What is Periapical
Granuloma?
A periapical granuloma is a relatively common lesion or
growth that develops around the tip of a tooth's root.
It consists of a proliferating mass of granulation tissue
(new tissue that forms on a wound) and bacteria that forms
in response to dead tissue in the pulp chamber of the
tooth. The death of the pulp may be due to extensive decay,
deep restorations, or trauma to the tooth. The formulation
of a periapical granuloma represents the body's attempt
to heal and wall off an infection. Normally, periapical
granulomas resolve after the source of the infection is
removed (following root canal treatment), but residual
periapical granulomas may persist even after the offending
tooth is extracted unless the tissue is carefully removed
at the same time. Periapical granulomas enlarge slowly
and can grow to reach several centimeters in diameter.
Smaller lesions (a few millimeters in diameter) do not
have clearly defined borders and can be difficult to identify.
Larger lesions, however, have well-defined borders and
are often surrounded by bundles of collagen, a gelatin-like
substance, making them identifiable on an x-ray. As the
granulomas enlarge, the do not cause the affected area
to expand, but they can cause bone loss around the root
tips. Unless a secondary infection develops, there are
no other symptoms associated with periapical granulomas.
If allowed to progress, periapical granulomas
may develop into radicular cysts. In addition, they can
develop a secondary infection
which results in an acute or chronic abscess, causing
extreme pain. Besides pain, an untreated abscess may result
in spreading of the
infection into the surrounding soft tissue, the jaw bone,
or elsewhere in the body, creating a much more serious
situation.
Treatment Options
• We will likely need to remove the infected portions
of the tooth pulp by performing root canal therapy.
• If we cannot remove the infection with root canal
therapy, the affected tooth may need to be extracted (removed).
• We may prescribe antibiotics to fight the infection.
• If you have any discomfort associated with a secondary
infection, a warm salt water rinse may provide some relief.
Mix one teaspoon of salt in one cup of warm water, and
gently swish and spit.
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What is Pericoronitis?
Pericoronitis is a red swelling of the soft tissues that
surround the crown of a tooth that has only partially
grown in (erupted). The swelling ranges from soft to firm.
It can progress to become a knoblike mass of tissue that
is very painful when you chew or open and
close your mouth. It occurs most frequently around the
third molars (the wisdom teeth), but can happen around
the base of any tooth that hasn't grown in completely.
It is most common in teens and young adults, and can cause
severe pain, swelling, and spontaneous draining of the
infection.
Pericoronitis results from a bacterial infection caused
either by staphylococcal or streptococcal bacteria, or
both. The condition is often brought on when there is
an accumulation of plaque and/or tartar on the tooth,
or food particles trapped in surrounding gum tissues.
In severe cases, pericoronitis can cause intense pain,
fever, an increase in the number of white blood cells,
and overall fatigue. The infection is capable of spreading
into surrounding tissues. This results in cellulitis,
a very serious, often life-threatening infection that
must be treated quickly to prevent further spread and
possible swelling of the airway.
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What is Periodontitis?
Periodontitis is the number one cause of adult tooth loss.
It is characterized by an inflammation and/or degeneration
of the tissues
that give support to the teeth - namely the gums, the
connective tissue (the periodontal ligament), and the
surrounding bone (the
alveolar bone). Periodontitis is a continuation of the
infection that begins with gingivitis, a condition in
which plaque, a sticky, colorless
film of food and bacteria, forms on the teeth. If not
removed each day by brushing and flossing, the plaque
hardens and forms tartar
(also called calculus). The body's reaction to the bacteria
in plaque and tartar causes the typical signs of gingivitis
- red and swollen
gums.
As the plaque and tartar work their way down below the
gumline, the gums begin to separate from the tooth as
the bone and connective tissue are destroyed. Spaces form
between the teeth and gums; these spaces are called periodontal
pockets. The formation of these pockets indicates progressive
destruction of the supporting tissue, and creates the
perfect environment for the
growth of even more harmful bacteria.
Your body responds to the infection by sending white
blood cells (your body's natural defense) and other immune
cells to the infected
area. When the white blood cells reach your gums, they
release enzymes to attack the infection. Unfortunately,
these enzymes combine with the bacterial toxins, and together
they break down bone tissue as well as the gum's natural
attachment to the gums.
When periodontitis continues unchecked, the bone loss
also continues. Eventually so much bone is lost that teeth
become loose. As the disease progresses, the periodontal
pockets become deeper and bone loss increases. Teeth become
loose and may move (migrate) within the mouth, resulting
in gaps in your smile. The infection can also become painful,
as secondary infections and abscesses can form. Periodontitis
can affect one area of the mouth, multiple areas, or the
entire upper and lower arch. It rarely occurs prior to
18 years of age.
We use an instrument called a periodontal probe to check
for periodontal disease during your regular exam. The
probe allows us to check for pockets and bone loss. It's
always best to diagnose and treat periodontal disease
in its early stages, before bone has been lost, because
once bone tissue is gone, it never grows back on its own.
What is Peripheral Ossifying Fibroma?
Peripheral ossifying fibromas are well-defined oral growths
that contain bone tissue. They are most often found attached
to the gums
near the molars or premolars, and are usually connected
either by a wide base of tissue or by a stalk-like growth.
Usually, they are pink in color, much like the color of
the gum tissue. As they enlarge, they may become irritated
and more red in color. These lesions are
commonly associated with poor oral hygiene and early periodontal
(gum) disease, also called gingivitis.
Peripheral ossifying fibromas are smooth and firm to
quite hard, depending on the amount of bone they contain.
X-ray examination of these lesions will typically show
the central mass of bone. They normally do not bleed easily,
but often become ulcerated and reddened due to an infection
that is caused by irritation from chewing or vigorous
toothbrushing.
These lesions can occur at any age, but are most common
in children and young adults, and occur twice as often
among females. They can be found in the upper or lower
jaw, usually behind the molars.
Treatment Options
We will remove the fibroma surgically and correct any
source of irritation in the area. Healing in the mouth
is normally fairly rapid and
usually occurs without any problems, but these lesions
have been known to recur (re-develop) occasionally. Without
treatment, they can become very large and interfere with
normal chewing and swallowing. On occasion, very large
growths may cause obvious swelling or enlargement in the
face.
What is Pyogenic Granulomas?
Pyogenic granulomas are painless, localized, spherical
(ball-shaped) lesions that are most common on the gums,
but they can also occur on the lips, tongue, the inside
of the cheek, and occasionally on other areas in the mouth.
They often occur as a result of a minor injury or irritation,
such as sharp or rough fillings or deposits of tartar
under the gums, followed by low-grade infection and exaggerated
inflammation.
Pyogenic granulomas develop rapidly, are normally soft
and painless, and tend to bleed easily and profusely,
due to the many small blood vessels that exist within
them. Frequently, these lesions ulcerate and appear brownish
or purple, mottled red and white, or red and yellow. Pyogenic
granulomas vary in size from one centimeter to very large,
tumor-like or lobular masses. They are most common in
those between 11 and 40 years of age, but they can occur
at any age.
When pyogenic granulomas occur in pregnant woman, they
are also known as pregnancy tumors or granuloma gravidarum.
Granuloma gravidarum accompany the hormonal changes that
occur during pregnancy.
Treatment Options
• Pyogenic granulomas that are large or have been
present for an extended period of time require surgical
removal. We will also
remove or correct the irritating factor to ensure that
they do not develop again.
• In pregnant women, these lesions have been known
to disappear after delivery. However, this is not always
true, and given their tendency to bleed and ulcerate,
we will usually recommend surgical removal of the lesion.
We will also remove the source of the irritation.
• In spite of their growth potential, pyogenic granulomas
are totally non-cancerous lesions.
