Root inflammation

The inflammation affects the tissue inside the tooth and is usually very painful. Root canal treatment is often necessary, sometimes also an intervention on the tip of the root (tip resection)

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Tooth root inflammation - briefly explained

In most cases, due to progressive caries, bacterial colonization of the inside of the tooth by the pulp (the pulp, hence the name "pulpitis"). External forces (trauma) or pressure damage are less common causes. Pulpitis often leads to severe, short or long-lasting, sometimes throbbing toothache. Stopping this suddenly is a warning sign that the tooth is "dead". The therapy of advanced pulpitis consists in the so-called root treatment, i.e. the removal of infected tissue with the help of special instruments, disinfection with antibacterial solutions and the final hermetic sealing of the tooth interior with a special filling material. If the symptoms persist or the inflammation becomes chronic, surgical intervention may be necessary, the apicectomy.

Definition: what is root inflammation?

The colloquial terms "tooth root inflammation" and "tooth nerve inflammation" are synonyms for tooth pulp inflammation, medically called "pulpitis". Because it is the pulp (pulp) that reacts with inflammation when damaged by an infection or noxious agent (see background information: structure of the tooth).Inflammation of the tooth pulp, i.e. the inner soft tissue portion of the tooth, usually occurs due to spreading caries. This allows bacteria to get into the interior of the tooth. Because the inflammation also takes place in the area of ​​the tooth root, one speaks of "root treatment", although the crown and root are affected (dental: "endodontic treatment" = treatment of the inside of the tooth). The tooth root forms the area under the tooth crown and is anchored in the bone. The tooth roots taper towards the apex. If the inflammation persists in the tooth for a long time, it can lead to a reaction in the surrounding bone.

© istock / pick-uppath

Background information - structure of the tooth

Toothache can be caused in or on the tooth. Most often the inflammation of the tooth pulp (technically: "pulp", colloquially: "tooth nerve") is the trigger. Because fine nerve fibers run through the pulp towards the jawbone. If they are stimulated, they transmit pain signals to the central nervous system.

The tooth consists of the crown, which is shaped differently depending on the type of tooth, and one or more roots. The tooth crown is the visible part of the tooth covered with tooth enamel (the hardest material in the body), underneath is the root stuck in the jaw. The transition between crown and root is called the neck of the tooth. Teeth are made up of different layers: the enamel is on the outside, the dentin underneath and the pulp on the inside. It consists of layers of cells, blood vessels, nerve fibers and connective tissue. This bundle runs inside the tooth through root canals to the tip of the root. This is where the vessels and nerves exit into the jawbone.

Causes: How does a tooth root inflammation come about?

In most cases, tooth decay causes inflammation in the area of ​​the tooth root. If the caries bacteria are not combated early on, they will destroy the tooth layer by layer until they have reached the marrow. Through this, the germs can penetrate to the tip of the root and spread from there.

Mechanical triggers, such as a blow to the tooth or grinding of teeth, can rarely trigger the inflammation. Periodontitis that has not been treated or is only inadequately treated can also spread from the periodontium to the root of the tooth and inflame it. To explain: The tooth-holding apparatus surrounds the tooth in the area of ​​the gums and the jawbone.

Symptoms: how does a tooth root inflammation manifest itself?

If the most sensitive part of the tooth, the marrow, is inflamed, it causes severe toothache. The affected tooth is also sensitive to pressure, cold and heat. Sometimes it really knocks. If the inflammation has already spread, it can spread to the jawbone and the surrounding tissue. The result is an abscess (accumulation of pus), which manifests itself, for example, in the form of a "thick cheek", depending on which tooth is affected. The spread of the infection along certain layers in the neck and head area is a serious complication and requires invasive treatment. Signs that the infection is spreading include:

Jaw clamp, difficulty swallowing, lumpy speech and / or swelling of the face / neck area.

Important: If you have severe toothache, see the dentist quickly. If there is an abscess in the jaw area, there is a risk that the germs will spread further in the body. Also important: If a tooth starts throbbing and hurts violently, but then suddenly no longer, this does not have to be a good sign. It can happen that the pulp dies as a result of the inflammation - and the tooth is "dead".

Diagnosis: how is a tooth root inflammation diagnosed?

First, in addition to the medical history (anamnesis), the dental examination of the dentition and the painful tooth takes place. Since pulpitis can only be recognized indirectly, the type, duration, intensity and trigger of the symptoms are important criteria. A cold test or an electrical stimulus provides information on whether the pulp is still reactive or has already died. An X-ray can show whether a cause can be identified (tooth decay under fillings or crowns) or whether the inflammation has already spread to the bone. The length of the root canals can also be determined electrometrically. The exact length of the root is determined with the help of electrical resistance measurements.

Therapy: How is a tooth root inflammation treated?

Tooth root treatment: A pulpitis can subside by eliminating the cause (for example removal of caries and filling) - it is then "reversible". If the bacteria get out of hand or if the pulp is no longer supplied with blood (for example due to trauma), pulpitis becomes "irreversible". Then a root canal treatment is required, more precisely, a root canal treatment. To do this, the dentist must first drill out the tooth (technical term: trephine) and then remove the inflamed or already decayed tissue. In addition to bacteria, viruses, fungi and even unicellular organisms may also be found in them. The affected root canals are then cleaned using special instruments (manual or mechanical). The length of the root canals can be determined electrometrically. The exact length of the root is determined by means of electrical resistance measurements.

It is particularly important to rinse the canals with various disinfecting solutions in order to make the root canals as free of germs as possible. Ultrasound or laser light can also be used to increase the cleaning and disinfecting effect. The cleaned root canals are then sealed with a special compound - a root filling paste.

In the case of a bacterial infection, anti-inflammatory and disinfecting agents are often applied temporarily after preparation and disinfection - possibly several times. The aim is to reduce the number of germs as much as possible and to achieve freedom from symptoms, in order to then create a seal that offers no room for renewed bacterial colonization. After the root canal has been filled, an X-ray control image is made to check the complete filling or overfilling. For this purpose, the root filling material is mixed with a substance that is visible in the X-ray image. The defect is then temporarily filled. If the tooth is no longer causing discomfort, it can be finally restored - with a filling or often with an artificial crown. In some patients, the root canals are curved or branched out, which makes cleaning difficult. Therefore, the inflammation sometimes does not subside or persists in the area of ​​the root tip. A referral to a specialist can be useful here.

Root tip resection: If the symptoms persist or chronic inflammation persists, a so-called root tip resection may be necessary. This is a surgical procedure in which a piece of the tip of the root and possibly inflamed tissue or a cyst in the bone is removed. At the same time, possibly unreached parts of the root canals are sealed off from the root tip ("retrograde"). This is the last chance to preserve a diseased tooth. If the method is unsuccessful, the tooth must be removed.

Note: The statutory health insurance companies only cover the costs of a root canal treatment under certain conditions. Therefore, seek advice before the treatment whether and, if so, what costs you will have to pay.

Our expert: Dr. Joachim Hüttmann, dentist

© W & B / private

Our advisory expert:

Dr. Joachim Hüttmann has been working as a dentist in his own practice in Bad Segeberg since 1986. After an apprenticeship as a dental technician and studying dentistry, he received his doctorate in the subject of periodontology.

Swell:

  • Dental central office for quality assurance, root tip resection. Online: https://www.zahnmedizinische-patienteninformationen.de/documents/10157/1129556/268572_1567523_Wurzelspitzenresektion.pdf/ (accessed on November 25, 2019)
  • National Association of Statutory Health Insurance Physicians, When is a dental root treatment necessary? Online: https://www.kzbv.de/wann-ist-eine-wurzelverarbeitung-erzutlich.85.de.html (accessed on November 25, 2019)
  • German dentist information, root canal treatment. Online: http://www.deutsche-zahnarztauskunft.de/?id=758872 (accessed on November 25, 2019)
  • German dentist information, apicectomy. Online: http://www.deutsche-zahnarztauskunft.de/?id=758870 (accessed on November 25, 2019)

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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