chronic apical periodontitis
Introduction
Introduction to chronic apical periodontitis Chronic apical periodontitis (chronicapical periodontitis) is a chronic inflammation of the apical and periodontal ligament of the teeth. The pathological anatomical features are proliferative inflammatory changes in the periapical tissue, namely the formation of fibrous and dentate tissues, and the changes in the periodontal ligament morphology. Patients have no obvious symptoms, some may have mild pain during chewing, some have no abnormal feeling, and some cases turn into acute inflammation when the body's resistance is reduced, so there may be a history of repeated pain and swelling. The type of lesion may include apical edema, chronic periapical abscess, periapical cyst and apical periostitis. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, bad breath
Cause
Causes of chronic apical periodontitis
the reason
The common causes of chronic 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:
1, infection: the most common infection comes from pulp disease, followed by periodontal disease through the apical foramen, lateral root canal and dentinal tubules secondary, 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.
2, trauma: teeth suffering from external forces, such as blows, collisions, falls, etc., can cause dental hard tissue, periodontal tissue and periapical tissue damage. Biting hard objects, such as sand biting into rice, biting walnuts, biting bottle caps, etc., can cause periapical damage.
3. Tumors: Tumors with periapical lesions have squamous cell carcinoma, lung cancer and breast cancer metastasis, jaw sarcoma, myeloma and ameloblastoma.
4, odontogenic factors: excessive pulp and root canal seal, root canal instrument through the root tip, improper orthodontic force, rapid separation of teeth, tooth extraction accidentally injured adjacent teeth can cause sharp-point injury.
pathology
1. Periapical edema: The bone tissue in the periapical lesion is destroyed and replaced by granulation tissue. There are lymphocytes, plasma cells, fogs and a small amount of neutrophils infiltrated in the granulation tissue, and there are fibroblasts and capillary proliferation. The granulation tissue is often surrounded by a fibrous capsule and proliferates in a cord-like or reticular epithelium.
2. Periorbital abscess or chronic alveolar abscess: is a chronic suppurative inflammation confined to the periapical region. The pus is mainly polymorphonuclear leukocytes and monocytes, surrounded by dense lymphocytes and plasma cells. A periapical abscess can form the gingival sinus through the alveolar bone and mucosa, or through the skin to form the skin sinus.
3. Periapical cyst: A periapical cyst is a periapical lesion surrounded by an epithelial lining that is filled with fluid and surrounded by granulation tissue. The inner layer of the capsule wall is a complete or incomplete epithelial lining, and the outer layer is surrounded by dense fibrous connective tissue, which is filled with cyst fluid and rich in cholesterol crystals. When the cyst is enlarged, the surrounding bone is pressed and absorbed, and the adjacent tooth is pressed to absorb the root.
Peripheral granuloma, periapical abscess and periapical cysts are closely related and can be transformed into each other, with a relationship of migration. Both acute and chronic periapical inflammation can become lesions, but once the teeth are cured, the lesions are eliminated.
4. Dense osteitis: It is a hyperplastic hyperplasia caused by mild, moderate, and chronic stimulation of the periapical tissue.
Prevention
Chronic apical periodontitis prevention
Oral health checkups are performed regularly. If necessary, ensure that the child is examined every six months, and the adult is examined once a year for oral and dental health; once every six months or one year, the teeth are removed and the underarm calculus is removed in time. Keep your mouth clean, keep a good brushing habit, and choose a suitable toothbrush and other cleaning tools.
Complication
Chronic apical periodontitis complications Complications, swelling, 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
Chronic apical periodontitis symptoms Common symptoms Toothache, gum bleeding, gingival pain, enamel, erosion, gingival ganglion, itch, abnormal teeth, abnormal tooth structure
1. Periapical edema: Patients generally have no symptoms, sometimes feel chewed and discomfort, occlusion is weak, there is a sense of discomfort during percussion, the teeth can be discolored, and the apex of the apex can be maintained relatively stable for a long time. The edema of the periapical edema is different in size and form, and the tooth is often pulled out together with the root tip.
2, periapical abscess or chronic alveolar abscess: is a chronic suppurative inflammation confined to the periapical region. Generally no symptoms, slight pain during percussion, history of repeated swelling
3, periapical cysts: usually no symptoms, cyst enlargement makes the jaw wall thin, bulging, palpation has a table tennis-like feeling. The pulp has no vitality. Cysts can be formed into sinus.
4, tight osteitis: no symptoms, no need for treatment.
Examine
Chronic apical periodontitis examination
Oral examination
1. Periapical edema: X-ray films show a circular or elliptical transmission image with sharply defined borders, with clear boundaries and normal or slightly dense surrounding bone. The range of the transillumination zone is small, and the diameter generally does not exceed 1 cm. The pulp vitality test was negative.
2. Periorbital abscess or chronic alveolar abscess: X-ray film shows that the boundary of the diffuse perimeter of the tip is not clear, the shape is irregular, the surrounding bone is loose and cloudy.
3. Pericardial cysts: X-ray films show clear borders with well-defined bones, and the transmission images are indistinguishable from the periapical granuloma. Large periapical cysts have large circular transillumination areas. The boundary is clear and there is a circle of obstructive white lines consisting of dense bone.
4. Dense osteitis: X-ray films show localized radiopaque images of the apex.
Diagnosis
Diagnosis and diagnosis of chronic apical periodontitis
1, there are cavities, trauma and history of dental surgery, pulp is not active, teeth are discolored, often have a history of acute periarthritis.
2, generally no symptoms, sometimes the teeth have discomfort or chewing pain. There is a strange feeling in percussion, and there are gums and skin sinus. When the apical periodontal cyst is swollen, the apical area is bulging, and there is a sense of table tennis.
3, X-ray film shows a sparsely thinned area. If you see a well-defined, well-defined sparse area with white lines around it, diagnose it as a periapical cyst.
