Apical Periodontitis – Causes, Symptoms & Treatment

Apical Periodontitis

Inflammation of the root of the tooth is called apical periodontitis . It is one of the odontogenic infections.

What is apical periodontitis?

Apical periodontitis is a bacterial infection that occurs at the tip of the tooth root. It is also known as root tip inflammation , apical osteitis or apical periodontitis . It is counted among the odontogenic infections.

We speak of apical periodontitis when harmful bacteria reach the tip of the root via an inflamed root canal. The germs can also penetrate the tooth via deep gum pockets and affect it. It is not uncommon for the pulp of the affected tooth to have already died. Dentists then speak of a dead or devitalized tooth. Apical periodontitis occurs both acutely and chronically.


Apical periodontitis is usually caused by tooth decay . The resulting tooth lesions allow bacteria to enter the tooth. Apical periodontitis is often preceded by inflammation of the dental pulp ( pulpitis ). The affected person does not always feel pain.

Other reasons for the occurrence of root tip inflammation can be trauma from dental treatment or fractures of the tooth . In some cases, grinding the tooth results in painful pulpitis. However, the inflammation can also take an almost painless course. As the disease progresses, the pulp of the tooth gradually dies off. The harmful germs spread further and further within the root canal system.

Eventually, they can advance into the adjacent jawbone. The immune system then reacts by breaking down the poorly supplied bone and replacing it with granulation tissue, which has better blood flow. In rare cases, the cause of apical periodontitis is not bacterial in nature but is caused by chemical irritation. Their origins are mostly medicinal root deposits or root fillings.

Symptoms, Ailments & Signs

The symptoms of apical periodontitis vary. In acute root tip inflammation, for example, symptoms such as pain when biting or tapping on the tooth often appear. An accompanying inflammation of the dental pulp is also possible, in which the patient falsely feels that the affected tooth is lengthening.

If the root tip inflammation takes a chronic course, this is referred to as primarily chronic apical periodontitis. In most cases, there is no pain. However, there is a risk that the inflammation will turn into a chronic form and then cause pain. Without appropriate treatment of apical periodontitis, it threatens to affect the jawbone.

Dentists refer to this as an apical granuloma or apical abscess. In some cases, a fistula also forms . Furthermore, apical tenderness is conceivable, which is accompanied by swelling and reddening. It is not uncommon for the tooth to react sensitively to touching it with the tongue.

If there is a tooth with dead pulp, there is a risk that it will cause further diseases. This can be neuralgia, repeated inflammation of organs, rheumatic diseases or allergies .

Diagnosis & History

Apical periodontitis can be diagnosed with the help of an X-ray examination . However, the typical brightening, which is a sure sign of an inflamed root tip, can only be recognized after a few weeks. The first indication is an enlarged periodontal gap.

X-rays show whether there are changes in bone density only after the bone has lost 30 percent of its mineral content, which can take several days or weeks. If the symptoms are only mild and the X-ray image does not provide sufficient information, another image must be taken after three months.

To diagnose a dead tooth, a vitality test is performed. If the tooth reacts to cold, this is an indication that the nerve has not yet died. In addition, a dead tooth can be extremely sensitive to a tap test. If there is still no extensive loosening of the tooth, the apical periodontitis usually takes a positive course after appropriate dental treatment.

However, if the loosening is very pronounced, the tooth will be lost. In most cases, however, the affected tooth can be saved with a root tip resection.


Since apical periodontitis is usually chronic, develops over many years and is only rarely painful, it often goes undetected for a long time. At some point, however, the teeth begin to wobble and fall out. Therefore, a good prognosis depends on an early start of therapy.

Even if the appropriate maintenance measures are taken in good time, one tenth of patients experience severe tissue loss and bone destruction. This is a refractory form that usually affects the molars. In addition to the subsequent loss of teeth, other general medical diseases can also develop.

Abscesses develop and increase the level of suffering. The risk of a heart attack or damage to internal organs increases. People with serious previous illnesses are predestined for apical periodontitis. A negative interaction can be seen in diabetes mellitus and apical periodontosis.

Diabetes mellitus can promote the development of periodontal disease. Periodontosis, in turn, reduces the otherwise good prospects for a mild course of the chronic increase in blood sugar levels. Apical periodontitis can also be risky for pregnant women, as the likelihood of an abortion or miscarriage increases.

When should you go to the doctor?

If the toothache is severe, especially when you bite down or tap the tooth, you should see a dentist. Symptoms indicate a serious dental condition that needs immediate attention. The doctor can determine whether it is apical periodontitis or another disease of the mouth or tooth space by means of an X-ray examination and anamnesis.

In addition, he can detect swelling, redness and fistulas and thus conclude on apical periodontitis. Other warning signs that require medical evaluation include teeth that are sensitive to touch and the feeling that the affected tooth has grown. Bad breath and abscesses are often added, which must be clarified on their own.

In less severe cases, apical periodontitis progresses slowly and without major complications. If no symptoms have developed, the teeth must be examined every three months. The doctor can suggest treatment at the appropriate time and reliably prevent further complications of apical periodontitis.

Treatment & Therapy

In order to effectively treat apical periodontitis, a root canal treatment must be performed. Because the pain also radiates to the neighboring teeth, it is not always easy to determine the position of the causative tooth. If there is pulpitis in addition to the apical periodontitis, this is treated at the same time.

Tooth extraction is an alternative to root canal treatment. This is particularly true in the case of extensive marginal bone loss or when the crown of the tooth has been severely destroyed by caries. Sometimes apical periodontitis also occurs in teeth that have had a root canal treatment a long time ago .

Then a new root filling or a root tip resection (WSR) is required. The dentist removes the tip of the tooth root. This often contains secondary canals that cannot be treated due to their small size. About a year after the root canal treatment, the dentist uses an X-ray to check that the root tip inflammation has healed. If the healing process is not successful, a root tip resection must be performed.

Outlook & Forecast

Apical periodontitis has a progressive disease course without the need for medical care and dental treatment. This ultimately ends in the loss of the tooth. General well-being is weakened and the bacteria can infect other teeth in the mouth. If the person concerned does not seek medical treatment, further tooth loss and inflammatory processes in the mouth occur.

The course of the disease is insidious and takes place over many years. However, it cannot be stopped with natural possibilities and self-healing powers. With medical care, the patient has a good prognosis. Depending on the severity of the disease, the current medical possibilities mean that dental treatment can be carried out with or without subsequent dentures.

In some patients, the affected region is treated with medicines and the diseased part of the tooth is removed. If these are to a considerable extent, the removed tooth is then built up with replacement preparations. In addition, the spread of the germs is stopped with medication. The patient can be discharged from treatment within a short time as cured.

Regular check-ups are then carried out to prevent renewed bacterial infestation. If the patient adheres to these and contributes to maintaining their dental health through comprehensive daily dental hygiene , they will remain symptom-free in the long term.


Plaque is the cause of dental diseases such as caries and the resulting apical periodontitis . So that there are no complaints in the first place, regular removal of the deposits is extremely important. In addition, the teeth should be cleaned thoroughly several times a day.


Apical periodontitis is a disease whose treatment belongs in the hands of the dentist. After the therapy, not only the dentist is responsible for the follow-up care, which is realized through regular check-ups. The patient is also involved in aftercare through active participation in everyday life. Oral and dental hygiene are very important in this context.

Since apical periodontitis is a bacterial disease, it is crucial not to provide a target for the bacteria in the mouth. So tartar is avoided as well as soft plaque, which allows periodontitis processes to develop again. Cleaning is consistently necessary and correct cleaning techniques can be learned from the dentist. Professional tooth cleaning (PZR) at the dentist removes hard and soft plaque and can also be the right time to learn the correct cleaning technique.

A root-treated tooth is often very sensitive and can be spared from chewing stress for a few days. However, the most important thing in periodontitis aftercare is not to smoke. Nicotine and periodontitis are closely related, which needs to be clearly proven. Nicotine even has the property of sometimes masking the symptoms of an existing periodontitis, which hinders the early detection of the disease and thus delays the timely treatment.

You can do that yourself

Apical periodontitis always requires medical treatment. However, conventional medical methods can be optimized for everyday use by taking a few measures and self-help tips.

First of all, a change in diet is recommended . Since the teeth and mouth can be extremely sensitive during the disease, particularly spicy, hot or irritating foods should be removed from the menu. Likewise, sour and heavily sugared foods as well as various luxury foods and medicines that could damage the jaw and teeth. Tooth-damaging products are best replaced with a healthy and balanced diet. During the acute phase, light soups, soft-boiled fruit and vegetables and baby food are particularly suitable.

To protect the teeth, regular and extensive dental care is also important. Those affected with apical periodontitis should clean their teeth several times a day with a toothbrush and dental floss . In order not to further irritate the inflamed areas, gentle care products should be used. In general, the measures mentioned are best worked out together with the doctor. In this way, everyday measures can optimally complement conventional medical treatment without complications occurring.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.