Preclinics of Conservative Dental Medicine · MU Sofia
53. Acute inflammatory periapical diseases – main symptoms and paraclinical examination.
Covers acute inflammatory periapical disease from the serous stage of acute apical periodontitis to the purulent acute apical abscess and its four-stage spread through the bone, with a comparison table of the two conditions. It also describes history and examination, pulp sensibility and electro-odontodiagnosis, radiographic findings, sinus tract tracing, differential diagnosis and the principle of drainage with antibiotics as an adjunct.
Topic 53 of 53 in the MU Sofia syllabus for Preclinics of Conservative Dental Medicine (Dental Medicine, Year 3). The free AceMed note covers it in 6 sections, about 904 words (7 min of reading), with 17 flashcards.
In this note
Introduction
Acute apical periodontitis – serous phase
Acute apical abscess – purulent phase and its spread
Clinical and paraclinical examination
Differential diagnosis and first-line management
Key points
Introduction
Acute inflammatory periapical diseases are acute reactions of the tissues around the root apex, most often to bacteria from a necrotic, infected root canal. They range from symptomatic (acute) apical periodontitis to the acute apical abscess – one of the commonest dental emergencies, which can spread into the jaw and the fascial spaces of the face. Anatomy of the periodontium and the classification are in topic 52.
Acute apical periodontitis – serous phase
Periodontitis apicalis acuta serosa (acute serous inflammation of the apical periodontium) is the first stage: hyperaemia and a serous exudate, without pus, in the apical periodontal ligament (PDL). Causes: a necrotic pulp, a still-vital inflamed pulp, occlusal trauma (a high filling) or over-instrumentation. Symptomatic apical periodontitis = inflammation of the apical periodontium with well-localised pain on biting and on percussion.
Continuous, spontaneous pain that the patient can localise to one tooth – the PDL has proprioceptors, the pulp has none.
The tooth feels “elongated” (too high): the exudate pushes it slightly out of its socket, so it meets the antagonist first and biting hurts.
Tender to vertical percussion; no swelling; general condition normal.
Pulp sensibility tests: negative if the pulp is necrotic, positive if the cause is a still-vital inflamed pulp or occlusal trauma.
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