Dental or apical granuloma

What is a dental or apical granuloma?
Apical granulomas are bacterial infections in the upper or lower jawbone. They arise at the tip of a tooth root and consist of granulated tissue surrounded by a fibrous capsule.

Periapical granuloma, root cyst and periapical abscess

The most common dental diseases are inflammatory injuries of the pulp (pulp) and periapical areas.

If inflammation (pulpitis) spreads from the tooth pulp, it can provoke many pathological changes at the root of the tooth. The most common are periapical granulomas, root cysts and periapical abscesses.

Various factors (such as host resistance and virulence of bacteria) can influence the local inflammatory response in the periapical region. Without microscopic diagnosis, a doctor often cannot distinguish between a periapical granuloma, a root cyst and a periapical abscess.
The examination by X-ray is insufficient for a specific diagnosis.

Periapical inflammatory injuries have common clinical features:
1) history of painful pulpitis, which leads to the death of the pulp.
2) Lack of response to electrical tests on the pulp.
3) Presence of deep caries through which the pulp is exposed, reconstruction near the pulp, a broken tooth and/or a broken crown with color change.
4) A destruction that causes an interruption of the hard tooth layer.


What are the causes of dental granuloma?

  • Granulomas are caused by tooth decay that has not been treated in time. At this point, bacteria can penetrate to the tooth nerve.
    If the bacteria enter the nerve, it can be damaged.
    One of the consequences is pulpitis, but inflammation or granuloma can also occur.
  • Other causes may include trauma, tooth extraction, periodontitis and chemical substances.
  • The formation of a dental granulomacan arise as a complication of a devitalized tooth.

What are the symptoms of granuloma?

It must be borne in mind that in many cases the granuloma is asymptomatic, since there is a balance between the granulocytes (white blood cells) and the bacteria.
Only if there are too many bacteria or festering material inside a tooth, you feel toothache.
The symptoms are not always obvious, since sometimes apical granuloma (infection in the area of the bone located near the upper section of the teeth) does not cause any symptoms and can only be “detected” by an X-ray.
In certain cases, an apical granuloma can cause hives (urticaria) and fever.
Also, enlarged cervical lymph nodes due to the infection can be observed.
In the blood test, ASLO (antibodies to streptolysin O) and ESR (erythrocyte sedimentation reaction) are increased.

What to do? What therapies are available for apical granuloma?

The therapy includes the treatment of the tooth root canal and provides for the cleaning and complete removal of the bacteria from the tooth.
If the granulomas prevent the healing of the tooth root canal, the only solution remains surgical intervention.
In some cases, this can lead to root tip resection (removal of a tooth root tip), in more complicated cases even to tooth extraction.
After the tooth has been extracted, the dentist can insert an implant.
There are no natural treatments or remedies for treating apical granuloma.

What techniques are used for granuloma removal?

There are three techniques: modification of the root canal, removal of the old filling material from the root canal, internal cleaning of the tooth and sterilization of the affected area.
The modification of the root canal can not be applied in all cases.

Root tip resection – The surgical removal of the tip of the tooth root and the pathological process (granuloma or cyst). Root resection is not a one-size-fits-all solution for all patients.

Tooth extraction – The dentist must extract the tooth if the two methods mentioned are not applicable.
Tooth extraction is a safe way to treat the problem. However, it should also be the last option.

Oral pyogenic granuloma

Oral pyogenic granuloma is the name of an oral disease. The term pyogenic granuloma is a misnomer because the disease does not cause pus formation and is not related to the granuloma.
In reality, this pathology is an inflammatory reaction that occurs due to irritation or trauma.
Oral pyogenic granuloma is essentially an oral disease, but it can occur in any area of the skin, nasal septum, limbs, and sometimes thighs.

A granuloma may bleed on its own or due to mild trauma.
It can occur in children and adolescents.
Women are affected more often than men.

What is an oral pyogenic granuloma?
This inflammatory hyperplasia causes a growth of nodules on the oral mucosa.
The nodules resemble tumors and are traced back to non-neoplastic origin.

An oral pyogenic granuloma is a condition that is due to different stimuli, such as local irritation, injury, and even hormonal factors.
Usually you see it in young women whose bodies undergo hormonal changes.

They are common in pregnant women and therefore this disease must necessarily be treated.
The nodules or lesions can occur at any time during pregnancy and appear primarily towards the end of the last trimester of pregnancy.
Most often, an oral pyogenic granuloma forms on the gums.
Sometimes it also appears on the inside and outside of the cheeks, on the tongue or on the upper jaw.

What are the causes of pyogenic granuloma?
Oral pyogenic granuloma is due to irritation of oral tissues. It can also arise due to physical trauma, hormonal change, and poor oral hygiene.
People suffering from tartar, protruding dentures, etc. can develop this inflammatory hyperplasia.

What are the symptoms of pyogenic granuloma?
These pregnancy tumors feel very soft and have a reddish-purple color.
It is harmless injuries that cause swelling on the gums.
These swellings ulcerate and are no larger than 2 cm. They are usually painless and cause pain only under pressure.

How is pyogenic granuloma treated? Therapy
In pregnancy, the pyogenic granuloma dries out and heals on its own. There is no treatment during pregnancy; however, it may be
necessary with repeated bleeding by removal or cauterization of the injury The disease is successfully treated by:

  • Conservative surgery
  • Cleaning and dental hygiene
  • Removal of tartar and appropriate cleaning of the area

Granulomas are always benign, but early detection and diagnosis help rule out the possibility of cancer.
A biopsy makes it possible to determine the treatment strategy.
Treatment options include removing the injury with a curette and cauterizing the area to prevent recurrence.

Sometimes doctors perform anesthesia to clean the area, some use chemical substances such as tricyclic antidepressants, podophyllin, silver nitrate or phenol.
Today, laser surgery is also used as a therapy.
Vascular lesions are polypoidal or exophytic and can sometimes degenerate malignantly, requiring surgery.
Surgical removal helps, but cannot completely prevent the possibility of recurrence.
The condition is essentially asymptomatic, with the exception of mild local pain and bleeding.

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