Dental granuloma is a limited inflammation of the periodontium, which is a small rounded formation located in the area of the dental root. It is characterized by a long asymptomatic course. Under the influence of various provoking factors, disease worsens with the appearance of a vivid clinical picture of an acute inflammatory process: severe pain in the tooth, swelling and redness of the gums. Diagnosis is carried out mainly by X-ray of the affected area or on the basis of visiography. Therapeutic tactics can be both conservative and operative. The choice of treatment method depends on the size of the granuloma, the degree of destruction of the tooth root and the presence of complications.
Dental granuloma may have a different location in relation to the root of the tooth, but granulomas are most often found in the area of the tip of the dental root. The latent course is fraught with a certain danger, since it does not allow to diagnose and treat the disease in time. In this regard, in dentistry, it is not uncommon for granuloma to be found already in a neglected state. But it, despite its small size, can become a source of a number of serious complications.
Most often, the formation of dental granuloma is a complication of pulpitis and is caused by the spread of the infectious process from the inflamed nerve passing in the root of the tooth. The second cause of pathology may be inflammation of the tissues surrounding the tooth — periodontitis. A tooth fracture and other injuries are a source of infection and can also lead to the development of dental granuloma. The cause of infection may also be non-compliance with the rules of asepsis and antiseptics when removing tooth pulp or treating dental canals.
The factors provoking the development of acute clinical manifestations of dental granuloma include hypothermia, a cold, stressful situations, sudden climate change, physical overstrain.
Dental granuloma is a limited inflammatory formation with a thin wall. In the granuloma area, there is an intensive proliferation of granulation tissue, which replaces the cells that died as a result of the inflammatory process. This overgrowth causes a gradual increase in granuloma size. Until the dental granuloma reaches a significant size, its existence may be invisible to the patient and even to the dentist. Often, the detection of such granulomas occurs only during dental radiography or orthopantomogram. With an increase in granuloma, pain and swelling of the gums appear.
Possible suppuration of dental granuloma. In such cases, there is an acute toothache, swelling and redness of the gums. There is a darkening of the tooth. There may be purulent discharge coming out between the tooth and gum. Suppuration of dental granuloma may be accompanied by the development of odontogenic periostitis (flux). At the same time, an increase in body temperature and a violation of the general condition of the patient is possible: headache, malaise, etc.
With a chronic asymptomatic course, disease can transform into a jaw cyst. It is separated from the surrounding tissues with the formation of a dense capsule, inside which there are necrotic masses and dead bacteria.
The growth of dental granuloma can be accompanied by the destruction of the root of the tooth in the area of its apex, which in turn can lead to tooth loss. The spread of the inflammatory process from the granuloma to the surrounding soft tissues can cause the formation of a limited abscess — a parotid abscess or the development of a diffuse purulent lesion — phlegmon. Involvement of bone tissue in the process leads to osteomyelitis of the jaw.
Since dental granuloma is a chronic focus of infection, its possible complications go far beyond dentistry. The spread of infectious agents in a hematogenic way can cause the development of sinusitis, pyelonephritis, infectious myocarditis and even sepsis.
Preventive dental examination does not always reveal granuloma, especially with its small size and the absence of any manifestations. It is possible to suspect dental granuloma in the presence of clinical symptoms indicating its proliferation or suppuration. An accurate diagnosis can be made by an X-ray of the tooth, on which a limited rounded area of darkening is revealed in the area of the tip of the tooth. Radiovisiography also allows you to diagnose dental granuloma.
Treatment and prevention
Despite the fact that today there are several effective ways to treat dental granuloma, it is not always possible to save a tooth. The choice between conservative and operative treatment methods is based on the assessment of the size of the dental granuloma, the condition of the tooth tissues, the presence / absence of complications, the existing plan of prosthetics or implantation.
Conservative methods of treatment of dental granuloma consist in filling its cavity with various filling materials injected through the root canal. To eliminate the infection, antibiotic therapy is performed.
Surgical treatment of dental granuloma until recently consisted only of tooth extraction. To date, it is possible to carry out more gentle operations, consisting in resection of the root tip or hemisection of the tooth. With the development of odontogenic periostitis or parotid abscess, it is opened and drained.
It is not possible to preserve the tooth in cases when dental granuloma is accompanied by a vertical crack of the root, obstruction of root canals, multiple perforations of the root of considerable size, pronounced destruction of the tooth, which is prognostically unfavorable for its restoration.
Prevention of dental garnuloma consists in passing regular preventive examinations and professional oral hygiene; timely treatment to the dentist in case of any symptoms from the dental system and treatment of diseases that can cause the development of granuloma (pulpitis, periodontitis).