December 14, 2019
Dental pulp gets infected either due to tooth cavities or accidental exposure which leads to necrosis or death of the pulp. Persistent infection eventually causes inflammation and the person’s immune system walls it off with granulation tissue made of leukocytes, lymphocytes, capillaries, plasma cells and fibroblasts. The site gets surrounded by a fibrous capsule and is known as dental granuloma. This is the body’s natural method to wall off infection and prevent its spread into nearby areas. However, as the granuloma contains a network of capillaries, sometimes it still leads to spread of bacteria.
Dental granuloma is a small mass that may form somewhere in the dental root of a dead tooth, though most commonly it is found at the tip of the root. Normally it does not create any issues and is often detected during routine dental examination or x-rays. In some cases the granuloma may remain dormant and the surrounding capsule may become thicker, completely walling off dead bacteria and dental pulp.
However, it can flare up and cause severe pain and swelling of the gums. Patient will also complain of sensitivity to hot and cold as well as pain while chewing.
Causes of tooth granuloma flare up
There are several factors that can lead to sudden flare up of a dormant dental granuloma. Things like injury, fracture of tooth, tooth decay may lead to infection which may cause pulpitis, i.e., dental pulp inflammation. Another factor leading to exacerbation of symptoms is periodontitis or inflammation that has spread to the tissues and bone around the tooth. A granuloma may also become problematic after extraction of the infected tooth where some infection remains despite proper cleaning. Other provoking factors can be stress, pressure, colds and so on. Exacerbated chronic abscess is also known as the dental term 'phoenix abscess'.
Further complications, other than pain, swelling of the gums and tooth loss, can have serious outcomes. Infection from the granuloma may spread into connective tissues and soft tissues (phlegmon). It can lead to pus formation, abscess as well as infection of the bone (osteomyelitis). Unfortunately dental granuloma infection can also spread beyond the oral cavity and lead to systemic infection.
The treatment plan is based on the size of the granuloma, extent of infection and complications. At the initial stage of infection, endodontic treatments, i.e., root canal therapy and aspiration irrigation may be carried out to get rid of infection. Filling material may be used to pack the mass and antibiotics are also prescribed to eliminate the infection entirely.
However, surgery may be required in some cases where conservative treatment is not effective. If the tooth is cracked or carious it cannot be saved and has to be extracted. Nowadays hemisection or root apex resection is preferred to complete tooth extraction in an effort to save the natural tooth as far as possible. Hemisection involves removal of only the damaged part of root and the related crown of the tooth. On the other hand, root apex resection involves removal of only the diseased part of the root along with surrounding tissue. In the case of an abscess, it is opened and drained out.