Dental Granulomas – Causes, Symptoms & Treatment


Sometimes tooth granulomas can form at the root tip or in the area of ​​the periodontal pockets after tooth or gum inflammation .

What are dental granulomas?

Tooth granulomas usually result from chronic irritation or inflammation of the teeth or gums. Tooth granulomas are small nodules that can sometimes be felt in the jaw, especially around the gums. The area is tender to tender, tooth granulomas in the gum area may also bleed. No matter where they are, tooth granulomas are usually associated with pain .

Tooth granuloma is a nodular tissue in the area of ​​the teeth or gums. As you can see from the name dental granulomas, they are granulated structures made up of different cells, mostly lymphocytes , blood vessels and connective tissue cells.

Tooth granulomas can develop in response to ongoing inflammation, infection, or allergies . There are different types of dental granulomas. They can appear in the gum area or at the root tip of teeth.


The various tooth granulomas can have different causes:

There are fungus-shaped tooth granulomas called epulis. These tooth granulomas are most often caused by inflammation that the surrounding tissues of the tooth are responding to. Such inflammation can form in a periodontal pocket and then expand. Epulis can also develop as a result of prolonged irritation from the edges of fillings, crowns or pressing prostheses. A special form of these tooth granulomas occurs during pregnancy (epulis gravidarum).

Root tip granuloma is usually caused by progressive tooth decay , which leads to inflammation inside the tooth and spreads to the root and jawbone area. This inflammation forms tooth granulomas that encapsulate and form a focus at the root tip of the tooth.

Foreign body granulomas can occur around the teeth or on other parts of the body if a foreign body penetrates the tissue and causes persistent inflammation there, which encapsulates into a granuloma. The foreign objects can be metal particles, wood chips or thread.

Symptoms, Ailments & Signs

The typical symptoms of tooth granulomas include more or less severe pain. These are the same symptoms that occur with all inflammations in the tooth area. Tooth granulomas can be hidden at the root of the tooth or visible as a bulging of the gums (epulis). While the so-called apical granulomas (root tip granulomas) are primarily characterized by pain, an epulis can also bleed slightly.

However, tooth granulomas can remain painless for a long time. This is why invisible granulomas are sometimes discovered late. Apical granulomas usually cause discomfort when biting or when eating cold or hot food. In these cases, severe toothache occurs even though the tooth in question has already died.

However, there is granulation tissue at the root of the tooth, which is inflamed and presses on the jawbone under mechanical stress. The epulis, in turn, is a mushroom-shaped or hemispherical structure that sits on the gum line. It is a pink bulging of the gums.

Epulis often occurs during pregnancy. However, it can also arise as a result of constant irritation from poorly fitting dentures, crowns or disturbing filling edges, as well as from insufficient oral hygiene. In rare cases, so-called internal tooth granulomas are also observed, which form as a result of chronic tooth nerve inflammation. Since the tooth is only poorly supplied by the granulation tissue, tooth fractures often occur.

Diagnosis & History

Tooth granulomas usually manifest as persistent tooth pain that forces one to see a dentist . The dentist first has the patient’s symptoms described – mostly throbbing toothache – and then examines the oral cavity more closely.

He can easily diagnose epulis because these tooth granulomas occur in the area of ​​the gums, often bleed and are easily recognizable with the naked eye. The dentist examines them and then decides how to treat the tooth granulomas. However, he cannot see root tip and foreign body granulomas with the naked eye; an X-ray of the jaw must be taken to diagnose these tooth granulomas.

If tooth granulomas are completely removed together with the infected tissue, the focus of inflammation can heal well. However, tooth granulomas can form again in the same place if the tissue of the tooth granulomas is not completely removed. If the inflammation persists for a long time, dental granulomas can form jaw cysts, which can damage the jawbone.


When dental granulomas grow and crowd out neighboring tissue, serious complications can occur. At the same time, protrusions and sometimes also pain occur, which, due to their chronic nature, represent a considerable psychological burden. The epulis granuloma form can cause small nodules on the gums, which can lead to further pain and sometimes bleeding.

Furthermore, tooth granulomas can form recurrences, i.e. arise again after successful treatment. If the inflammation persists for a longer period of time, cysts can form, which in turn can damage the jawbone. Jaw cysts can also cause infection and tissue damage. Pronounced growths sometimes cause sensory disturbances and numbness in the affected area.

The therapeutic treatment of a tooth granuloma does not involve any major risks. However, local anesthesia can cause side effects such as temporary confusion, memory problems, and panic attacks. A surgical procedure occasionally results in wound healing disorders or the formation of scars.

Due to the localization of tooth granulomas, healing can be complicated. Concomitantly prescribed drugs also harbor risks and side effects that can develop into serious complications in the case of previous illnesses or a combination therapy with other drugs.

When should you go to the doctor?

A doctor should be consulted in the event of persistent or chronic inflammation of the gums. If there are problems with eating, toothache or swelling in the mouth area, a check-up by a doctor is necessary. A doctor is required in the event of an unusual taste in the mouth, irregularities when wearing braces or dentures, or problems with speech. Discoloration of the gums or deformities in the facial area are considered warning signs of the organism.

They must be examined by a doctor so that a diagnosis can be made. Irritation in the mouth area, a general feeling of being unwell, loss of appetite or a refusal to eat are signs of a health problem. A doctor is needed so that measures can be taken to alleviate the symptoms. Since pregnant women have an increased risk of acquiring dental granulomas, special vigilance is necessary, especially in them.

Any changes that occur should be discussed with a doctor immediately. If teeth are fractured, medical care should be sought immediately. Before taking any pain-relieving medication, it is always advisable to consult a doctor or medical professional. Side effects can occur that cause an increase in symptoms. If teeth become loose or dentures slip, a visit to a doctor is also necessary.

Treatment & Therapy

If left untreated, tooth granulomas cause pain over a long period of time in most cases. Tooth granulomas can be removed under local anesthesia.

In addition, the dentist must also treat the root and inflamed tissue that caused the tooth granulomas. If areas of the bone are affected, these must also be removed. In the case of a severely decayed tooth, the dentist will decide to extract this tooth because of the risk of renewed inflammation.

With apical granuloma, the dentist must remove part of the tooth root and the infected tissue around it by performing an apical resection.

In addition to surgical interventions, the tooth, root and jaw area are treated with medication to heal the inflammation.


There is no direct way to prevent tooth granulomas , but a lot can be done by practicing good oral hygiene through regular cleaning of the teeth and interdental spaces, which together prevent tooth decay and gingivitis. Because tooth granulomas usually appear on inflamed teeth, caries prophylaxis is also prophylaxis against tooth granulomas.


Follow-up care for dental granuloma should extend beyond the end of the healing period, with limited interventions available. The defect is treated openly with a tamponade and bandage plate. The focus is on ongoing examinations and accompanying diagnostics so that deterioration or further symptoms can be ruled out as far as possible.

It is therefore important to consult the doctor early on in the event of any change. By allowing the doctor treating you to intervene, the course of the disease will be positively influenced. This is usually done with medication using ointments and tablets. The course of therapy depends on whether the drug can already be discontinued.

Occasionally, however, medical interventions in the patient’s oral cavity are also necessary. As part of the aftercare, the patient can also implement a few things themselves that have a positive effect on the course of the disease. Improving oral hygiene is fundamental. Regular oral care is essential to prevent further dental granulomas from forming. This includes brushing your teeth and rinsing with an antibacterial mouthwash. When taking medication and applying ointments, it is essential to ensure the prescribed regularity.

You can do that yourself

Irritation of the teeth or gums should be avoided in order to minimize the increase in health problems. For this purpose, the intake of the food must be checked and, if possible, optimized. Acidic foods, alcohol or nicotine should be avoided.

Worn or inserted braces and existing dentures are to be checked for pressure in the mouth area. Pressure points can intensify existing symptoms or lead to disturbances in the healing process. As soon as they occur, a doctor should be consulted so that they can be checked. In these cases, it is not advisable to act independently.

Tooth granulomas are usually associated with the occurrence of pain. Nevertheless, the consumption of painkillers is not recommended without a doctor’s consultation. Complications and side effects can occur that can lead to serious disorders. In everyday life, the existing physical and mental stressors should be reduced to a minimum. Persistent mental overload has a negative impact on the recovery process and must therefore be reduced as quickly as possible and over the long term.

To prevent existing health irregularities from spreading, daily tooth and mouth cleaning is necessary despite the symptoms. The cleaning processes in the mouth and throat should be adapted to the health possibilities, but should never be stopped completely. The jaw should also not be put under excessive strain.

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.