Teeth are composed of a hard outer structure useful during chewing and a soft tissue on the interior that builds the tooth during its early development. This soft tissue has no vital function in maintaining the tooth after complete development. However, it is disease of this tissue that can cause a throbbing toothache during the middle of the night.
Definition
The dental pulp is the soft tissue on the inside of the tooth containing nerved, blood vessels and connective tissue, according to the American Association of Endodontists. The pulp exits the tooth through small holes at the tip of the root and possibly along the sides of the root. Tooth foramen is the name for one of these holes. The pulp becomes continuous with the periodontal ligament surrounding the root at the foramen. Apical periodontitis is inflammation of the periodontal ligament at this portal of entry for the pulp, according to the website Endodontic Topics.
Causes
Tooth decay, cracks, trauma and repeated dental procedures cause inflammation of the dental pulp, according to the University of Iowa College of Dentistry. Severe inflammation leads to necrosis or infection of the pulp. This infected tissue causes inflammation of the periodontal ligament surrounding the root. This apical periodontitis typically appears at the foramen at the tip of the root, but can also occur at foramina located anywhere along the root.
Symptoms
Pain from apical periodontitis is severe, persistent, spontaneous and localized to the diseased tooth, according to the American Academy of Family Physicians. Pain when chewing, redness and tenderness of the surrounding gum may exist. Temperature sensitivity can range from extreme in the case of an inflamed pulp to nonexistent in the infected pulp. According to the American Association of Endodontists, apical periodontitis may be present without any symptoms.
Diagnosis
A dentist uses several tests to diagnose apical periodontitis, including the examination of a dental X-ray. Apical periodontitis can demonstrate a reabsorption or dissolving of bone around the root on an X-ray, according to Endodontic Topics. Another possible radiographic change is a thickened periodontal ligament space around the root. A tooth with apical periodontitis is usually tender to percussion or tapping by a metal dental instrument, according to the American Academy of Family Physicians. A dentist will also perform thermal tests with ice and heat.
Treatment
The diseased dental pulp requires removal in order to treat an apical periodontitis. Root canal treatment or tooth removal are the two alternatives which accomplish this goal, according to the American Academy of Family Physicians. Antibiotics and pain medications can provide temporary relief from the symptoms, but do not remove the source of the problem. Without removal of the diseased pulp, the symptoms will eventually return.
Prevention/Solution
The key to preventing apical periodontitis is protecting the dental pulp. Meticulous oral hygiene and regular dental checkups help prevent the causes of pulp inflammation. Seeing a dentist at the onset of any sensitivity, pain or swelling can help prevent the progression of inflammation to infection and subsequent apical periodontitis.
