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2.3 Acute Apical Periodontitis

Acute apical periodontitis would be better described as symptomatic apical periodontitis.

The first extension of pulpal inflammation into the periradicular tissues is called acute apical

periodontitis (AAP).It can be defined as inflammation of all the supporting structures of the teeth

in the area surrounding the apex of the tooth. Periapical inflammation is usually due to tooth

infection which characteristically causes pain of tooth in its socket. It is often accompanied by

destruction of bone and occasionally, the root apex of tooth. However the periapical tissue has

the ability to heal if the cause of inflammation is removed.

Figure 2.3.1 : Apical Periodontitis

(source: American Family Physician 2003)

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2.3.1 Causes of apical periodontitis

1. Infection by far the most common cause, bacteria causes decay of tooth which leads to

pulp inflammation ( pulpitis ) and death of the pulp (the soft inner part of the tooth). If

pulpitis is not treated; bacteria, bacterial toxins or products of inflammation can extent

down the root canal and cause periodontitis.

2. Trauma any direct blow to the tooth can sometimes cause the pulp of the tooth to die

and it may become infected by bacteria from the gum margins, leading to apical

periodontitis. A sudden bite on a hard object, undue pressure during orthodontic

treatment or a filling that is high can sometimes cause acute periodontitis though usually

short-lived.

3. Root canal treatment mechanical instrumentation through the tooth root during

treatment or chemical irritation from root-filling materials may result in inflammation of

the periapical region.

2.3.2 Signs and Symptoms

1. The affected tooth is often having a large decay area, a filling or may be discolored due to

a dead pulp in the tooth.

2. The gum over the root of the affected tooth is red and sore.

3. May be associated with swelling of the face for infection can penetrate the overlying

bone or soft tissues.

4. Sometimes connected with fever or body discomfort.

5. Radiologically there is usually widening of the periodontal ligament space.

http://www.intelligentdental.com/2009/09/09/causes-of-sore-gums/http://www.intelligentdental.com/2009/09/09/causes-of-sore-gums/

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6. Pain associated with the disease:

1) Is spontaneous in onset with a moderate to severe intensity in pain and usually

persists for long periods of time (hours).

2) Is more intense and throbbing if inflammation becomes more severe and pus starts to

form.

3) Can be pinpointed to the affected tooth.

4) Is aggravated by biting of teeth. In some cases, the tooth feels high or like it is

coming out and is very sensitive to touch.

5) Has often been followed by pain in the pulp and usually associated with a dead tooth.

6) Hot or cold substances do not cause pain unless in multirooted teeth whereby some

pulp tissue remains healthy.

2.3.3 Treatment

1. Root canal treatment is required. The root canals must be completely cleaned, shaped and

dressed. The tooth may need to be stabilized whilst cutting the access cavity, as the vibration

when cutting can be uncomfortable.

2. Sodium hypochlorite is used as an irrigant, and calcium hydroxide as the medicament after

complete cleaning.

3.

The occlusion is adjusted to relieve any discomfort on biting.

4. Antibiotics are ineffective for the treatment of acute apical periodontitis if root canal

treatment is not carried out.

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5. Therefore the practice of prescribing antibiotics instead of undertaking root canal treatment is

not recommended, as pain will be prolonged.

6. Analgesics may be required, and a combination of paracetamol (500 mg six times daily) and

ibuprofen (200 mg six times daily) should be sufficient.

Reference:

intelligent dental . (n.d.). Retrieved from intelligent dental:

www.intelligentdental.com/2009/12/14/apical-periodontitis-symptoms-and-treatment/