Periapical periodontitis or apical periodontitis (AP) is an acute or chronic inflammatory

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

around the apex of a tooth root, most commonly caused by

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

invasion An invasion is a military offensive in which large numbers of combatants of one geopolitical entity aggressively enter territory owned by another such entity, generally with the objective of either: conquering; liberating or re-establishing con ...

of the pulp of the tooth. It is a likely outcome of untreated

dental caries Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicatio ...

(tooth decay), and in such cases it can be considered a

sequela A sequela (, ; usually used in the plural, sequelae ) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Derived from the Latin word, meaning “sequel”, it is used in the medical field to mean a complication ...

in the natural history of tooth decay,

irreversible pulpitis Pulpitis is inflammation of dental pulp tissue. The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth’s blood and nutrients. Pulpitis is mainly caused by bacterial infection which itself is ...

and pulpal necrosis. Other causes can include

occlusal trauma Occlusal trauma is the damage to teeth when an excessive force is acted upon them and they do not align properly.Bibb, CA: Occlusal Evaluation and Therapy in the Management of Periodontal Disease. In Newman, MG; Takei, HH; Carranza, FA; editors: ...

due to 'high spots' after

restoration Restoration is the act of restoring something to its original state and may refer to: * Conservation and restoration of cultural heritage ** Audio restoration ** Film restoration ** Image restoration ** Textile restoration * Restoration ecology ...

work,

extrusion Extrusion is a process used to create objects of a fixed cross-sectional profile by pushing material through a die of the desired cross-section. Its two main advantages over other manufacturing processes are its ability to create very complex c ...

from the tooth of root filling material, or bacterial invasion and infection from the

gums The gums or gingiva (plural: ''gingivae'') consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health. Structure The gums are part of the soft tissue linin ...

. Periapical periodontitis may develop into a

periapical abscess A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a ba ...

, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp (

odontogenic infection An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. The term is derived from '' odonto-'' (Ancient Greek: , – 'tooth') and '' -genic'' (Ancient Greek: , ; – 'birth'). The most common ...

), or into a

periapical cyst Commonly known as a dental cyst, the periapical cyst is the most common odontogenic cyst. It may develop rapidly from a periapical granuloma, as a consequence of untreated chronic periapical periodontitis. Periapical is defined as "the tissues su ...

, where an

epithelial Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...

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.

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'.)

Acute periapical periodontitis

Acute (or symptomatic) periapical periodontitis.... Malaise thumbing pain due to Inflammation within periodontal ligament

Chronic periapical periodontitis

Chronic (or asymptomatic) periapical periodontitis.

Related lesions

In addition to

es, periapical periodontitis can give rise to various related lesions, including

periapical granuloma Periapical granuloma, also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes a ...

s and

cysts A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac (like the manner in which water molecules group together to form a bubble) ...

. A periapical granuloma (also referred to as an 'apical granuloma' or 'radicular granuloma') is a mass of chronically inflamed

granulation tissue Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size ...

that forms at the apex of the

root In vascular plants, the roots are the organs of a plant that are modified to provide anchorage for the plant and take in water and nutrients into the plant body, which allows plants to grow taller and faster. They are most often below the sur ...

of a nonvital (dead) tooth. (Although not a true

granuloma A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...

, given the absence of

granulomatous inflammation A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious o ...

, the term 'periapical granuloma' is widely accepted.)

Treatment

Treatment options may include antibiotic therapy (in the short term, augmented by chewing gum), 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. 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

External links

{{Oral pathology Periodontal disorders