Dental Granuloma – Symptoms, Causes, Treatment

Dental Granuloma also known as Periapical granuloma is a disease that occurs at the root tip of the tooth. It is the end result of tooth decay (cavities/caries). If left untreated, it can result in loss of tooth and surrounding bone. Hence in this blog, we will talk about periapical granuloma, its causes, symptoms, detection, management, and most importantly prevention.

What is Periapical Granuloma?

Periapical granuloma occurs when tooth decay is left untreated for a long period and the infection reaches the pulp of the tooth followed by the periapical region (the area surrounding the root tip of the tooth which includes bone, nerves, blood vessels, etc). It has a high tendency to occur in females (>50%), but can also affect males.

Any decayed tooth can result in periapical granuloma but front teeth (incisors and canine) have more chances of developing this disease compared to back teeth (premolars and molars). It can occur in any teeth of both jaws (upper as well as lower). However, upper jaw teeth are frequently involved.

What are the symptoms of Periapical Granuloma?

• Tooth discoloration- The involved tooth is usually darkened in color and loses its natural color (white or yellow). Largely decayed tooth where food lodges in the tooth.
• Pain– Pain and discomfort can be experienced while eating or drinking food items.
• Swelling– A swelling can be felt below the gums of the tooth which can be present on the cheek side or tongue side.
• Pus– Sometimes, pus discharge is there from the sinus (tract from the root tip towards the gums) which can also lead to bad taste in the mouth.

Causes of Periapical Granuloma

• Poor oral hygiene leads to dental caries. Dental caries/cavities/tooth decay is the main cause for this disease. If a tooth with decay is left untreated for a long time, then the infection/bacteria reaches the pulp and periapical tissues.
• Trauma/injury to the tooth due to some impact or blow can also result in damage to the periapical tooth region.
• Crack or fracture of the tooth surface.

Detection of Periapical Granuloma

• Dental caries can be seen as black or brown spots on the tooth surface.
• A dental x-ray (known as IOPA) is required to confirm this disease.
• Microscopic examination for large swelling is required for the final diagnosis of periapical diseases.

Treatment Options for Periapical Granuloma

At an early stage, a simple dental filling can stop this process. If a decayed tooth is left untreated then most probably a root canal therapy is required. If the swelling is large and the tooth cannot be saved, it has to be removed from the jaw (Dental tooth extraction).

Complications

If periapical granuloma is also left untreated, it can result in a periapical cyst which can lead to large defects in the jaw and can lead to loss of multiple teeth.

How can Periapical Granuloma be prevented?

It is important to note that it is 100% preventable. Pit and fissure sealants are applied by the dentist on healthy teeth to prevent caries. Regular dental checkups can aid in the early detection of caries. A dental filling can halt this process by removing the infection from the tooth. Root canal therapy at the right time can protect the periapical tissues. For children, Fluoride application on the tooth can prevent teeth from decaying.

Conclusion

Periapical granuloma can lead to tooth loss which can easily be saved by being vigilant about your oral health. Prevention can be done by means of fluoride application, pit and fissure sealants and regular dental check ups at Clove Dental. Dental fillings and root canal therapy at the earliest is essential to save the tooth.

References:

• Banomyong D, Arayasantiparb R, Sirakulwat K, Kasemsuwan J, Chirarom N, Laopan N, Lapthanasupkul P. Association between Clinical/Radiographic Characteristics and Histopathological Diagnoses of Periapical Granuloma and Cyst. Eur J Dent. 2023 Jan 4. doi: 10.1055/s-0042-1759489. Epub ahead of print. PMID: 36599448.
• Couto AMD, Meirelles DP, Valeriano AT, Almeida DS, Moraes Ê, Tarquinio SBC, Batista AC, MendonÇa EF, Costa NDL, Alves PM, Nonaka CFW, Abreu LG, Aguiar MCF. Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10,381 cases and literature review. Braz Oral Res. 2021 Mar 15;35:e033. doi: 10.1590/1807-3107bor-2021.vol35.0033. PMID: 33729278.
• Moraes Ê, Tarquinio SBC, Batista AC, MendonÇa EF, Costa NDL, Alves PM, Nonaka CFW, Abreu LG, Aguiar MCF. Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10,381 cases and literature review. Braz Oral Res. 2021 Mar 15;35:e033. doi: 10.1590/1807-3107bor-2021.vol35.0033. PMID: 33729278.