Dental Pain From Teeth
|Classification of pulp status||Features|
Peri- radicular pain can be of pulpal origin, most commonly due to disease in the pulp extending into the peri-radicular tissues but can also be of periodontal origin due to periodontal disease.
Apical periodontitis is a term used to describe acute inflammation of the periodontal ligament surrounding the tooth. This can be caused by inflammatory mediators from irreversibly inflamed pulp, bacterial toxins from necrotic pulp, restorations that have not been property contoured and in some cases, from treatments such asendodontic treatment.There is both an acute and chronic form of this condition.Acute apical periodontitis features include moderate to severe pain, usually stimulated by touch and pressure and may also include spontaneous pain.The chronic form of the condition can be asymptomatic but may also include pain from surrounding tissues when stimulated.
Apical abscess is a term used to describe an extension of apical periodontitis where the bacteria have infiltrated the peri radicular tissues and are causing a severe inflammatory response; there is also an acute and chronic form of this condition.
An acute apical abscess can cause facial swelling and can cause other systemic consequences such as a high temperature and feelings of malaise. In some cases this condition can be life-threatening when the inflammation compromises the airway; this is termed Ludwig’s Angina.
A chronic apical abscess can be asymptomatic as the pressure from the inflammation is being drained through a sinus tract; a draining sinus can usually be seen clinically. A periodontal abscess is a localised inflammation affecting the periodontal tissues. It is caused by bacteria pre-existing in a periodontal pockets, traumatic insertion of bacteria or foreign body or can occur after periodontal treatment. This condition has a rapid onset, is stimulated by touch and involves spontaneous pain. It is important to note that an apical abscess may drain through the periodontal pocket giving a false interpretation of periodontal abscess or a periodontal abscess may appear at the apex of the tooth giving a false interpretation of apical abscess; a tooth may also have both lesions at one point in time.