| disease | Periapical Disease |
Periapical diseases include acute and chronic periapical periodontitis. Periapical disease refers to inflammation of the periodontal tissues confined to the apical region, including the cementum, periodontal membrane, and alveolar bone. Pathologically, it can be further divided into serous and suppurative periapical periodontitis. The latter, with obvious symptoms and severe conditions, is also known as acute alveolar abscess. It can spread suppurative inflammation to the periapical external spaces, causing redness, swelling, and lower eyelid edema, which may affect vision. Especially in children, it is often mistaken for an eye disease, leading to ophthalmological examinations before being referred back to dental treatment—a scenario not uncommon in clinical practice. For example, an acute alveolar abscess in the mandibular third molar can lead to suppurative infections in the parapharyngeal space, masseteric-parotid space, and even the temporal space, submandibular space, and various spaces in the floor of the mouth. Such cases are quite severe, and without timely and appropriate treatment, the prognosis can be poor, even life-threatening. On the other hand, chronic periapical periodontitis presents with milder symptoms, a prolonged course, and slow progression, often forming fistulas that persist for months or years. If a chronic periapical cyst develops, a larger one may cause facial deformity. If this condition occurs in children, it can affect the growth and development of the maxillofacial region, potentially leading to facial deformities.
bubble_chart Clinical Manifestations
1. Percussion pain, occlusal pain.
2. Tooth mobility, elongation sensation.
3. The patient can clearly identify the affected tooth.4. Periapical redness and swelling, obvious tenderness, shallow transitional groove.
5. Persistent spontaneous pain, advanced stage presents throbbing pain.
6. Fever, chills, and sometimes elevated body temperature.
7. Enlarged and tender regional lymph nodes.
8. Tooth discoloration.
9. Non-vital pulp. Insensitive to temperature and electrical testing.
10. Periapical fistula, redness and swelling, with purulent discharge.
11. Periapical bone expansion, with a ping-pong ball sensation, tooth displacement, and mobility. In severe cases, facial deformity may occur.
12. Aspiration of viscous cystic fluid and cholesterol crystals in cases of bone expansion. {|111|}
bubble_chart Auxiliary Examination
1. Routine blood test
2. General radiography
3. Secretion and tissue culture + drug sensitivity
1. The tooth feels elongated, with obvious percussion and touch pain.
2. The patient can clearly identify the affected tooth.
3. There is periapical redness and swelling, with a shallow transitional groove.
4. Periapical abscess with facial deformity, obvious tenderness, and enlarged, tender submandibular lymph nodes.
5. Bulging of the apical bone with a ping-pong sensation, and cystic fluid upon puncture.
6. Symptoms include fever, chills, elevated body temperature, increased white blood cell count, and general discomfort.
7. X-ray shows a radiolucent area at the apex. {|106|}
bubble_chart Treatment Measures
1. Acute periapical periodontitis:
(1) Open the pulp for drainage. (2) Incision and drainage of abscess. (3) Adjust excessively high cusps under local anesthesia to prevent traumatic occlusion. (4) Root canal treatment.
(1) Root canal treatment (2) Apicoectomy (3) Curettage of periapical cyst.
The inflammatory pain of periapical periodontitis can be relieved with anti-inflammatory treatment, distinguishing it from trigeminal neuralgia.
1. Cure: No symptoms or signs within at least 1 year after treatment; X-ray shows normal periapical condition.
2. Improvement: After treatment, pain disappears, swelling or fistula resolves. X-ray shows significant reduction in periapical lesions.
3. No cure: After treatment, fistula forms or recurrent swelling/pain occurs, and periapical lesions do not shrink.
