Tooth granuloma: what is it, symptoms, how is tooth granuloma treated

What is a tooth granuloma?

Tooth granuloma (granulomatous periodontitis) - This is a chronic, usually asymptomatic and non-purulent inflammation of the apex of the tooth root and surrounding tissues. A typical silent complication of tooth decay, cracked or chipped tooth, granuloma is mainly caused by bacterial invasion from the side of the root canal (the tubule inside the root, in which nerve fibers and blood vessels).

The formation of a "bag-like ball" in case of a disease occurs painlessly, but with the appearance of factors that reduce immunity (coldhypothermia), an inflammatory process develops, which is accompanied by toothache, swelling, redness of the gums.

The disease is considered dangerous because it is difficult to diagnose in the early stages. And the diagnosis of the disease in the later stages, when the formed ball is filled with pus, is dangerous by the development of complications unfavorable for life.

Even in the absence of noticeable symptoms, a tooth granuloma still requires careful intervention. In the early stages, the infection does not create any problems or disturbances, because the bacteria and granulocytes (a type of white blood cell) in the granuloma are in a kind of dynamic equilibrium. When this form of forced coexistence ceases and bacteria gain the upper hand, the granuloma can become acute, causing serious complications such as abscesses or dental fistulas.

Classification

There are several types of dental granulomas that differ in the severity of the infection. Among the most common forms are:

• basal - concentrates in the area of ​​the root of the affected tooth;
• inter-root - formed in the area between the root of the molar and the premolar;
• apical - located next to the apical puncture of the tooth;
• purulent granuloma - accompanied by the formation of a fistulous passage through which purulent exudate is withdrawn.

There are also 3 stages of the disease:

1. First stage: microbes are introduced into the pulp of the tooth, which provokes its inflammation, and then leads to death.
2. Second stage: bacteria, multiplying, pass through the root canals and affect the bone tissue of the jaw.
3. Third stage: as a result of prolonged inflammation, deformation of areas of the bone occurs, instead of which connective tissue is formed, which separates microbes and transforms into a capsule shape.

At the initial stage of the development of the disease, a seal is formed in the form of one small ball, but according to as the disease progresses, the ball increases in size and affects nearby tissues, causing severe pain in tooth.

Each stage stretches for quite a long time, as a result of which the disease can form from several months to several years.

Tooth granuloma symptoms

Symptoms that, according to clinical indications, are considered characteristic of the disease:

• bloody smudges and pain in the gum area;
• strong painful sensations in the tooth;
• the manifestation of symptoms characteristic of an infection in the oral cavity;
• redness of the gums;
• temperature increase;
• shaping inflammation of the gums near the tooth;
• blackening of the enamel;
• purulent discharge between the affected tooth and the gum.

In the most common cases and in the early stages of a simple granuloma inflammation is asymptomatic and quiet, which makes it difficult to identify the problem and its quick cure.

Therefore, at the initial stage, the infection does not cause much disturbance, since bacteria and granulocytes can coexist, creating a kind of dynamic balance that persists for years.

When this balance is disturbed and bacteria suppress white blood cells, for example, due to the destruction of the protective functions of the immune system, the granuloma becomes chronic and aggravated, causing complications and inflammation that cause severe pain and the discomfort.

The first symptom reported is a sharp toothache located in the area of ​​the infection. Other common symptoms include swelling of the gums. photo above), severe discomfort and, in severe cases, eye pain, headache, fever (fever) inflammation of the lymph nodes in the neck (cervical lymphadenitis). In some cases, the granuloma manifests itself immediately in the form reddish abscess on the gum.

This happens when the granuloma gradually begins to expand, increase in volume, abscess and - if not treated in time, it can reach the surfaces of the bone, infect the area and form a fistula, or cysts.

Causes of tooth granulomas

In dentistry, there are no specific reasons provoking the development of the disease, which complicates the diagnostic process.

However, the development of granulomas can be triggered by the following factors:

• complication of pulpitis, including in the process of performing endodontic procedures (treatment of pulpitis);
• periodontitis - inflammation of the tissues surrounding the tooth;
• the presence of a running caries;
• tooth injuries (chips, cracks), as they are a source of infection and can also lead to the development of dental granulomas;
• non-observance of the rules of asepsis and antiseptics when removing the pulp of the tooth or treating the root canals of the teeth;
• hypothermia, a cold, stressful situations, a sharp change in climate, physical overstrain provoke the development of acute clinical manifestations of dental granuloma

In addition, inflammation can form on the root of the tooth due to some mechanical damage to the crown or the jaw itself.

There are situations when a disease forms under the inserted crown. This is possible only in cases where a poor-quality crown installation or rigid teeth turning was performed.

Dentists say that the disease is almost always found after prolonged caries. Due to the penetration of bacteria into the pulp, their gradual reproduction is carried out, and this provokes an exacerbation of the granuloma. Bacteria deform bone tissue over time.

Situations are not excluded when the granuloma develops as a result of tooth extraction. In this situation, microbes penetrate into the tightening wound, which form a "bag-shaped ball". If you manage to cure the infection, then the formation of granulomas can be avoided.

Diagnostics

Diagnosing granulomas is a very difficult task, therefore, if several symptoms characteristic of this disease appear at the same time, you should immediately contact your dentist.

When contacting a dental clinic, the first thing that should be prescribed is an X-ray, on which, as mentioned above, the disease manifests itself in the form of a dark spot. In addition, sometimes radiovisiography can be prescribed - it also helps to identify the presence of a disease and has a lesser emitting effect on the body than X-rays.

A visual examination by the dentist of the oral cavity is also carried out.

The above methods are not as effective in detecting the focus of the disease as 3D computed tomography. Using this method, it is possible to assess not only the presence of a neoplasm, but also its condition (i.e., the stage of the disease).

A prerequisite for diagnostics is a visit to a professional doctor, in some cases it is even desirable to go to a private clinic.

How is tooth granuloma treated?

The main treatment for the disorder is removal of the granuloma itself, since pharmacological treatment rarely has any effect. For example, antibiotic therapy can only cure an infection in the acute phase and not in the chronic phase. The methods that the specialist will apply depend on the severity of the infection, hence the size of the granuloma and the underlying conditions of the tooth. In general, there are two general methods for treating tooth granulomas:

- Drug therapy.

If the disease is detected at an early stage, antibiotics and rinsing will be sufficient.

This is especially true in relation to children with baby teeth.

For the treatment of granulomas, the following antibacterial drugs can be used:

• Amoxicillin;
• Ciprofloxacin;
• Doxycycline;
• Azithromycin;
• Amoxiclav.

A granuloma or cyst can only be treated with antibiotics under the guidance of a healthcare professional.

Antibiotic therapy will only help if this is an acute initial stage of the disease.

- Surgical intervention.

If the granuloma has grown very much, drug therapy will be ineffective, so you will have to resort to surgical intervention. During surgery, the doctor first dissects the gum to allow pus to drain out of it. This prevents pus from entering the bloodstream and surrounding tissues.

Then there should be drainage in the tooth for three days. To eliminate the inflammatory process for these three days, an additional course of drug therapy is prescribed. Then the wound is sutured, after which the tooth is left or removed.

The doctor makes the decision to remove a tooth in the following situations:

• the infection was provoked by problems in the periodontal pocket;
• the tooth has been destroyed so badly that it is no longer possible to restore it;
• root canals cannot be treated due to patency problems.

Surgical removal of granulomas is carried out with a chronic (protracted) form of the disease or in cases where a cyst is present.

Complications

Problems other than pain, swelling of the gums and loss of teeth caused by the disease can have serious consequences. A granuloma infection can spread to connective tissue and soft tissue (causing phlegmon). Cellulitis can lead to pus, abscess, and bone infection (osteomyelitis). Unfortunately, dental granuloma inflammation can also spread outside the mouth and lead to systemic infections such as sore throat, endocarditis (inflammation of the heart valves) pneumonia and so on ..

Prophylaxis

It is necessary to carefully observe oral hygiene, diligently brush your teeth (this action is performed twice a day: in the morning and in the evening), it is also worth undergoing constant preventive examinations at dentist.

Dentists offer a number of recommendations for maintaining dental health:

• if you have healthy teeth, you need to visit the dentist 2 times a year, if you have painful teeth, you need to visit the dentist at least 4 times a year;
• with the development of caries, it is urgently needed to be treated;
• do not use a hard toothbrush so as not to damage the surface of the tooth enamel and the gum itself, change the toothbrush every two months;
• Strengthen your teeth by rinsing your mouth with herbal infusions.