Dental granuloma is a limited inflammation of periodontal, which is a small rounded formation located in the area of dental root. It is characterized with a long asymptomatic course. Under the influence of various provoking factors, dental granuloma becomes aggravated with emergence of a vivid clinical picture of acute inflammatory process: severe pain in the tooth, swelling and reddening of the gums.
Diagnosis of a dental granuloma is carried out mainly by radiographic imaging of the affected area or on the basis of visuographic. Therapeutic tactics can be both conservative and operational. The choice of method of treatment depends on the size of granuloma, degree of root destruction and presence of complications.
So, here in this article we are going to consider on the following points:
Tooth granuloma may have a different location in the tooth root, but most often granulomas occur in apex of the tooth root. The latent flow of dental granuloma carries a certain danger, because it does not allow diagnosing and treating the disease in time. In connection with this there are some cases in dentistry where granuloma is detected already in a neglected state. But it, in spite of its small size, can become a source of number of serious complications.
Most often, formation of dental granuloma is a complication of pulpitis and is caused by spread of infectious process from inflamed nerve that goes through the root of tooth. The second cause of dental granuloma may be inflammation of surrounding tissues of the tooth – periodontitis. Fracture of tooth and other injuries are a source of infection and can also lead to the development of dental granuloma. The cause of infection may not be compliance with the rules of asepsis and antiseptics when removing tooth pulp or treating nerve canals.
Factors that provoke development of acute clinical appearance of dental granuloma include hypothermia, colds, stressful situations, a sharp climate change, physical stress and pressure.
Dental granuloma is a limited inflammatory formation having a thin wall. In the area of granuloma, there is an intensive growth of granulation tissue, which replaces dead cells as a result of inflammatory process. This growth causes a gradual increase in granuloma size. While tooth granuloma does not reach significant dimensions, its existence may not be noticeable to a patient and even to a dentist. Often a detection of such granulomas occurs only when X-ray of the tooth or orthopantomogram. When granuloma increases in size, pain and swelling of the gums appear.
Suppuration of a dental granuloma is possible. In such cases, acute toothache, swelling and redness of the gums occur. There is a darkening of the tooth. Appearance of purulent discharge is possible between a tooth and gum. Suppuration of dental granuloma may be accompanied by the development of odontogenic periostitis (flux). It is possible that body temperature is raised and the patient’s general condition is disturbed: headache, malaise, etc.
With a chronic asymptomatic course, the tooth granuloma can be transformed into a maxillary cyst. There is its delimitation from surrounding tissues with the formation of a dense capsule, inside of which are necrotic masses and dead bacteria.
The growth of the dental granuloma can be accompanied by destruction of the tooth root in the area of its apex, which in turn can lead to tooth loss. The spread of inflammatory process from granuloma to surrounding soft tissues can cause formation of a limited abscess – a parathleteal abscess or development of diffuse purulent lesions – phlegmon. Involvement of bone in the process leads to osteomyelitis of the jaw.
Since the dental granuloma is a chronic focus of infection, it’s possible that complications go far beyond limits of dentistry. The spread of infectious agents by hematogenous way can cause development of sinusitis, pyelonephritis, infectious myocarditis and even sepsis.
Preventative dental examination does not always allow revealing granuloma, especially with its small size and absence of any clear appearance. To suspect a dental granuloma it is possible at presence of clinical signs testifying to its sprawl or suppuration. To make a correct diagnosis, an X-ray photograph of the tooth is recommended, on which a limited rounded area of darkness is revealed in around apex of the tooth. Radiovisiography also makes it possible to diagnose dental granuloma.
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 methods of treatment is carried out on the basis of an assessment of the size of the dental granuloma, state of the tooth tissues, the presence / absence of complications, existing plan for prosthetics or implantation.
Conservative methods of treatment of a dental granuloma are in filling its cavity with various filling materials introduced through the root canal. To eliminate infection, antibiotic therapy is carried out.
Surgical treatment of dental granuloma until recently consisted only in the removal of the tooth. Today, it is possible to carry out more caring operations, consisting of resection of the apex of the root or hemisection of the tooth. With the development of odontogenic periostitis or perimaxillary abscess, it is opened and drained.
To save a tooth is not possible in cases when tooth granuloma is accompanied by a vertical root crack, obstruction of root canals, multiple root perforations of considerable size, visible tooth destruction, which is prognostically unfavorable for its restoration.
Prevention of dental granuloma consists of regular preventive examinations and professional hygiene of the oral cavity; timely visits to dentist if there are any symptoms from the tooth-jaw system and treatment of diseases that can cause development of granuloma (pulpitis, periodontitis).