Treatment of root inflammation
introduction
Tooth root inflammation generally affects the tip of the tooth (apex) and is therefore also called root tip inflammation (apical Periodontitis).
It is usually treated with a root canal treatment. This can also be repeated if symptoms persist. One then speaks of a revision of the root treatment. If there is no improvement in the inflammation after the revision, a new revision makes no sense either.
In this case, a root resection may have to be performed. The inflamed root tip is removed in a surgical procedure, whereby the remaining tooth is preserved.
also read: Revision of a root canal treatment
Figure root inflammation
- Tooth enamel -
Enamelum - Dentin (= dentine) -
Dentinum - Tooth pulp in the tooth cavity -
Pulp dentis in Cavitas dentis - Gums -
Gingiva - Cement -
Cementum - Root skin -
Periodontium - Alveolar bone (tooth-bearing
Part of the jawbone) -
Pars alveolaris - Opening of the tooth root tip -
Foramen apicale dentis - Blood vessels
- Nerve fibers
Root inflammation -
Pulpitis
a - dental caries -
Caries dentium
b - gingivitis -
Gingivitis
c - Entz. of the tooth support system -
Periodontal disease
d - Entz. at the root tip -
Apical ostitis
You can find an overview of all Dr-Gumpert images at: medical illustrations
therapy
Root filling
The therapy of a tooth root inflammation consists primarily of an ordinary root canal treatment. If necessary, the dentist will first numb the affected tooth and then drill it open.
In the course of this, he will remove carious defects, if any, and provide access to the pulp and the nerve fibers embedded in it.
In the past, a so-called coffer dam was laid before the actual treatment. This means that a metal clamp with a rubber band is attached to the tooth to be treated. The cofferdam serves to shield the tooth so that no saliva and bacteria contained in it can get into the tooth.
However, the attachment of the cofferdam is very uncomfortable.
For this reason, more and more people are resorting to a relative drying of the tooth to be treated. The tooth is only protected by cotton rolls and by sucking off the saliva. The preparation of the tooth is so painless, but there is a greater risk of saliva getting into the root canals.
The dentist will then remove the pulp, including the nerve fibers located in it, from the tooth root.
This is achieved with the help of root files of different lengths and thicknesses (Reamer, Hedstrom or K-files). The root is now processed, i.e. hollowed out and freed from dead and / or inflamed tissue. A disinfecting alternating rinse with different solutions is then carried out.
Read more on the topic: Root canal treatment
The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite.
The further course of the root treatment depends on the condition of the tooth. If the tooth roots are less inflamed, the root can usually be filled in the same session. If the tooth is severely inflamed, in most cases the dentist will first apply an antibacterial, anti-inflammatory drug to the root and then leave the tooth for a few days (3-5 days) let rest.
As soon as the tooth root inflammation subsided and the root canal is dry, it is filled with so-called gutta-percha points and a density cement. An X-ray control image is now used to check whether the root reaches the tip (apex) is filled and the tooth is then closed.
If the root inflammation occurs in teeth that are already filled with roots, more extensive therapy is necessary. This can happen, for example, with very crooked or not completely drained tooth roots. The attending dentist will likely perform a so-called apicectomy or remove the existing root canal filling and reprocess and fill the tooth.
Read more on the topic: Root canal treatment procedure
Apical resection
In the case of apicectomy (Apectomy) the tip of the root of an inflamed tooth is removed.
This is a surgical procedure that should be performed by a dental surgeon. The removal of the tooth root may be necessary in the course of a tooth root inflammation if the attempt to preserve the tooth by means of a root canal treatment has failed.
The prospect of saving the tooth with such a root tip resection is 90 - 97%.
Read more on the topic: Procedure for a root tip resection
During the operation, the gum in the area of the diseased tooth is opened, after which the surgeon will open the jawbone with the help of a so-called ball burr (Osteotomy). This gives the doctor a good overview of the tissue to be treated and can cut off and remove the inflamed tooth root tip.
A so-called retrograde root filling is then carried out. Retrograde means that the root canals are not filled starting from the tooth crown, as is usual.
The gutta-percha points are introduced starting from the severed root tip. This has the advantage that the root filling begins exactly at the end of the tooth roots.
The jaw must then be closed again, for this 2 - 3 stitches are sewn. The nerves can be damaged during a surgical root tip resection, which manifests itself in the patient's loss of sensitivity in the area of the lip (numbness).
In addition, as with any operation, bleeding and / or wound healing disorders can occur. The patient is therefore urgently advised to refrain from consuming alcohol and nicotine after the operation.
For more information on this topic, see: Root Resection
Treatment of severe pain
With tooth root inflammation, the pain can become so acute and intense that the only option is to remove the inflamed tissue from the pulp. The dentist numbs the tooth, drills a hole in it and manually removes the nerve from the root canal with hand files. This treatment can still cause pain, as inflamed tissue is difficult to numb. In the case of inflammation, the pH of the gums is acidic and the anesthetic cannot work well in this environment, which can lead to pain during the treatment.
Even if the nerve has been completely removed from the inside of the tooth, the patient may still feel pain during the following root canal treatment. When treating the root canals, the length is measured and the tooth is prepared to this length. If the practitioner comes to the measured end of the root tip, it may well be that the patient feels this as an uncomfortable pulling.
Although the nerve tissue has been removed from the inside of the canal, there may still be nerve tissue directly below the tip of the root that is intact and causes discomfort to the person affected by the slightest irritation. In this case it is necessary to numb the tooth. Anesthesia directly into the root canal would make sense, as it does not cause the patient to suffer from long-term numbness of the cheek and lip, but only anesthetizes the nerve tissue locally. This form of anesthesia is often completely sufficient for the treatment.
Read more on the topic: Pain at the root of the tooth
Antibiotics for tooth root inflammation
In the treatment of a tooth root inflammation, the supportive drug administration of an antibiotic is definitely debatable, but in which case does it make sense?
Acute tooth root inflammation, which is symptomatically accompanied by an accumulation of pus or a developed abscess, is almost always treated with an antibiotic.
In the case of an abscess, there is a risk that this swollen, encapsulated accumulation of pus will spread to the surrounding vessels and thus enter the cardiovascular system. To prevent the bacteria from reaching the heart and damaging it, it makes sense to give the antibiotic to kill them as quickly as possible.
Read more about this under Abscess on the tooth.
Furthermore, an antibiotic should be prescribed if you have a weakened immune system as well as previous diseases of the heart and primarily the heart valves (please refer: Valvular heart disease).
But which class of antibiotics is best suited here? Antibiotics can be roughly classified according to their mode of action. All subgroups fight bacteria, but one group only prevents the microorganisms from multiplying, they are called bacteriostatic, while the other, the bactericidal antibiotics, inhibits the cell wall growth of the bacteria and thus actively destroys them.
Antibiotics that have been tried and tested for tooth root inflammation are mainly aminopenicillins, which belong to the bactericidal antibiotics and belong to the penicillin class. The aminopenicillins include, for example, amoxicillin and ampicillin. These are broad spectrum antibiotics, which means that many different bacteria are combated at the same time. Since one does not test beforehand which bacterium is individually responsible for the inflammation, the aminopenicillins have proven to be the most important antibiotic in the treatment of tooth root inflammation.
Read more on the subject below Antibiotics for tooth root inflammation.
Antibiotic side effects
However, as with any antibiotic therapy, there are some side effects that can occur. It is possible that the intestinal bacteria that are “good” for the human body are also destroyed by the antibiotic, causing diarrhea and digestive problems. Overdosing can cause seizures, which is why the exact dosage must be strictly adhered to.
Furthermore, a relevant part of the population is allergic to penicillins and administration of one of these subspecies can lead to an allergic shock, which can be life-threatening. In order to avoid this so-called anaphylactic shock, all allergies must be stated in the doctor-patient conversation. If new ones are added, the dentist must be informed immediately. In the case of allergic patients, the dentist must order a replacement preparation.
Clindamycin is often used for this. Clindamycin is one of the bacteriostatic Antibiotics and inhibits the reproduction of bacteria, but does not kill them. It is effective against the bacteria that cause root inflammation and has proven itself as a substitute preparation for infections in the tooth and jaw area. But clindamycin also causes nausea, vomiting and diarrhea more often by weakening the intestinal bacteria and can rarely lead to liver damage.
Despite these side effects, the dentist has to weigh up whether the surgical treatment or the root canal treatment alone is sufficient to kill the bacteria, or whether there is a risk that the bacteria could quickly attack the cardiovascular system and thus lead to severe heart damage. It is extremely important that the patient strictly and conscientiously adheres to the dosage in order to maintain the effectiveness of the antibiotic and to give intolerances and allergies no chance.
The so-called resistances often develop through premature discontinuation of the antibiotic or incorrect intake by the patient, as not all bacteria are destroyed in this way and the survivors can get used to the antibiotic, remain in the body and multiply. An antibiotic can therefore quickly relieve symptoms if taken correctly, but can also have bad consequences if taken incorrectly.
Read more on the subject below Side effects of antibiotics.
Home remedies for root inflammation
Home remedies are often the first place you can do something before going to see your doctor. Whether the best-known home remedy clove oil or others like rosemary leaves, all home remedies are suitable for local application, for rinsing the mouth or for chewing. Rubbing in the mucous membranes can relieve swelling and reduce redness.
Even so, these home remedies do not reach the actual location of the problem below the root tip. They can only soothe the gums from the outside and are therefore not advisable for treating tooth root inflammation on their own, as they do not fight the bacteria at the tip of the root. Nevertheless, the calming effect of clove oil and rosemary juice has been known for centuries and a supportive rubbing into the swollen, reddened gums can definitely alleviate the symptoms.
However, the use of home remedies should be discussed with the dentist so that the use of home remedies remains beneficial for optimal therapy and contributes to a quick recovery.
Read more on the subject below Home remedies for toothache
Homeopathy for tooth root inflammation
Homeopathy is gaining popularity these days and for some people it is the new all-purpose weapon against any kind of pain. Naturopathy is also often used to combat toothache caused by tooth root inflammation. But is homeopathy sufficient as the sole therapy to completely cure the disease?
The magic bullet in homeopathy are globules. The small granules are said to help against many diseases and are even safe for small children, which is why many mothers resort to them. Globules are made from cane sugar and put in a herbal tincture. In dried form, they can also help in the case of tooth root inflammation, counteracting the inflammatory process, relieving pain and reducing the swelling of the gums.
The globules can accelerate the healing process, but as the sole therapy cannot completely cure the tooth root inflammation, which is why root canal treatment is often unavoidable. In the case of tooth root inflammation, globules with a potency of D12, which stands for a medium-strength effect, are taken. Preparations such as Belladonna, Arnica montana or Apis mellifica are just a few examples of globules that are specifically used for tooth root inflammation.
Homeopathy can be credited with the fact that the immune system, which has been weakened by the disease, is treated with globules and the body regains full health more quickly. As a support for dental treatment, globules should definitely be considered, but the intake should be discussed with the dentist beforehand so that the dosage is also individually adjusted.
Read more on the subject below Homeopathy for toothache.
costs
If a nerve within the tooth is inflamed, the last option is often to remove it and perform a root canal treatment. In general, it can be said that the health insurance companies have a big part take over the root canal treatment. Even so, many dentists rate it extra costprovided that they use particularly modern mechanical processes. The modern methods of machine reprocessing are associated with higher chances of successful therapy, but optimal root filling is also possible using the classic manual therapy.
With modern machine technology, the use of the instruments used is much more expensive than the assumption of costs provided by the cash registers. In general, however, there are also services that are not taken over at all.
The electrical length measurement of the root canals, the use of electrophysical and chemical methods and the insertion of more than 3 medical insoles are not covered by health insurance. Also the Revision, i.e. the revision and removal of a not optimally manufactured root filling and subsequent renewal of this is a private service for many dentists.
For example, electrical length measurement is a treatment step that is only beneficial for the patient. If the classic variant is used, an X-ray must be made of the tooth to estimate the length. The modern length measurement is more precise and is gentle on the patient because it does not use harmful X-rays.
The dentist can bill privately for the services that are not covered by the health insurance fund. Most dentists charge an additional payment for each canal that is treated within a tooth. Patients have to come along 50-100 euros additional payment per channel calculate. The respective additional payment must be clarified with the dentist in advance and can vary from practice to practice. It is advisable to contractually determine the costs before the treatment, to be informed and clarified in advance, so that the respective additional payment is fully justified.
Symptoms
Probably the most important symptom of apical periodontitis is the pain in the affected tooth.
The attending dentist will tap the tooth before the therapy, because it is precisely then that the irritated tooth nerves react quite violently (tapping pain).
Theoretically, it is quite easy to localize the inflamed tooth, but in practice the whole thing is more difficult because the affected patients usually feel sensitive to knocking in two or three neighboring teeth.
In an emergency there is an X-ray (Dental film) Information about the tooth to be treated. Most dentists generally take an X-ray as soon as a patient with such severe toothache visits the practice.
In addition, there is pronounced bite pain (Pain when biting) a relatively clear indication of the presence of an inflamed tooth root.
If there is deep caries of the tooth and the vitality test, i.e. the reaction to being cold, is negative, this is also a clear sign of apical periodontitis.
But it is also possible that tooth pulp inflammation (Pulpitis) in combination with a tooth root inflammation (apical periodontal disease) occurs, in this case the vitality test will be positive. The result of the vitality test should therefore be consumed with caution; it alone cannot provide any information about the treatment measures to be selected.
