Periapical dental radiograph showing chronic periapical periodontitis on the root of the left maxillary second premolar. Note large restoration present in the tooth, which will have undergone pulpal necrosis at some point before the development of this lesion.
Specialty
Dentistry
Periapical periodontitis or apical periodontitis[1] (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth.[2] It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp (odontogenic infection), or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.
Etymologically, the name refers to inflammation (Latin, -itis) around (peri- ) the root tip or apex (-apical) of the tooth (-odont-). Periradicular periodontitis is an alternative term.
Contents
1Diagnosis
1.1Classification
1.1.1Acute periapical periodontitis
1.1.2Chronic periapical periodontitis
2Related lesions
3Treatment
4Epidemiology
5References
6External links
Diagnosis
The radiographic features of periapical inflammatory lesions vary depending on the time course of the lesion. Because very early lesions
may not show any radiographic changes, diagnosis of these lesions relies solely on the clinical symptoms. More chronic lesions may show lytic (radiolucent) or sclerotic (radiopaque) changes, or both.
Classification
Classification of periapical periodontitis is usually based on whether the process is acute/symptomatic or chronic/asymptomatic.
(Note: alternative names for periapical periodontitis include 'apical periodontitis' and 'periradicular periodontitis'.)
In addition to periapical abscesses, periapical periodontitis can give rise to various related lesions, including periapical granulomas and cysts.[3] A periapical granuloma (also referred to as an 'apical granuloma' or 'radicular granuloma') is a mass of chronically inflamed granulation tissue that forms at the apex of the root of a nonvital (dead) tooth.[4] (Although not a true granuloma, given the absence of granulomatous inflammation, the term 'periapical granuloma' is widely accepted.)[4]
Treatment
Treatment options may include antibiotic therapy (in the short term), root canal therapy, or extraction.
Epidemiology
Periapical periodontitis of some form is a very common condition. The prevalence of periapical periodontitis is generally reported to vary according to age group, e.g. 33% in those aged 20–30, 40% in 30- to 40-year-olds, 48% in 40- to 50-year-olds, 57% in 50- to 60-year-olds and 62% in those over the age of 60.[5] Most epidemiologic data has been generated in European countries, especially Scandinavia. While millions of root canal treatments are carried out in the United States alone each year, total numbers of such cases do not provide reliable indicators of frequency, even for symptomatic periapical periodontitis (given that root canal treatment is not always indicated or complied with, and may also be performed in the absence of periapacial periodontitis).
References
^Nair PN (April 2006). "On the causes of persistent apical periodontitis: a review". International Endodontic Journal. 39 (4): 249–81. doi:10.1111/j.1365-2591.2006.01099.x. PMID 16584489.
^Segura-Egea JJ, Castellanos-Cosano L, Machuca G, López-López J, Martín-González J, Velasco-Ortega E, et al. (March 2012). "Diabetes mellitus, periapical inflammation and endodontic treatment outcome". Medicina Oral, Patologia Oral y Cirugia Bucal. 17 (2): e356-61. doi:10.4317/medoral.17452. PMC 3448330. PMID 22143698.
^Graunaite I, Lodiene G, Maciulskiene V (January 2012). "Pathogenesis of apical periodontitis: a literature review". Journal of Oral & Maxillofacial Research. 2 (4): e1. doi:10.5037/jomr.2011.2401. PMC 3886078. PMID 24421998.
^ abNeville BW, Damm DD, Allen CA, Bouquot JE (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 113–124. ISBN 978-0721690032.
^Hargreaves KM, Cohen S, Berman LH, eds. (2010). Cohen's pathways of the pulp (10th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 529–555. ISBN 978-0-323-06489-7.
Periapical, mandibular and maxillary hard tissues – Bones of jaws
Agnathia
Alveolar osteitis
Buccal exostosis
Cherubism
Idiopathic osteosclerosis
Mandibular fracture
Microgenia
Micrognathia
Intraosseous cysts
Odontogenic: periapical
Dentigerous
Buccal bifurcation
Lateral periodontal
Globulomaxillary
Calcifying odontogenic
Glandular odontogenic
Non-odontogenic: Nasopalatine duct
Median mandibular
Median palatal
Traumatic bone
Osteoma
Osteomyelitis
Osteonecrosis
Bisphosphonate-associated
Neuralgia-inducing cavitational osteonecrosis
Osteoradionecrosis
Osteoporotic bone marrow defect
Paget's disease of bone
Periapical abscess
Phoenix abscess
Periapical periodontitis
Stafne defect
Torus mandibularis
Temporomandibular joints, muscles of mastication and malocclusions – Jaw joints, chewing muscles and bite abnormalities
Bruxism
Condylar resorption
Mandibular dislocation
Malocclusion
Crossbite
Open bite
Overbite
Overeruption
Overjet
Prognathia
Retrognathia
Scissor bite
Maxillary hypoplasia
Temporomandibular joint dysfunction
Salivary glands
Benign lymphoepithelial lesion
Ectopic salivary gland tissue
Frey's syndrome
HIV salivary gland disease
Necrotizing sialometaplasia
Mucocele
Ranula
Pneumoparotitis
Salivary duct stricture
Salivary gland aplasia
Salivary gland atresia
Salivary gland diverticulum
Salivary gland fistula
Salivary gland hyperplasia
Salivary gland hypoplasia
Salivary gland neoplasms
Benign: Basal cell adenoma
Canalicular adenoma
Ductal papilloma
Monomorphic adenoma
Myoepithelioma
Oncocytoma
Papillary cystadenoma lymphomatosum
Pleomorphic adenoma
Sebaceous adenoma
Malignant: Acinic cell carcinoma
Adenocarcinoma
Adenoid cystic carcinoma
Carcinoma ex pleomorphic adenoma
Lymphoma
Mucoepidermoid carcinoma
Sclerosing polycystic adenosis
Sialadenitis
Parotitis
Chronic sclerosing sialadenitis
Sialectasis
Sialocele
Sialodochitis
Sialosis
Sialolithiasis
Sjögren's syndrome
Orofacial soft tissues – Soft tissues around the mouth
Actinomycosis
Angioedema
Basal cell carcinoma
Cutaneous sinus of dental origin
Cystic hygroma
Gnathophyma
Ludwig's angina
Macrostomia
Melkersson–Rosenthal syndrome
Microstomia
Noma
Oral Crohn's disease
Orofacial granulomatosis
Perioral dermatitis
Pyostomatitis vegetans
Other
Eagle syndrome
Hemifacial hypertrophy
Facial hemiatrophy
Oral manifestations of systemic disease
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