Periapical Is a pathology

July 15, 2011 - PRLog -- Periapical disease is limited to the apical cementum, apical periodontal ligament and alveolar bone around the periapical tissue and other diseases.

Periapical pathological cause

1 infection

Periapical disease, the most common infections from dental pulp disease, followed by periodontal disease by apical, side of the root canal and vice and secondary dentin tubules, blood-borne infections are relatively rare.

Modern view, periapical disease, a major pathogen infection as the main anaerobic bacteria are mixed infections, Bacteroides melanin production of acute periapical major pathogens. Bacterial endotoxin is a cause of chronic periapical inflammatory cytokines, periapical granuloma is a major factor.

2 trauma

Teeth subjected to external forces, such as strikes, collisions, falls, etc., can cause dental hard tissue, periodontal and periapical tissue damage.

Biting hard objects, such as rice bite the sand, walnut bite, bite-bottles, etc., can lead to traumatic occlusion periapical damage.

3 tumor

Spread damage to the periapical tumor squamous cell carcinoma, lung cancer and breast cancer metastasis, jaw sarcoma, myeloma, and ameloblastoma.

4. Odontogenic factors

Pulp and root canal sealing drug overdose, piercing the apical root canal instruments, orthodontic force properly, rapid separation of the teeth, tooth extraction can accidentally hurt the adjacent teeth and other injuries caused by sharp-week.

Clinical manifestations of periapical disease

(A) acute periapical (Acute apical periodontitis)

Acute periapical anatomical characteristics of periapical exudate accumulation, transformation and diffusion or absorption, in addition to some of the trauma caused the acute periapical inflammation, the pulp is necrotic and more. By inflammation in the development Process can be divided into

1. Acute serous periapical (acute serous apical periodontitis)

Early apical periodontal membrane hyperemia, vasodilatation, plasma exudation, edema and inflammatory cell infiltration. At this point the pressure due to apical migration of the teeth out, the patient feels teeth, elongation, early contact with the teeth, bite discomfort or slight pain, bite, teeth clenched hard pushed when the blood due to the surrounding apical temporarily alleviate symptoms. At this time, the apical cementum and alveolar bone did not change significantly.

With the development of disease, blood sedimentation increased tissue edema, vascular bleeding, to periapical film chamber pressure was significantly higher sense of teeth increased elongation, slightly loose, not on the bite, and a persistent spontaneous pain, to locate. Inspection percussion pain, mild apical gingival swelling, tenderness.

2. Acute suppurative periapical (acute suppurative apical periodontitis)

By acute serous periapical continue to develop from, but also by acute exacerbation of chronic periapical caused. Performance of the periapical periodontal ligament damage dissolved, the accumulation of pus, abscess surrounded by a significant infiltration of inflammatory cells and bone resorption. It is also known as acute apical abscess or acute alveolar abscess.

Apical accumulation of pus in the common area along the resistance of the discharge, drainage channels are:

(1) pus into the canal through the apical foramen, root canal if the open drainage channel, drainage is an ideal way.

(2) drainage of pus through the periodontal space. In this way a larger drainage resistance, and much of the periodontal tissue damage.

(3) pus by bone marrow proliferation, or even perforation of mandibular cortical plate to form a subperiosteal abscess, due to periosteal stripping and bone pain is very severe surface. If the periosteum is dissolved, then the formation of mucous membranes or subcutaneous abscess. After the formation of gingival ulceration or skin sinus sinus, chronic periapical disease.

As the root length and root anatomy of different parts, different drainage channels, formed parts have different sinus. Maxillary central incisor root of the alveolar process is very low and long, penetrating the nasal cavity at the end of pus; maxillary lateral apical side of the tongue often biased, pus can be worn palatal palatal bone plates and abscess formation; maxillary posterior teeth root and close to the bottom of the maxillary sinus, and sometimes pus can penetrate the maxillary sinus; maxillary molar palatal root abscess, subperiosteal even be extended to the soft palate back; and mandibular incisors can cause swelling of the chin; mandibular molar root is long, pus hyoid bone in the jaw muscle Reattachment, to the floor of the mouth soft tissue spread, causing severe cellulitis floor of the mouth, jaw osteomyelitis, even can lead to cavernous sinus thrombosis.

Pus into the marrow cavity, the pain is very severe, was persistent, throbbing, severe loosening of teeth, touch, call obvious pain, gingival and facial swelling, tenderness, swelling the root end, a sense of tooth elongation, did not dare to bite, headache, fever, irritability, suffering face, belongs to lymph nodes, tenderness. The formation of submucosal abscess, due to internal pressure to reduce jaw pain significantly reduced, but still significant soft tissue edema. If no incision and drainage, pus rupture on their own. From the beginning to the formation of submucosal inflammatory abscess about 3-5 days.
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