periapical periodontitis

{{Short description|Inflammation at the apex of a tooth root}}

{{Infobox medical condition (new)

| name = Periapical periodontitis

| synonyms = Apical periodontitis, periradicular periodontitis

| image = Chronic apical periodontitis.jpg

| caption = Periapical dental radiograph showing chronic periapical periodontitis on the root of the left maxillary second premolar. Note large restoration present in the tooth, which will have undergone pulpal necrosis at some point before the development of this lesion.

| pronounce =

| field = Endodontics

| symptoms =

| complications = Apical extrusion of pulpal debris, abscesses in the head and neck, Ludwig Angina{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=}}

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| causes = Pulp infection{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=It may occur due to the advancement of dental caries, trauma, or operative dental procedures. The infected pulp is the main cause of apical periodontitis.}}

| risks = Dental caries, dental trauma, dental procedures, professional misconduct{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=A periapical radiolucency often persists when the root canal treatment cannot control the infection because some clinical steps were not adequately followed, such as insufficient aseptic control, poor instrumentation, inadequate access cavity design, unreached canals, and restoration leakage.}}

| diagnosis = Apical Radiolucencies, Apical Radiopacities{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=Apical radiopacities are likely not associated with endodontic infection directly but are commonly found on routine radiographic evaluation. Radiopacities are generally benign.}}

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| treatment = Root canal treatment,{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=Further management is indicated when a periapical radiolucency remains unchanged after one year of root canal treatment, when it has increased in size, or if it appears in an endodontic-treated tooth without a prior apical disease.}} periradicular surgery,{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=non-surgical endodontic retreatment or periradicular surgery are treatment alternatives to save the tooth.}} retrograde root canal treatment{{cite book | last=Kvist | first=Thomas | last2=Jonasson | first2=Peter | title=Retrograde Root Canal Treatment | publisher=Springer International Publishing | publication-place=Cham | date=2021 | isbn=978-3-030-78666-3 | doi=10.1007/978-3-030-78666-3 | page=}}

| medication = Antibiotic in case of a sudden onset of symptoms in less than 24 hours.{{cite book | last=Blake | first=Ahren | last2=Tuttle | first2=Travis | last3=McKinney | first3=Reed | title=StatPearls | chapter=Apical Periodontitis | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | date=2024 | pmid=36943974 | page= | quote=Antibiotic use is generally contraindicated, except in cases with rapid onset or systemic involvement.}}

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Periapical periodontitis or apical periodontitis{{cite journal | vauthors = Nair PN | title = On the causes of persistent apical periodontitis: a review | journal = International Endodontic Journal | volume = 39 | issue = 4 | pages = 249–81 | date = April 2006 | pmid = 16584489 | doi = 10.1111/j.1365-2591.2006.01099.x | doi-access = free }} (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth.{{cite journal | vauthors = Segura-Egea JJ, Castellanos-Cosano L, Machuca G, López-López J, Martín-González J, Velasco-Ortega E, Sánchez-Domínguez B, López-Frías FJ | display-authors = 6 | title = Diabetes mellitus, periapical inflammation and endodontic treatment outcome | journal = Medicina Oral, Patologia Oral y Cirugia Bucal | volume = 17 | issue = 2 | pages = e356-61 | date = March 2012 | pmid = 22143698 | pmc = 3448330 | doi = 10.4317/medoral.17452 }} It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp (odontogenic infection), or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.

Etymologically, the name refers to inflammation (Latin, -itis) around (peri- ) the root tip or apex (-apical) of the tooth (-odont-). Periradicular periodontitis is an alternative term.

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