Periapical abscess is an accumulation of pus in a confined space in the region of the apical third of the root of the tooth.
With the development of a purulent-inflammatory process in the area of a painful tooth, patients note:
- a constant pain of blunt character;
- increased pain when eating and chewing food.
During the examination of the mucosa in the oral cavity, the development of the abscess is indicated by its hyperemia and edema, which, in the absence of treatment, is supplemented by fluctuations. Performing vertical percussion gives a positive result. To confirm the diagnosis, the doctor can refer the patient to an additional examination - radiography.
The primary goal of the therapy is to alleviate the condition of the patient. To do this, it is necessary to create an outflow of pus from the abscess cavity, and then purify the affected root canals with the subsequent restoration of the integrity of the affected bone and periapical tissues.
In most clinical cases, this pathology is detected in young people.
Contents
Periapical abscess almost always occurs as a complication in chronic periodontal disease, when in the regioninflammation gets infected. Microorganisms that most often provoke inflammatory changes in periodontitis are identified: - anaerobic rods;
- peptostreptococci;
- Prevotella Intermedia.
Because of the anatomical features of the face structure, the area of the lesion is severely limited, and the first signs of 
formation appear early enough. Seasonality is marked - autumn-spring period.
The formation of periapical abscess is possible due to the spread of infection in the canals of the tooth with the development of acute periodontitis or exacerbation of a destructive tooth disease - caries. Other reasons for the development of pathology are:
- jaw injuries, combined with a violation of the integrity of the neurovascular bundle;
- overheating of pulp when preparing teeth for prosthetics;
- is a destructive effect on the pulp tissue of photopolymer materials.
A periapical abscess may occur if the procedure of endodontic treatment or incomplete filling of the channels during the installation of a permanent seal fails.
The following conditions predispose to the development of the disease that depress immunity:
- frequent hypothermia;
- various infectious diseases.
With weak resistance of the human body, even a conditionally pathogenic flora can lead to the development of an inflammatory disease in the periapical tissue area. Immediately after the penetration of microorganisms into the root of the tooth begins the process of infiltration of the walls of the root canal by bacteria and the products of their vital activity. This negative effect results in damage to the root part of the tooth and periodontal disease.
On the introduction of infection the body reacts with an inflammatory process, leukocytes are sent to the lesion area. Emerging macrophages are necessary for the activation of the complement system, which allows us to recognize bacteria as antigens and to develop antibodies capable of destroying them. Because of the evolving "battle", blood cells accumulate in the area of the lesion, which disrupts the circulation of blood through the vessels-a slowdown. And this leads to an increase in vascular permeability and the development of edema.
As the bacteria and blood cells are destroyed in the affected area, the concentration of lysosomal enzymes provoking the activity of osteoclasts increases, which is accompanied by the destruction of the periodontal and tissues surrounding the affected area. Infiltration of leukocytes causes the formation of small ulcers prone to fusion, which ultimately leads to the formation of an abscess.
In the last stage of periodontitis development there is a breakthrough of soft tissues and the formation of an abscess
Three-dimensional model of the process of abscess formation:
Varieties of cavities
Periapical abscess is acute and chronic, with a fistulous entry and without a cavity in the tissues.
Acute flow is accompanied by a transcannular bacterial contamination in the periodontal tissue and is accompanied by a clear symptomatology.
In chronic form, due to a protracted process, germination of the granulation tissue is noted in the bone marrow and mucosal spaces. It is possible to form an abscess with other areas of the face:
- skin surface;
- with maxillary sinuses;
- by the nasal cavity;
- the oral cavity.
Features of the clinical picture
The development of the periapical abscess causes complaints about a fairly intense, dull, pulsating tenderness in the area of the lesion. Pain is intensified during meals.
When the inflammatory process occurs, there is a change in the shape of the face due to swelling of the soft tissues. With the development of the pathological process in the upper jaw area, there are no abnormalities when opening the mouth. Also, there may be inflammation of the masticatory muscles, and if the abscess is located in the area of the wisdom teeth, this can lead to the formation of a contracture.
Patients at the same time complain about problems with opening the mouth and the presence of pain when swallowing. If the adequate treatment is not performed in a timely manner, the acute form becomes chronic.
When examining the oral cavity on the mucosa over the focus of inflammation, a swelling is revealed, which is painful when touched. The symptom of fluctuation and positive vertical percussion is revealed. The most frequent localization of the focus of inflammation is the buccal side of the alveolar process. When the periodontal disease in the area of the palatine canals, second premolars and molars, the abscess forms in the sky.
At the same time, a carious lesion can be detected on the affected tooth or a seal can be inserted. The affected tooth changes color, more often it acquires a gray shade.
With inflammation in the oral cavity, there is an increase in regional lymph nodes. Deterioration of general condition is noted. There are complaints of general malaise, headaches and hyperthermia. If a fistula is formed, then the symptomatology of the pathology is erased, and with an objective examination, the presence of a cavity with granulations is noted.
Diagnosis: methods and criteria
When diagnosed, the physician takes into account existing complaints, a history of the disease, objective examination data and the findings of additional investigation of the affected area:
- radiography;
- EDI;
- thermography.
Periapical tissues with a fistulous entrance
During the examination, the dentist can easily determine the existing asymmetry of the face due to swelling. Mucous over the focus is red and painful, fluctuations are possible. The causative tooth is more often almost completely destroyed, less often restored or covered with a crown.
With carious lesions of the tooth, sounding is painless. If the pulp is opened, then probing in the root canal reveals the mass of the paste or filling material. Often non-viable pulp communicates with the carious cavity.
On the roentgenogram in the case of an exacerbation there is an expansion of the gap in the periodontium in conjunction with the site of destruction of bones in contact with the affected area. When performing the aiming X-ray in the area of the lesion, a lesion focus with uneven edges is revealed, and the horses of the affected tooth may be washed out.
When carrying out differential diagnosis, pathology is compared with periodontitis, abscess with other localization, periostitis, osteomyelitis and other inflammatory diseases of the jaw.
The following specialists can perform the examination:
- dentist-therapist;
- is a dental surgeon.
How is the
treated? After the diagnosis, the doctor produces an outflow of accumulated pus in the area of inflammation. The outflow can be created at the mouths of the canals in the tooth, followed by their cleaning with tools and medications. Throughout the treatment the tooth does not close.
After the procedure, the patient is recommended to rinse the mouth with saline solutions, make hyperosmotic baths, and also take antibiotics.
After the inflammation is reduced, temporary fillings are established in the cavity. If the treatment was conducted qualitatively, and the patient complied with all the medical recommendations, then after removing the temporary seal, a constant is established in its place. But before its installation, it is absolutely necessary to perform an X-ray sighting.
In the case of chronic form of the disease, local treatment uses aseptic bandages with antibiotic and hormonal preparation, calcium containing pastes and gutta percha pins. Orally administered antibiotics, NSAIDs.
Draining is carried out by creating an outflow through the soft tissues.
With a favorable course, the focus of inflammation is completely eliminated. If conducted conservative therapy has not given effect, then it is recommended to perform dental-preserving operations. If the course of inflammation is characterized only by the increase in symptoms, the tooth must be removed.
To achieve positive dynamics, all medical recommendations must be followed exactly.
formation appear early enough. Seasonality is marked - autumn-spring period. In the last stage of periodontitis development there is a breakthrough of soft tissues and the formation of an abscess
Patients at the same time complain about problems with opening the mouth and the presence of pain when swallowing. If the adequate treatment is not performed in a timely manner, the acute form becomes chronic. Periapical tissues with a fistulous entrance
After the inflammation is reduced, temporary fillings are established in the cavity. If the treatment was conducted qualitatively, and the patient complied with all the medical recommendations, then after removing the temporary seal, a constant is established in its place. But before its installation, it is absolutely necessary to perform an X-ray sighting.