What Is Periapical Periodontitis?

When you hear the phrase "periapical periodontitis," what's the first thing that pops into your head? You might think of gum disease and gingivitis since periodontitis is the more advanced stage of gum disease.

But periapical periodontitis is a bit different. More commonly known as apical periodontitis, says the American Association of Endodontists (AAE), it means inflammation of the periodontium (the tissue that surrounds your teeth). The inflammation is typically located at or around the tip — or apex — of the tooth's root.

Types of Apical Periodontitis

The AAE's Glossary of Endodontic Terms lists two different types of apical periodontitis: asymptomatic and symptomatic. As you might guess, asymptomatic apical periodontitis doesn't produce any clinical signs or symptoms. However, this condition produces inflammation of the tissue surrounding the teeth and can cause the destruction of that tissue. As the American Dental Association notes, asymptomatic apical periodontitis was once referred to as chronic periapical periodontitis. It's usually ongoing and develops gradually.

The other type of apical periodontitis is symptomatic apical periodontitis. This type of inflammation causes pain and discomfort when a person bites down or when a dentist taps on the surrounding teeth. Symptomatic apical periodontitis is usually acute, meaning it comes on suddenly and gets worse quickly, but it can also be chronic.

Causes of Apical Periodontitis

Typically, apical periodontitis occurs after there's another problem with the tooth. For example, the inflammation can develop if a person has an untreated cavity. In some cases, apical periodontitis can develop if there is an infection in the pulp of the tooth or if the pulp has died (known as pulp necrosis). Injury or trauma to a tooth can also potentially cause apical periodontitis.

What to Do If You Think You Have Periapical Periodontitis

Depending on whether it's symptomatic or asymptomatic, apical periodontitis isn't always something you can detect on your own. It's typically something that an endodontist can diagnose and treat. In the case of symptomatic apical periodontitis, it's a good idea to see your dentist if you notice any pain or discomfort in a tooth when you bite down or put pressure on it. If you have a history of cavities or infections in your teeth, seeing your dentist regularly allows them to note any asymptomatic inflammation and to refer you to an endodontic specialist if needed for treatment.

Treating Apical Periodontitis

How periapical periodontitis is treated depends in part on what treatments have already been performed and on how advanced the inflammation is. In some cases, a root canal might be all that's needed to minimize the inflammation. If a person has already had a root canal and the inflammation seems to be the result of a persistent infection or a new infection, a procedure called an apicoectomy might be needed. During an apicoectomy, the tip of the tooth's root is surgically removed. Although it is usually a last resort, there may be some instances when the best treatment option is to remove the tooth.

Although it seems as if antibiotics would potentially be helpful when it comes to treating apical periodontitis, there isn't much evidence to demonstrate whether that is the case or not. One review from the Cochrane Database of Systematic Reviews found that there is "very low-quality," insufficient evidence when it comes to determining whether or not systemic antibiotics would help adult patients with apical periodontitis.

Anytime you think something is going on with your teeth, gums or the health of your mouth in general, the best thing you can do is schedule an appointment with your dentist. They can take a look inside your mouth, assess your symptoms and recommend the appropriate next steps.