Description, Causes and Risk Factors:
A proliferation of granulation tissue surrounding the apex of a nonvital tooth and arising in response to pulpal necrosis.
A periapical granuloma is a relatively common lesion or growth that develops around the tip of the tooth's root. It consists of a proliferating mass of granulation tissue and bacteria that forms in response to dead tissue in the pulp chamber of the tooth. The death of pulp may be due to extensive decay, deep restorations, or trauma to the tooth. The formulation of a periapical granuloma represents the body's attempt to heal and wall off an infection. Normally, periapical granuloma resolve after the source of infection is removed, but residual periapical granuloma may persist even after the offending tooth is extracted unless the tissue is carefully removed at the same time.
Periapical granuloma enlarge slowly and can grow to reach several centimeters in diameter. Smaller lesions (a few millimeter in diameter) do not have clearly defined borders and can be difficult to identify. Larger lesions, however, have well defined borders and are often surrounded by bundles of collagen, a gelatin-like substance, making them identifiable on an x-ray. As the granuloma enlarge, they do not cause the affected area to expand, but they can cause bone loss around the root tips. Unless a secondary infection develops, there are no other symptoms associated with periapical granuloma.
It allowed to progress, periapical granuloma may develop into radicular cysts. In addition, they can develop a secondary infection which results in an acute or chronic abscess, causing extreme pain. Besides pain, an untreated abscess may result in spreading of the infection into the surrounding soft tissue, the jaw bone, or elsewhere in the body, creating a much more serious situation.
Usually, the periapical granuloma is asymptomatic, but a secondary infection can cause pain. On radiographs, it appears a radiolucency (dark area) around the apex of a tooth's root.
Radiographically it is virtually impossible to differentiate granuloma from a cyst. If the lesion is large it is more likely to be a cyst. Radiographically both granuloma and cyst appear radiolucent, associated with the apex of non vital tooth.Radicular cysts are round or ovoid radiolucent areas surrounded by a narrow radio-opaque margin, which extends from lamina dura of involved tooth. In infected or rapidly enlarging cysts, radio-opaque margins may not be seen. Root resorption is rare but may occur.
The treatment often includes removal of the infected portions of the tooth pulp by performing root canal therapy. If we cannot remove the infection with root canal therapy, the affected body may need to be extracted. The antibiotics need to be prescribed to fight the infection.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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