Caries that is not cured in time threatens with a more serious inflammatory process in the mouth, namely inflammation of the tooth pulp (pulpitis). The pulp is the tissue that fills the cavity of the tooth and repeats its shape.
Granuloma of the tooth is a complication that occurs as a result of caries or trauma, inflammation of the periodontium (a complex of tissues surrounding the tooth), which is a small rounded formation located in the area of the root of the tooth.
What are the causes of tooth granuloma, how is it diagnosed and treated?
How granuloma occurs
If tooth decay is not treated, complications may occur. If the affected tooth suddenly stops hurting, this does not mean that it has “passed”.
After a period of pain, the nerve contained in the pulp of the tooth is necrotized: the tooth no longer hurts, but the carious lesion remains.
The pulp is filled with bacteria that multiply and reach the tooth root.
As a result, the inflammation passes into the alveolus, that is, the jawbone.
It is there that a granuloma is formed, which looks like a rounded formation that resembles a bag.
The danger of granuloma is that it is not characterized by symptoms for some time, but over time, when bacteria accumulate in it, it can cause severe pain, swelling and redness of the gums.
Granuloma of the tooth can have different locations in the root of the tooth, but most often it occurs in the apex of the root of the tooth.
Causes of tooth granuloma
Most often, the formation of a dental granuloma is a complication of pulpitis and is caused by the spread of an infectious process from an inflamed nerve passing through the root of a tooth.
The second cause of tooth granuloma can be inflammation of the surrounding tissues of the tooth – periodontitis.
A tooth fracture and other injuries can also lead to the development of a dental granuloma.
The cause of infection may be non-compliance with the rules of asepsis and antiseptics during the removal of the tooth pulp, that is, the treatment of root canals.
Factors that provoke the development of an acute clinical picture of a tooth granuloma include hypothermia, a cold, stressful situations, a sudden change in climate, physical exertion, and pressure.
Symptoms of tooth granuloma
Dental granuloma is a limited inflammatory formation with a thin wall. Intensive growth of granulation tissue occurs in the area of the granuloma, which replaces the cells that have died as a result of the inflammatory process. This growth causes a gradual increase in the size of the granuloma. However, the granuloma of the tooth does not reach significant sizes, it can be invisible to the patient and even to the dentist.
With a chronic, asymptomatic course, a dental granuloma can transform into a maxillary cyst. A dense capsule is formed on the gums, inside which there are necrotic masses and dead bacteria.
Such granulomas are often detected only during dental x-rays.
When the granuloma increases in size, pain and swelling of the gums appear. Suppuration and darkening of the tooth are also possible. Purulent secretions may appear between the tooth and the gums.
Also, the patient may have a feeling that the tooth has increased in size and discomfort when touching the tooth crown while chewing solid food.
Suppuration of a tooth granuloma can be accompanied by the development of odontogenic periostitis (flux). An increase in body temperature and a violation of the patient’s general condition are possible.
The growth of a tooth granuloma can lead to the destruction of the root of the tooth in the area of the apex, as a result of which the tooth can be lost. The spread of the inflammatory process from the granuloma to the surrounding soft tissues can lead to the formation of a limited abscess or the development of a spilled purulent lesion – phlegmon.
Involvement of the bone in the process leads to osteomyelitis of the jaw (purulent, infectious and inflammatory process). Since dental granuloma is a chronic source of infection, it is possible that complications may go beyond dentistry. The spread of infectious agents by the hematogenous route can cause the development of sinusitis, pyelonephritis, infectious myocarditis, and even sepsis.
This can be avoided if the lesions are treated in time.
Diagnostics
In many cases, a granuloma is detected on an X-ray, which shows a dark, usually round area of bone surrounding the root. A preventive examination does not always reveal a granuloma, especially if it is small in size.
Radiovisiography, which consists in the use of a special device — a radiovisiograph, which converts an X-ray image into a digital one and displays it on a monitor screen — also makes it possible to diagnose a tooth granuloma.
How is it treated?
Treatment of the root canals of the affected tooth helps to get rid of the granuloma.
If left untreated, a granuloma can grow to a noticeable size and turn into a cyst, a benign lesion that often requires surgery to remove. Often, cyst removal is accompanied by removal of the affected root tip (apicoectomy).
When odontogenic periostitis or perimaxillary abscess develops, it is opened and drained.
Despite the fact that today there are several effective methods of treating tooth granuloma, it is not always possible to save the tooth.
The choice between conservative and operative methods of treatment is made based on the assessment of the size of the tooth granuloma, the condition of the tooth tissues, the presence/absence of complications, etc.
Prevention
The prevention of granuloma formation is closely related to the prevention of caries: thus, periodic dental examinations and X-rays are a guarantee that granuloma never occurs.