Diagnosis and Classification
- Radiographic features vary depending on the time course of the lesion
- Early lesions may not show radiographic changes, relying on clinical symptoms for diagnosis
- Chronic lesions may show lytic or sclerotic changes, or both
- Diagnosis is based on the presence of clinical symptoms and radiographic findings
- Other diagnostic tools such as vitality tests and cone-beam computed tomography (CBCT) may be used
- Periapical periodontitis can be classified as acute/symptomatic or chronic/asymptomatic
- Acute periapical periodontitis is characterised by throbbing pain and inflammation within the periodontal ligament
- Chronic periapical periodontitis is typically asymptomatic
- Other names for periapical periodontitis include apical periodontitis and periradicular periodontitis
- Classification is important for determining appropriate treatment strategies
Related Lesions
- Periapical periodontitis can give rise to periapical abscesses, periapical granulomas, and cysts
- Periapical granuloma is a mass of chronically inflamed granulation tissue at the apex of a nonvital tooth
- Periapical granuloma may lack granulomatous inflammation, but the term is widely accepted
- Other related lesions include radicular cysts and apical periodontal cysts
- These lesions may require different treatment approaches compared to periapical periodontitis
Treatment
- Treatment options for periapical periodontitis include antibiotic therapy, root canal therapy, and extraction
- Antibiotic therapy is usually used in the short term and may be augmented by chewing gum
- Root canal therapy involves removing the infected pulp and filling the root canal
- Extraction may be necessary if the tooth cannot be saved or if there are complications
- The choice of treatment depends on factors such as the severity of the infection and the patient's overall oral health
Epidemiology
- Periapical periodontitis is a common condition
- Prevalence varies according to age group, with higher rates in older individuals
- Epidemiologic data is mainly generated in European countries, particularly Scandinavia
- The total number of root canal treatments performed does not accurately reflect the frequency of periapical periodontitis
- Root canal treatment may be performed for reasons other than periapical periodontitis, leading to potential underestimation of its prevalence
Miscellaneous
- Other names for periapical periodontitis include apical periodontitis and periradicular periodontitis
- Other diagnostic tools such as vitality tests and cone-beam computed tomography (CBCT) may be used
- The severity of the infection and the patient's overall oral health are factors in determining treatment options
Periapical periodontitis or apical periodontitis (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth. It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp (odontogenic infection), or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.
| Periapical periodontitis | |
|---|---|
| Other names | Apical periodontitis, periradicular periodontitis |
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| Periapical dental radiograph showing chronic periapical periodontitis on the root of the left maxillary second premolar. Note large restoration present in the tooth, which will have undergone pulpal necrosis at some point before the development of this lesion. | |
| Specialty | Dentistry |
Etymologically, the name refers to inflammation (Latin, -itis) around (peri- ) the root tip or apex (-apical) of the tooth (-odont-). Periradicular periodontitis is an alternative term.
