Caries, if not treated in time, can lead to a more serious inflammatory process in the mouth, namely inflammation of the tooth pulp (pulpitis). The pulp is the tissue that fills the tooth cavity and follows its shape.
A tooth granuloma 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 tooth root.
What are the causes of tooth granuloma, how to diagnose and treat it?
How granuloma occurs
If caries is left untreated, complications may occur. If the affected tooth suddenly stops hurting, it does not mean that the pain has ‘gone away’.
After a period of pain, the nerve contained in the tooth pulp is necroticised: 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 spreads to the alveolus, or jawbone. It is there that a granuloma is formed, which looks like a rounded formation resembling a pouch
The danger of granuloma is that it does not have symptoms for some time, but over time, when bacteria accumulate in it, it can cause severe pain, swelling and redness of the gums.
Tooth granuloma can be located in different places in the tooth root, but most often it occurs at the top of the tooth root.
Causes of tooth granuloma
Most often, the formation of a dental granuloma is a complication of pulpitis and is caused by the spread of the infectious process from the inflamed nerve passing through the tooth root.
Another cause of tooth granuloma can be inflammation of the surrounding tooth tissues – periodontitis.
A tooth fracture and other injuries can also lead to the development of a tooth granuloma.
The cause of infection may be non-compliance with the rules of asepsis and antisepsis during the removal of the tooth pulp, i.e. root canal treatment.
The factors, provoking the development of an acute clinical picture of dental granuloma include hypothermia, colds, stressful situations, sudden climate change, physical exertion and pressure.
Symptoms of tooth granuloma
A dental granuloma is a limited inflammatory formation with a thin wall. In the area of the granuloma, there is an intensive growth of granulation tissue, 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, a dental granuloma does not reach significant size, it can be invisible to the patient and even to the dentist.
In a chronic asymptomatic course, a dental granuloma can transform into a maxillary cyst. A dense capsule forms on the gum, inside which there are necrotic masses and dead bacteria.
Often, such granulomas are detected only during tooth X-ray.
When a granuloma grows in size, pain and swelling of the gums appear. There may also be suppuration darkening of the tooth . Purulent discharge may appear between the tooth and the gum.
The patient may also experience 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 may be accompanied by the development of odontogenic periostitis (flux). There may be an increase in body temperature and a violation of the patient’s general condition.
The growth of a tooth granuloma can lead to the destruction of the tooth root in the apex area, which can result in tooth loss. 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 a dental granuloma is a chronic focus of infection, it is possible that complications may go beyond dentistry. The spread of infectious pathogens by hematogenous means can cause the development of sinusitis, pyelonephritis, infectious myocarditis and even sepsis.
This can be avoided by treating the lesions on time.
Diagnostics
In many cases, a granuloma is detected on an X-ray, which shows a dark, usually rounded area of bone surrounding the root. A routine check-up may not always detect a granuloma, especially if it is small.
Also, radiovisiography makes it possible to diagnose a tooth granuloma, which involves the use of a special device – a radiovisiograph, which converts an X-ray image into a digital image and displays it on a monitor screen.
How is it treated?
Root canals treatment of the affected tooth helps to get rid of 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, the removal of a cyst is accompanied by the removal of the affected root apex (apicoectomy).
In case of odontogenic periostitis or a periosteal abscess, it is opened and drained.
Despite the fact that today there are several effective ways to treat a tooth granuloma, it is not always possible to save the tooth.
The choice between conservative and surgical methods of treatment is based on an assessment of the size of the tooth granuloma, the condition of the tooth tissue, the presence/absence of complications, etc.
Prevention
Prevention of granuloma formation is closely related to caries prevention: periodic dental examinations and X-rays are therefore the key to ensuring that granulomas never occur.