliferation occurs).Chronic periapical abscess (if pus
accumulation persists).
8 Points for chronic apical
periodontitis