acute apical periodontitis
Introduction
Introduction to acute apical periodontitis Acute apical periodontitis (acuteapical periodontitis) is a purulent inflammation from the alveolar bone, the periodontal ligament and the root of the cementum, which is often from light to heavy, from small to large. It may develop into a localized osteomyelitis of the alveolar bone and, in severe cases, may worsen the osteomyelitis of the jaw. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, abscess, bad breath
Cause
The cause of acute apical periodontitis
The common causes of acute apical periodontitis are mostly from pulp infection, which is a secondary lesion of pulpitis. In addition, it can also be caused by stimulation of chemical agents during periodontal infection, external tooth injury or root canal treatment. The specific causes are as follows:
Infection (30%):
The most common infection comes from endodontic disease, followed by periodontal disease secondary to the apical foramen, lateral accessory root canal and dentinal tubules. Blood-borne infections are relatively rare. Hyundai believes that the main pathogens of acute infection are acute anaerobic bacteria, and melanin-producing bacteria are the main pathogens of acute periapical inflammation. Bacterial endotoxin is an inflammatory factor of chronic periapical inflammation and is the main cause of periapical granuloma.
Trauma (20%):
The teeth are subjected to external forces such as blows, collisions, falls, etc., which can cause damage to the hard tissues, periodontal tissues and periapical tissues of the teeth. Biting hard objects, such as sand biting into rice, biting walnuts, biting bottle caps, etc., can cause periapical damage.
Tumor (15%):
Tumors that affect periapical lesions include squamous cell carcinoma, lung cancer and breast cancer metastasis, jaw osteosarcoma, myeloma, and ameloblastoma.
Odontogenic factors (20%):
The pulp and root canal are over-sealed, and the root canal instrument wears the root tip. Improper orthodontic force, rapid separation of teeth, and inadvertent injury to adjacent teeth can cause sharp-onset injury.
Prevention
Acute apical periodontitis prevention
Good habits, correct oral health awareness, and the selection of appropriate preventive health products can be combined to prevent or prevent periodontal disease.
Pay attention to oral hygiene and develop good hygiene habits. Persist in getting up early and brushing your teeth before going to bed, gargle after a meal, understand and master the correct brushing method.
Pay close attention to the early signs of periodontal disease. If you have bleeding gums when you brush your teeth or eat something, you should pay attention to it early because it is a manifestation of inflammation in the periodontal. You should go to the hospital as soon as possible to check the condition of the gingival calculus and the atrophy of the gums.
Effectively improve the immunity of teeth and mouth, killing periodontal disease in the bud; while purchasing suitable toothpaste, toothbrush, floss, avoiding the deterioration of gum problems caused by improper oral care products.
Complication
Acute apical periodontitis complications Complications, swelling, abscess, bad breath
1, periodontal swelling or multiple periodontal abscess may occur.
2, bite weakness, dull pain, bleeding gums and bad breath.
3, when the body's resistance is reduced, periodontal bag exudate drainage is not smooth, can cause periodontal swelling, at this time the gums are oval protrusion, redness and swelling, tooth looseness increased, there is pain, the patient feels local Severe pain, sometimes multiple abscesses at the same time, called multiple periodontal abscesses. At this time, the patient may have symptoms such as elevated body temperature, general malaise, submandibular lymphadenopathy, tenderness and the like.
Symptom
Acute apical periodontitis symptoms common symptoms toothache, gums, bleeding, itching, swelling, gums, swelling, gums, black lines
The main appearance of acute apical periodontitis is "bite and jaw pain." The patient is likely to have a history of pulp disease or a history of trauma; at first it may be just a slight painful feeling. If you bite your teeth, you may feel a sense of comfort; then you will have a bite of jaw pain, dull pain, or visible gum pain. Strong, even loose, no pulp, no vitality, permanent teeth or deciduous teeth may have some reaction before pulp necrosis; dental fillings, caries and other periodontal tissue diseases, crowns or periodontal pockets Turns dark.
Acute apical periodontitis is a localized painful inflammation that occurs around the root tip of the tooth. According to its development process, it can be divided into two stages: acute serous apical periodontitis and acute suppurative apical periodontitis.
Acute serous apical periodontitis
It can be caused by pulpitis or bite wounds, etc., and can occur on vital pulp or inactivated teeth. The main symptom is bite pain. The patient has a history of pulp disease, a history of trauma, and a history of imperfect endodontic treatment; at the beginning, there is only mild pain or discomfort, and the jaw is tight and feels comfortable; then, dull pain, bite pain, and the tooth has a floating, elongated feeling. The pain is persistent, spontaneous, and limited, and the teeth are clear. The oral examination shows that the gums are severely painful, and there is a degree of looseness. The corresponding parts of the root tip of the fistula can also cause pain. The pulp vitality test is mostly unresponsive, young. Permanent teeth or deciduous teeth may respond before pulp necrosis; can be found in the teeth with smashing, filling, other dental hard tissue diseases, crown discoloration or deep periodontal pocket; X-ray examination of the periapical tissue image No obvious abnormal performance.
Acute suppurative apical periodontitis
Often developed from acute serous apical periodontitis, it can also be caused by acute exacerbation of chronic apical periodontitis. Also known as acute suppurative apical abscess or acute alveolar abscess, it is one of the most serious dental diseases seen in the clinic. In the initial stage of apical abscess, spontaneous persistent severe pain, increased exacerbation, patients do not dare to match, pain (3 +), loose III degree, mild pain, apical gingival flushing. During the development to the subperiosteal abscess stage, there are still severe pain, pain, looseness and other symptoms. The patient has a painful face. The gingival area of the apical area is flushed and swollen, and the mucosal turning point becomes shallow, flattened, painful and has deep fluctuations. The soft tissue of the corresponding cheeks is reactive edema, regional lymph nodes are swollen and painful, and the lower molars may be accompanied by limited opening; general malaise, elevated body temperature, increased white blood cell count, and severe cases may be associated with the maxillofacial region. cellulitis. In the submucosal abscess stage, the pain is relieved, the pain is relieved, and the mucosa in the apical area is limited to a hemispherical bulge. The percussion has obvious fluctuation and the systemic symptoms are relieved. X-ray films of acute apical periodontitis: no significant changes or only widening of the periodontal space. If the episode of chronic apical periodontitis occurs, the transmission image of the apical alveolar bone destruction can be seen.
Examine
Acute apical periodontitis examination
X-ray examination showed no obvious change in the apex of the acute periapical periodontitis or only the periodontal membranous cavity was widened. If the acute apical periodontitis was acute, the periapical bone destruction and transmission image could be seen.
Diagnosis
Diagnosis and diagnosis of acute apical periodontitis
1. There are cavities, trauma and history of dental surgery. Most of the pulp has no vitality.
2, there is a violent persistent spontaneous pain, can clearly locate, loose teeth, stretch, touch sniper pain, bite pain.
3, apical area soft tissue red, swollen, severe abscess formation, maxillofacial cellulitis, submandibular lymph nodes, tenderness, aversion to cold, fever and other systemic symptoms.
4, X-ray film examination of acute periapical inflammation, no change in the apex of the apex or only periodontal membranous cavity widening, if the acute apical periodontitis episodes, the apical pericardial bone destruction transmission image.
Acute periapical abscess should be differentiated from acute periodontal abscess. Most periodontal abscesses are deep periodontal pockets involving multiple teeth, or periodontal pockets, and the soft tissue of the pocket at the neck is tight, resulting in the periodontal pocket or deep periodontal The pus in the tissue cannot be drained from the mouth of the bag, and a localized abscess is formed in the soft tissue of the bag wall. Most occur in the late stage of periodontitis, usually an acute process. In the clinical manifestations, there are elliptical or hemispherical abscesses on the lip (cheek) side or the tongue () side of the affected tooth. The gums in the abscess are red and swollen, and the percussion has a sense of fluctuation. The affected teeth may have symptoms and signs such as undulating pain, floating, looseness, and bite pain. However, because acute apical abscesses and acute periodontal abscesses have different sources of infection and inflammatory spread pathways, the clinical manifestations of the two are different, and the identification points are usually more clear. The teeth of acute apical abscess are caused by dental disease (such as rickets) secondary to dental pulp infection, and then inflammatory lesions occur in the periapical tissue. The inflammation is centered on the apex and spreads to the surrounding periodontal tissues. . The infection of acute periodontal abscess is caused by the pathogen in the periodontal pocket. In addition to the clinical manifestation of the acute abscess, there are also periodontal pocket formation, purulent sac, alveolar bone resorption and teeth. Looseness and other manifestations of periodontitis. However, sometimes the teeth are combined with periodontal and endodontic, apical lesions, such as acute apical periodontitis after the apical abscess through the periodontal ligament to the gingival sulcus, or a long history of periodontitis At the same time as periodontal abscess, the infection has been retrogradely caused by pulp necrosis, and even periodontal bone destruction is connected with lesions in the apical region. In these cases, it is sometimes easy to confuse the two in the clinic, increasing the difficulty of identification.
