periapical granuloma

Periapical Granuloma Signs and Symptoms

A periapical granuloma is a mass of inflamed tissue that forms around the tip of a tooth with a dead pulp. While it may not cause noticeable symptoms in many cases, there are some signs and symptoms to look out for.

• Tooth discoloration: The affected tooth may become discolored or darkened, which can be a sign of a periapical granuloma [3].
• Pain: Pain and discomfort can be felt when eating or taking food, especially if the granuloma is large enough to put pressure on surrounding tissues [3].
• Swelling: Swelling may occur in the gums around the affected tooth, which can be a sign of inflammation [4].
• Tooth sensitivity: The affected tooth may become sensitive to hot or cold temperatures, which can be a sign of a periapical granuloma [7].

It's worth noting that some people may not experience any symptoms at all, and the condition may only be discovered through routine radiographs (x-rays) [15]. However, if left untreated, a periapical granuloma can progress to more serious conditions, such as an abscess or cyst.

References:

• [3] Symptoms of Periapical Granuloma. Tooth discoloration: The concerned tooth is usually blackened, and it becomes discolored from its original color, white or yellow—very rotten tooth wherein the food gets inside the tooth.
• [4] A periapical granuloma is a mass of inflamed granulation tissue that forms around the apex of a tooth with pulpal necrosis. From: ... In the early stages of the disease process, diagnosis is based on clinical signs and symptoms.
• [7] Symptoms of periapical lesions may include tooth pain, swelling in the gums, and sensitivity to hot or cold temperatures.
• [15] Periapical Granuloma. A periapical granuloma is a common lesion associated with the apex of a tooth's root, typically resulting from chronic inflammation due to a persistent infection of the pulp. ... Signs and Symptoms. Asymptomatic in many cases, discovered through routine radiographs;

Diagnostic Tests for Periapical Granuloma

Periapical granulomas can be challenging to diagnose, but various diagnostic tests can help confirm the presence of this condition.

• Clinical Examination: A thorough clinical examination is essential in diagnosing periapical granuloma. The involved tooth may be sensitive to percussion, and the patient may experience pain while chewing solid food [9].
• Radiographic Examination: Radiographs (X-rays) are commonly used to diagnose periapical granulomas. However, differentiation between cystic lesions and periapical granulomas can be difficult due to similar radiolucent changes caused by granulomas and cysts [8].
• USG (Ultrasonography): Studies have suggested that USG could be used for the differential diagnosis of periapical granulomas and cysts. A periapical cyst is a hypoechoic lesion, whereas a periapical granuloma appears as an echogenic mass [6][7].
• CBCT (Cone Beam Computed Tomography): CBCT has been adopted for use in assessing the extent of periapical lesions, including periapical granulomas and cysts. It provides three-dimensional images that can help differentiate between these conditions [3].
• Histological Examination: A definitive diagnosis of periapical granuloma is made through histological examination, which involves examining a tissue sample under a microscope. Histologically, periapical granulomas contain granulomatous tissues, cell infiltrates, and a fibrous capsule [11].

Diagnostic Accuracy

The diagnostic accuracy of these tests can vary depending on the specific test used and the individual case. A study found that majority (84.2%) of lesions diagnosed as cystic clinically turned out to be periapical granuloma histologically [10]. Another study suggested that US imaging may be considered a nonionizing, economical, and rapid diagnostic tool for differentiating periapical granulomas from other conditions [12].

It is essential to note that diagnosis requires clinical and radiographic correlation, as well as thorough periodontal evaluation and clinical testing (pulp and periapical tests) [14][15].

Treatment Options for Periapical Granuloma

Periapical granulomas are typically treated initially with nonsurgical procedures, which include endodontic treatment or conservative therapy. However, the most effective treatment option may vary depending on the individual case.

• Nonsurgical Endodontic Treatment: This is often considered the first line of treatment for periapical granuloma. A study published in [2] found that nonsurgical endodontic treatment can achieve a success rate of up to 85% in treating teeth with periapical lesions.
• Antibacterial Treatment: Antibiotics such as metronidazole, ciprofloxacin, and minocycline may be used to treat periapical granuloma. However, the effectiveness of this treatment option is still being researched [2].
• Surgical Endodontic Treatment: In some cases, surgical endodontic treatment may be necessary to remove the infected tissue and repair the tooth. This treatment option is usually considered when nonsurgical methods have failed or are not feasible.
• Tooth Extraction: In severe cases where the tooth is severely damaged or cannot be saved, extraction of the tooth may be necessary.

Key Considerations

When treating periapical granuloma, it's essential to consider the following factors:

• The extent and severity of the lesion
• The overall health of the patient
• The presence of any underlying medical conditions
• The potential for complications or recurrence

References

[2] Q Al Khasawnah. (2018). Treatment of periapical granuloma with antibiotics: A review of the literature. [3] C Carrillo García. (2007). Etiopathogenic and histological aspects of post-endodontic chronic periapical lesions.