Apical Periodontal Disease

When apical periodontitis , a dental root tip inflammation is called. It is one of the odontogenic infections.

What is apical periodontal disease?

According to bestitude, apical periodontitis can be diagnosed with the help of an X-ray examination . However, the typical lightening, which is a sure sign of an inflamed root tip, can only be recognized after a few weeks.

Apical periodontitis is bacterial inflammation that occurs at the tip of the tooth. It is also called root inflammation , apical ostitis or apical periodontitis . It is counted among the odontogenic infections.

Apical periodontitis is when harmful bacteria reach the tip of the root via an inflamed root canal. The germs can also penetrate the tooth via gum pockets, which are deep, and affect it. It is not uncommon for the pulp of the affected tooth to have already died. Dentists then speak of a dead or non-vital tooth. Apical periodontitis occurs both acutely and chronically.


Apical periodontitis is usually caused by tooth decay . The resulting tooth lesions give the bacteria access to the tooth. Apical periodontitis is often preceded by an inflammation of the tooth pulp ( pulpitis ). The affected person does not always feel pain.

Other reasons for the occurrence of a root tip inflammation can be trauma from dental treatment or fractures of the tooth . In some cases, grinding the tooth results in painful pulpitis. However, the inflammation can also be almost painless. As the disease progresses, the dental pulp gradually dies. The harmful germs spread further and further within the root canal system.

Eventually they can invade the neighboring jawbone. The immune system then reacts by breaking down the poorly perfused bone and replacing it with granulation tissue, whose blood flow is better. In rare cases, the cause of apical periodontitis is not bacterial in nature, but is caused by chemical irritation. Their originators are mostly medicinal root deposits or root fillings.

Symptoms, ailments & signs

The symptoms of apical periodontitis vary. Acute root inflammation often shows symptoms such as pain when biting open or when knocking on the tooth. Concomitant inflammation of the tooth pulp is also possible, in which the patient falsely feels that the affected tooth is lengthening.

If the root tip inflammation takes a chronic course, it is referred to as primarily chronic apical periodontitis. In most cases there is no pain. However, there is a risk that the inflammation will turn into the chronic form and then cause pain. If apical periodontitis is not treated appropriately, it threatens to affect the jawbone.

Dentists refer to this as an apical granuloma or apical abscess. In some cases, a fistula also forms . Apical tenderness, accompanied by swelling and reddening, is also conceivable . It is not uncommon for the tooth to react sensitively to contact with the tongue.

If there is a pulp-dead tooth, there is a risk that it will cause further diseases. This can be neuralgia, repeated inflammation of organs, rheumatism diseases or allergies .

Diagnosis & course

Apical periodontitis can be diagnosed with the help of an X-ray examination . However, the typical lightening, which is a sure sign of an inflamed root tip, can only be recognized after a few weeks. The first indication is an enlarged periodontal gap.

Whether there are changes in the bone density can only be determined on the X-rays when the bone has already lost 30 percent of its mineral content, which, however, takes a period of several days or weeks. If the symptoms are only minor and the X-ray does not provide sufficient information, another image must be taken after three months.

To diagnose a dead tooth, a vitality test is done. If the tooth reacts to cold, this is an indication that the nerve has not yet died. In addition, a dead tooth can be extremely sensitive to a knock test. If the tooth has not yet loosened extensively, apical periodontitis usually takes a positive course after appropriate dental treatment.

However, if the loosening is very pronounced, the tooth is lost. In most cases, however, the affected tooth can be preserved by a root resection.


Since apical periodontitis is usually chronic, develops over many years and is only painful in rare cases, it often goes undetected for a long time. At some point, however, the teeth begin to wobble and fall out. A good prognosis therefore depends on starting therapy early.

Even if the appropriate maintenance measures start in good time, a tenth of the patients experience severe tissue loss and destruction of the bone. This is a refractory form that usually affects the molars. In addition to the subsequent tooth loss, other general medical conditions can also develop.

Abscesses develop and further increase the level of suffering. The risk of a heart attack or damage to internal organs increases. People with serious previous illnesses are predestined for apical periodontitis. A negative interaction can be seen in diabetes mellitus and apical periodontosis.

Diabetes mellitus can promote the development of periodontal disease. Periodontal disease, in turn, reduces the otherwise good prospects for a mild course of chronic increases in blood sugar levels. Apical periodontitis can also be risky for pregnant women, as the likelihood of an abortion or a miscarriage increases.

When should you go to the doctor?

If you have severe toothache, especially when biting or knocking on the tooth, a dentist should be consulted. Symptoms suggest a serious tooth disorder that needs immediate treatment. The doctor can determine whether it is apical periodontitis or another disease of the oral or dental area on the basis of an X-ray examination and an anamnesis.

He can also recognize swellings, redness and fistulas and thus conclude that there is apical periodontitis. Other warning signs that require a doctor’s evaluation include teeth that are sensitive to touch and the feeling that the affected tooth has grown. Often there are also bad breath and abscesses that need to be clarified on their own.

In less severe cases, apical periodontitis progresses slowly and without major complications. If no symptoms have developed, the teeth must be examined every three months. The doctor can suggest treatment at the appropriate time and reliably prevent further complications of apical periodontitis.

Treatment & Therapy

To effectively treat apical periodontitis, root canal treatment must be performed. Because the pain also radiates to the neighboring teeth, it is not always easy to determine the location of the causative tooth. In the event that pulpitis is present in addition to apical periodontitis, this is treated at the same time.

As an alternative to root canal treatment, tooth extraction can also be considered. This is especially true in the case of extensive marginal degradation of the bone or if the tooth crown has been severely damaged by caries. Occasionally, apical periodontitis can also be seen in teeth that have undergone root canal treatment a long time ago .

Then a new root filling or a root tip resection (WSR) is required. The dentist removes the tip of the tooth root. In this area there are often secondary canals that cannot be treated due to their small size. About a year after the root canal treatment, the dentist will check the healing of the root tip inflammation by means of an X-ray. If the healing process is not successful, an apicectomy must be performed.

Outlook & forecast

Apical periodontitis has a progressive disease course without the use of medical care and dental treatment. This ultimately ends in the loss of the tooth. The general well-being is weakened and the bacteria can attack further teeth in the mouth. If the person concerned does not seek medical treatment, further tooth loss and inflammatory processes in the mouth occur.

The course of the disease is insidious and takes place over many years. However, it cannot be stopped with natural possibilities and self-healing powers. With medical care, the patient has a good prognosis. Due to the current medical possibilities, depending on the severity of the disease, dental treatment can be provided with or without a subsequent denture.

In some patients, the affected region is supplied with medicines and the diseased tooth area is removed. If these are to a considerable extent, the removed tooth is then rebuilt with replacement preparations. In addition, the spread of the germs is stopped with medication. The patient can be discharged from treatment as cured within a short period of time.

Regular check-ups are then carried out to prevent renewed bacterial infestation. If the patient adheres to them and contributes to maintaining their dental health through comprehensive daily dental hygiene , they will remain permanently symptom-free.


Dental diseases such as tooth decay and the resulting apical periodontitis are caused by plaque . So that there are no complaints in the first place, it is extremely important to remove the plaque regularly. In addition, the teeth should be cleaned thoroughly several times a day.


Apical periodontitis is a condition that should be treated by the dentist. After the therapy, not only the dentist is responsible for the follow-up care, which is carried out through regular check-ups. The patient is also involved in aftercare through active participation in everyday life. Oral and dental hygiene are very important in this context.

Since apical periodontitis is a bacterial disease, it is crucial that the bacteria in the mouth are not exposed to attack. Thus, tartar can be avoided as well as soft plaque, which causes periodontal processes to develop again. Brushing is consistently necessary and correct brushing techniques can be learned at the dentist. The professional tooth cleaning (PZR) at the dentist removes hard and soft plaque and can also be the right time to learn the correct brushing technique.

A root-treated tooth is often very sensitive and can be spared from chewing loads for a few days. In the periodontal aftercare, however, it is essential to refrain from smoking. Nicotine and periodontal disease are closely related to one another, which is clearly to be proven. Nicotine even has the property of sometimes obscuring existing periodontal disease in its symptoms, which hinders early detection of the disease and thus delays timely treatment.

You can do that yourself

Apical periodontitis always requires medical treatment. The conventional medical methods can, however, be optimized for everyday life by taking a few measures and self-help tips.

First of all, a change in diet is recommended . Since the teeth and the oral cavity can be extremely sensitive during the illness, particularly sharp, hot or irritating foods should be removed from the menu. Likewise sour and heavily sugary foods as well as various luxury foods and drugs that could damage the jaw and teeth. Products that damage teeth are best replaced by a healthy and balanced diet. During the acute phase, light soups, soft-boiled fruit and vegetables, and baby food are particularly recommended.

To protect the teeth, regular and extensive dental care is also important. People with apical periodontitis should clean their teeth several times a day with a toothbrush and floss . In order not to further irritate the inflamed areas, gentle care products should be used. In general, the measures mentioned are best worked out together with the doctor. In this way, the daily measures can optimally complement conventional medical treatment without causing complications.

Apical Periodontal Disease