Chronic Periapical Periodontitis Prognosis and Treatment

Even if you’ve never had root canal surgery, you probably know that the procedure is one of the more invasive ones you can get at a basic walk-in dental practice. However, root canal therapy is actually one of the easiest and most popular solutions to a range of periapical conditions. So what are these diseases and what are some other ways dentists choose to treat them?

Well, periapical infections are those that affect the tissues surrounding the root of the tooth. Apical periodontitis is generally the result of caries or trauma that penetrates the dental pulp and travels into the jaw. If the condition advances, it can even cause bone destruction. Luckily, the endodontist at Millennium Dental specializes in treating dental conditions that affect the interior of the tooth.

The Difference Between Regular Dentists and Endodontists

Your garden variety dentist should be able to keep your teeth looking and feeling good. They tend to deal in tooth fillings, crowns, and other aesthetic and protective devices and procedures.

Conversely, those who specialize in endodontics are supposed to ensure the health of their patient’s teeth from the inside out. Even the name of the specialty is made up of the Greek words for “inside” and “tooth.”

Generally, an endodontic specialist would have two or three years of experience in advanced education programs on top of the four-year stint in dental school. Rather than installing fillings or cleaning teeth, they spend more of their time diagnosing and treating tooth pain.

After all, feeling pain coming from our teeth is a surefire sign that damage has been done to the dental pulp. Aside from housing the blood vessels that deliver nutrients to our teeth, the pulpy core also contains the nerve endings that take signals back to the brain. Pain is usually a good indicator that the outer layers of the tooth — the enamel and dentin — have been compromised, leaving the vulnerable pulpy core exposed.

Therefore, having a toothache is already reason enough to visit an endodontist. But once we have done that — what would an appointment even look like?

How Would an Endodontist Diagnose Apical Periodontitis?

As we have established, any kind of tooth pain is a good reason to visit an endodontist. When patients let their pain go on for too long, they risk having the infection transfer from the inside of their tooth to the periapical area. From there, it can easily infect the surrounding jaw tissues and even bone. And even before the bacteria get a chance to infect the bone, it will probably form an abscess of pus in the area.

Of course, apical periodontitis can also occur without an infection transferring from the dental pulp to the root of the tooth. For example, let’s say that a patient had an improperly installed restoration. If the tooth filling is protruding, every bite may be applying undue pressure on the periapical ligament, thus causing inflammation. In that case, the inflammatory process will start in the tissues that connect the tooth to the jawbone, not the dental pulp.

So what can you expect an endodontist to do if you come to them with periapical periodontitis? Well, the appointment itself would look much like any other visit to the dentist. We’d start by considering the symptoms a patient is experiencing.

What Are the Main Symptoms of Chronic Apical Periodontitis?

As we have established, the most obvious symptom of periapical issues is the pain that comes with them. However, an endodontist would consider other indicators of infection as well.

An infected root of a tooth often presents as vertical tenderness upon biting down. Additionally, the pressure of biting can often agitate the area, resulting in redness and swelling. Of course, all these symptoms can range in intensity, to the point that some people even experience asymptomatic apical periodontitis.

However, even if pain and swelling are minimal in those cases, the same inflammatory processes are taking place. At least patients who feel pain know that something is wrong. Those with no symptoms would need to be lucky enough for a dentist to notice their symptoms during regular checkups.

If a dentist identifies signs of infection around the root of a tooth, they would probably refer the patient in question to an endodontic specialist. To confirm the diagnosis, they might also take a radiograph or a 3D scan of the area before developing a treatment plan.

Treatment for Chronic Periapical Periodontitis

One of the best things about specialized treatment is that endodontists are trained in pain management techniques regular dentists might not use. Since they always deal with dental pulp, they have a range of numbing medications they can use. That’s why endodontic therapy is one of the less painful options for those who develop infections in the root of the tooth.

As for the treatment plan itself, that will naturally depend on the exact symptoms the patient presents with. At this point, clinical tests would have shown if the patient is suffering from pulpitis — an inflammation of the dental pulp. Moreover, they might have shown if the infection is reversible or not. In the latter case, a root canal extraction would be necessary.

A dentist would first remove as much of the infected tissue as they could. Then, a few days after inserting a numbing agent into the tooth chamber, they would extract as much of the nerves and blood vessels from the tooth. Hollowing the tooth out allows the dentist to apply medicine to the root as well, and wrap it all up with a root canal filling. However, in more extreme cases, a total tooth removal might be necessary in order to treat the infected flesh underneath.

Still, the primary goal of an endodontist would be to bring the tooth back to life. The only way they would be able to do that is if the pulp infection was reversible. If that is the case, the process of treating the area would involve caries removal and a quick filling application.

The trick is in catching the inflammation before it spirals into a serious toothache. As it happens, that’s exactly why we recommend having regular dental checkups!

When Should You See an Endodontist?

As a rule of thumb, toothaches are as good of a reason as any to visit one’s endodontist. After all, if we’re at the point of feeling pain — chances are, the dental pulp is already involved. Since the core of the tooth is under the purview of endodontics, it’s best to go right to the specialist.

At the dental clinic, you can expect the dentist to go through your dental history with you. If you have had recent trauma or restoration work done, it may have produced the infection. Several clinical tests later, your dentist will present you with a diagnosis and a treatment plan. You’ll be back to your old self in a matter of days!