Granuloma of the tooth and its root: treatment with modern and folk remedies. How dangerous is dental granuloma and what is it? Causes and methods of treating the disease What is dental granuloma

Treatment of granuloma on the root of a tooth is carried out in medicine different methods, the main thing is to determine from the symptoms which method will be most effective.

The disease is unpredictable and dangerous - in the early stages the disease may not manifest itself, however, sharp pain occurs completely suddenly, and it can also lead to serious complications.

What kind of disease is this?

Granuloma is a round inflammatory cyst formation, which is located in the area of the tooth root (mainly at its apex), consisting of dead bacterial cells.

It has clear boundaries and can grow quickly, which leads to the spread of infection throughout the body and damage to healthy tooth tissue. The shape resembles a small sac of granulation tissue, the size of which ranges from 5-8 mm in diameter.

Due to the asymptomatic course of the disease, there is a possibility of its development in the muscles of the face and neck. In the absence of proper care, the pus can also reach the heart area, which leads to immediate death.

Causes

The main causes of granuloma are untreated caries or pulpitis (for example,). From this we can conclude why it is usually called a complication of the above diseases.

Both reasons contribute to the penetration of microbes into the tooth pulp - it is this that becomes inflamed and destroyed over time. By multiplying, microbes infect bone tissue - in its place connective tissue is formed, isolating all the bacteria inside itself, thereby becoming something like a capsule.

In addition to these factors, the occurrence of the disease can be affected by:

injuries that can lead to tooth infection;
complication of pulpitis or periodontitis;
inflammation of the tissue around the tooth or its fracture;
non-compliance with sterility in the treatment of other diseases of the oral cavity;
teeth that were treated more than 10 years ago;
presence of a tooth under a crown.

For the last two points, a failure in the body’s immune system is especially dangerous - there is a high probability that the granuloma capsule may burst unexpectedly, resulting in inflammation of the gums, and the roots of the teeth are exposed and it loses its fixation.

Photo and radiography

An x-ray is the most reliable way to determine inflammation at the root of a tooth, and is shown below along with an illustration of a granuloma, which shows the problem area.

Symptoms

If a granuloma occurs, it may not be observed obvious signs However, the disease acts like a time bomb - at one moment unbearable pain appears, accompanied by severe swelling of the gums.

Therefore, it is almost impossible to recognize its symptoms for a long time, but there are still factors that appear at a late stage of the disease, upon discovering which you should consult a doctor as soon as possible.

Causes for concern are:

painful, discomfort discomfort when chewing food;
darkening of the surface of tooth enamel;
the appearance of flux or phlegmon;
availability of abundant purulent discharge between the gum and tooth;
increased body temperature and malaise;
severe headache.

In no case should the above symptoms of the disease be ignored, since the granuloma becomes chronic over time and can develop into a jaw cyst - a dense capsule is formed in the patient’s mouth, the contents of which are necrotic masses, actively reproducing microbes and dead bacteria.

Diagnostics

Since in the early stages of the development of the disease, the externally infected tooth is absolutely no different from a healthy one, it is possible to recognize it only with visible growth and suppuration of the already affected area.

In order to detect a granuloma, the dentist needs to conduct a detailed examination of the patient - signs of the disease are usually noticeable immediately, in the form of swelling on the gums and pain in that area.

So far the most accurate and the right way diagnosis is an x-ray, on which the damaged area will be visible in the form of a darkened area - a dark “hole” at the base of the diseased tooth. Also, to recognize it, the patient undergoes radiovisiography (diagnosis of the condition of the teeth using digital radiographic equipment).

Treatment of granuloma on the tooth root

As a rule, the treatment method depends on the size of the granuloma, the condition of the tooth tissue and the complications present. They come in the following types:

Therapeutic methods.
Surgical intervention.
Folk remedies.

Therapeutic methods

Such treatment methods are only possible with early stage development of the disease - carried out thanks to sulfonamide drugs and antibiotics, these drugs directly counteract the infectious lesion. Sometimes such treatment also involves restoring a tooth from destruction, thanks to modern prosthetic methods.

In turn, filling has five main stages:

opening the tooth affected by granuloma and cleaning its internal canals;
flushing the canals with special solutions and then placing them in medicines;
filling a tooth with a temporary filling;
re-treatment of the canals with antibacterial drugs;
final filling of the tooth and its restoration.

Surgical intervention

Doctors try their best to avoid surgical intervention, but due to patients’ neglect therapeutic methods treatment at an early stage, the absence of surgery on a diseased tooth becomes impossible.

Depending on the presence of a complication and its stage, before the operation the patient’s gums are opened in order to pump out the pus, and then drainage is installed in the resulting wound (for no longer than three days).

There are several methods of surgical intervention.

Root apex resection (cystectomy)

It is prescribed if the tooth affected by granuloma is of strategic importance. The process itself consists of opening the tooth, washing it with a disinfectant solution and removing the inflammation along with the root tip, after which the removed tissue is replaced with artificial tissue and the tooth is filled.

The difficulty lies precisely in the fact that the operation cannot be performed efficiently on a molar, where the risk of such formations occurs most often.

Hemisection

After hemisection, a crown must be placed on the tooth and its condition is carefully monitored using x-ray control.

Removal

Removal is resorted to only at the most advanced stage of the disease, when:

the patient has periodontitis at the stage of gum pocket formation;
in case of vertical root crack;
with multiple severe tooth decay.

In the case of surgery, the pus is removed through a specially made wound, and after some time the granuloma disappears on its own.

Another method of removing disease, which is considered one of the best and gentlest of its kind. In this procedure, a laser beam is introduced through a channel into the granuloma itself, thereby causing the latter to evaporate.

Laser radiation not only has a beneficial effect on the enamel and tissues in general, but also guarantees complete preservation of the tooth, does not cause stress to the patient and ensures a completely painless process, however, such equipment may not be available in ordinary clinics.

Folk remedies

It is not possible to cure the disease on your own at home. However, for prevention purposes or to relieve symptoms, the following recipes can be used:

Tincture of calamus and - add vodka and infuse 30 grams of dry calamus root and the same amount of propolis in a dark place for two weeks. After the tincture is ready, strain it thoroughly. They should be used for rinsing the mouth: the prepared solutions should be mixed in a 1:1 ratio (just a spoonful). Important: do not rinse for longer than 3-5 minutes.
The coating formed on the nail when dipped in linden honey - the method is very extreme, but has a strong effective force. To prepare, you need to dip a hot nail into linden honey, and after a couple of minutes, remove the coating that has formed on it using a knife. It is recommended to apply the resulting mass onto sore gum to relieve swelling and pain in the granuloma area.

Video: cyst or granuloma?

Possible complications

Neglecting treatment for granulomas on the tooth root can negatively affect the patient’s health and give rise to serious consequences:

destruction of the apex of the tooth root and loss of the root itself;
sepsis, sinusitis, pyelonephritis are possible when the infection spreads throughout the body;
osteomyelitis of the jaw - with a purulent process of bone tissue;
meningitis, encephalitis, inflammation of peripheral nerves - often occur when the infection spreads to the maxillary sinus or anterior fossa of the skull;
, which is much more difficult to treat, can cause cancer.

The disease is a constant source of infection in the body, therefore, it can lead to various diseases, ranging from gumboil to ailments of internal organs.

Prevention

regular oral cleaning;
rinsing after every meal;
regular visits to the dentist (2 times a year);
healthy lifestyle: regular exercise and a balanced diet;
timely treatment of caries and gingivitis;
preventive rinsing of the mouth with special rinses or herbal infusions;
use soft so as not to damage or injure the gums.

Additional questions

Is it possible to save a tooth?

Yes, it is quite possible to save it, like an inflamed gum, however, treatment depends on the degree of development of the disease and its abandonment. If the problem is not identified early, treatment can often involve tooth extraction or gum surgery.

By international classification diseases, granuloma is in class 11 (“Diseases of the digestive organs”), in section K13 (“Other diseases of the lips and oral mucosa”) and is coded K13.4 – “Granuloma and granuloma-like lesions of the oral mucosa.”

To summarize, all granulomas are divided into simple and complex. The first type is characterized by a slight compaction of granulation tissue without the release of purulent exudate. Developed forms have a pronounced focus of inflammation and large sizes (up to 10 millimeters in diameter). Some experts do not share the concepts of cyst and granuloma. This needs to be sorted out. A classic granuloma does not have clear boundaries and shape, while a cyst is a capsule with purulent fluid, much larger in size, usually with less pronounced symptoms. On the other hand, a cyst is a developed form of granuloma, i.e., in fact, its more complex type.

How does the treatment of a cyst differ from the treatment of a granuloma?

Many experts distinguish three forms of the disease: granuloma, cystogranuloma and cyst. Depending on the type, a technique is selected and a detailed treatment plan is drawn up. It is believed that the initial form of granuloma can be treated conservatively, and to get rid of the cyst one cannot do without surgical intervention. This statement is partly true, but when drawing up a treatment plan, you must first of all evaluate the clinical picture. Cyst large sizes(more than 8 millimeters in diameter), which affects the roots of healthy teeth, has penetrated the maxillary sinus, caused a serious abscess or osteomyelitis, and must definitely be removed. Granulomas and cystogranulomas of small sizes in the absence of extensive inflammatory processes with the spread of purulent exudate are today quite successfully treated with antibiotics or endodontic manipulations.

Tooth granuloma: antibiotic treatment of simple forms of the disease

As already mentioned, granuloma at the initial stage responds well to treatment, since it is only a small nodule of connective tissue. For successful healing, as a rule, it is enough to undergo a course of treatment of dental granuloma with antibiotics. For this purpose, drugs from the group of tetracyclines (Doxycilline), lincosamides (Lincomycin) and penicillins (Amoxiclav) are usually used. The type of drug and treatment concept depend on the degree of pathology and the doctor’s recommendations. It is believed that for the simplest forms of granuloma without visible signs of inflammation, antibiotics in ampoules are prescribed, and to treat granuloma in a more advanced stage, injections are necessary. In addition, the doctor usually prescribes antimicrobial and anti-inflammatory drugs, as well as the use of antibacterial gels and ointments.

Treatment of granuloma at home

Can dental granuloma be treated? folk remedies? Yes, but only as an addition to the main therapy. Treatment with folk remedies for granulomas on the root of a tooth usually includes rinsing with various tinctures and decoctions. The most common of them are tincture of calamus and propolis, decoctions of chamomile and calendula, as well as regular soda solution. Often, the use of folk remedies is prescribed after surgical treatment of cysts and granulomas in order to reduce the inflammatory process and pain in the postoperative period.

Tooth granuloma: treatment of medium forms

To treat advanced forms of granuloma, endodontic techniques are used, which involve opening the root canal cavity. Treatment of diseases at this stage takes several stages and is carried out over a number of visits to the doctor.

Main stages:

dental treatment, opening and antiseptic treatment dental canals;
are placed in the canal cavity medicinal preparations based on antibiotics;
after expiration required period the canal cavity is opened again and filled with calcium-containing paste;
At the final stage, permanent canal filling and tooth restoration are performed.

Separately, it is necessary to mention two modern physiotherapeutic technologies for the treatment of granuloma, which are successfully used in endodontics.

Depophoresis. This is cleaning the canal cavity from pathogenic microorganisms using a copper suspension. Under the influence of electric current tiny particles actively move throughout the canal cavity and destroy the source of inflammation.

Dental microscope. A very useful and expensive device that allows for the most precise manipulations and provides a more predictable treatment result.

Laser treatment of dental granuloma

Laser treatment is considered one of the most advanced in medicine and is also used in dentistry. It is believed that treatment of dental canal granuloma with a laser allows you to do without the use of drugs, since the beam destroys the accumulation of granulation tissue and destroys all pathogenic microorganisms. This impact has its supporters and opponents. Fans laser treatment they assure the maximum effectiveness of the technique and provide statistical data demonstrating the effectiveness of this method. On the other hand, the cost of treating dental granuloma with a laser is higher compared to classical endodontic manipulations; the use of certain medications is still required, and in case of non-standard structure of the root canals (in particular, with severe curvature), the use of a laser is less effective. It can also be used during direct surgical intervention in the process of processing and removing tissue. This reduces the invasiveness of the operation, but increases the final cost of treatment.

Tooth granuloma: treatment of severe forms

Treatment complex shapes granulomas, in particular large cysts, are only possible using surgical techniques. The same goes for treatment of this disease after unsuccessful manipulations that caused numerous perforations of the tooth root. Below are the main granuloma removal techniques.

Complex granuloma on the root of a tooth: treatment	Description of the technique
Cystectomy (apex resection)	The doctor removes the granuloma along with the root tip, after which the canals are filled. Before the procedure begins, it is often necessary to drain the pus, which requires an incision in the gum and a certain time for the fluid to completely drain out (on average 2-3 days). To restore bone tissue in the area of surgery, the use of osteoplastic materials is required.
Hemisection	The granuloma is removed along with part of the root and crown, after which the tooth is restored. This is often how granulomas are treated when a tooth canal is perforated.
Separation	The technique is applicable exclusively to molars. The tooth is divided into two parts, after which the doctor carries out all therapeutic and restorative manipulations through the resulting gap.
Removal of a tooth	An extreme measure that is resorted to when all other methods are impossible for a number of reasons. These include severe damage to the tooth, as well as numerous perforations or a vertical crack in the root.

Important: Treatment of tooth granuloma under the crown requires extraction and subsequent replacement of the orthopedic element. If after treatment of granuloma the tooth hurts and the severe pain does not subside after several days, you should consult a doctor.

How much does it cost to cure granuloma?

You need to understand that the treatment of granulomas and cysts almost always involves endodontic, therapeutic or surgical procedures. In addition, after its completion, the patient requires tooth restoration, which also depends on the degree of damage. That is why you can find out the exact cost of treating granuloma only after undergoing an examination and the necessary diagnostic procedures.

A destructive dental formation, granuloma on the root of a tooth is dangerous due to its latent development in the initial stages.

If not treated promptly, it can cause serious complications in the human body.

Most often, inflammation affects: the face, neck, heart.

Description of the pathology

Granuloma is a cystic formation located at the base of the tooth and in the periodontium.

A tooth with a granuloma on the root (left) and a healthy one (right)

Purulent contents accumulate in the capsule, after which it becomes the main focus of the inflammatory process, which damages healthy tooth tissue. Infection cannot be prevented without treatment.

Education

It can become chronic with periodic inflammation of connective tissues. An exacerbation of the inflammatory process occurs after infection of the canals, and the altered tissues trigger an immune response to intensify the fight against pathogenic microorganisms.

Granuloma on the root of a tooth has its own sequence of development and is divided into stages:

pulpal inflammation– leads to the development of a large number of bacteria, which gradually leads to necrosis;
progression of microorganisms– infections penetrate into the bone tissue area, as a result of which the neoplasm becomes noticeable;
destruction– occurs when the bone begins to peel away from the epicenter of the infection, and a dense capsule appears in place. Inflammation progresses inside with rapid proliferation of microbes, rapid tissue growth occurs, and suppuration occurs.

The last stage needs emergency therapy, since infection can spread further to other organs and significantly affect the immune system.

Reasons for appearance

Granuloma can be provoked by many different negative factors, such as decreased immunity when the virus enters the blood, incorrect tooth extraction, or inadequate cleaning of canals during filling.

Other factors may also cause:

constant stress;
physical reboots.

Modern dentistry does not name specific reasons for the appearance of granuloma, but there are several main factors that provoke the appearance of a defect.

The following factors may cause:

presence of caries or untreated dental diseases;
, and its incorrect therapy;
inflammatory process under the crown;
trauma during removal;
improper filling of teeth.

Symptoms

The disease can go on for a long time without manifesting itself. During acute inflammation, the body signals the presence of infection.

The patient may feel:

redness and swelling of the gums;
weakening of enamel;
fever;
muscle weakness, migraine.

Modern diagnostic methods

X-rays will help accurately recognize the presence of damage; the dentist will detect the area with the formation; it will be darker in the image. Special attention given to clients with pulpless teeth, such individuals may develop a granuloma on the root of the tooth under the crown, which significantly affects the condition of healthy teeth.

They also pay attention to filled teeth, since after the procedure an inflammation called granuloma of the tooth between the roots may form inside. .

Also for dental research can be used more modern views devices with less radiation.

– a snapshot of the entire jaw, focusing the image from different angles. Helps assess the condition of the jaw apparatus. It is carried out for severe forms of the defect with complications;
radiovisiography– digital x-ray helps to obtain the most accurate picture of the pathological process .

Preventive measures

A set of measures aimed at maintaining oral health.

Experts advise adhering to some basic hygiene rules:

systematic – 3 times a day, after each meal;
visiting the dental office – once every 6 months.

Attentive attitude to your health - timely removal of caries and timely fillings prevent the development of education.

Complications

The consequences of dental granuloma cause discomfort to a person, and can lead to the development of associated disorders in the body and oral cavity:

to tooth decay and loss;
spread of the inflammatory process to soft tissues;
abscess formation;
damage to bone tissue leads to osteomyelitis of the jaw.

After which the person will have all his teeth removed and implants placed.

To avoid granulomas, you should remove everything harmful factors influence on the body. Properly clean the oral cavity, strengthen teeth and immunity vitamin complexes, eat properly and rationally, avoid the appearance of (pulpitis, caries).

Treatment of granulomas of various locations

Regardless of the location of the granuloma on the tooth root, it requires treatment and the necessary therapy already at the initial stages of the development of the disorder in the patient. In patients, granuloma can form on different areas gums and oral cavity.

Orthopantomogram

The choice between conservative and operative method occurs on the basis of an analysis of the stage of the process, the condition of the dental tissues, the presence or absence of complications, the presence of prosthetics or implantation. In order for the doctor to choose the right method of recovery, he needs to conduct an examination and collect an anamnesis.

In this case, send:

to undergo an x-ray examination;
for rehabilitation of a diseased tooth.

In this case, the patient must strictly follow the doctor’s recommendations and follow the instructions.

Conservative course

This type of therapy includes taking antibacterial, sulfa drugs and tooth filling.

Restoration inhibits the growth of granuloma and prevents the process of destruction of healthy teeth.

For dental granuloma, treatment with antibiotics is a method aimed at completely destroying the bacteria and disinfecting the tooth; by doing this, dentists stop the progress of the disease. Additionally, periodic mouth rinses are prescribed.

Antiseptic drugs – successfully remove pain syndrome.

Filling – if the client has inflammation of the pulp, the specialist removes the source of infection and cleans the canals.

In advanced cases, the conservative method does not bring results, then the affected area is treated promptly.

Surgical course

The main goal of operational surgical interventions consists of opening the granuloma capsule, which is subsequently cleaned and the contents are removed using antiseptic and anti-inflammatory drugs.

During surgical treatment there is a need to open the gums for the purpose of drainage for the outflow of pus. The procedure can last up to 72 hours.

The surgical operation is performed with widespread use medicines having a versatile effect on the painful area.

When the client is very sensitive to the drugs, local anesthesia is given with herbal solutions, applied to cotton swabs and applied. Effective intervention without removal facilitates further dental prosthetics.

The following activities are carried out:

resection of the root apex involves opening the dental canal - the crown is opened and filled with a special agent.
the capsule is broken through and the damaged top is removed;
placement in a cleaned tissue cavity;
completion consists of installing a filling.

Hemisection of tooth

It is prescribed if there is a lesion in a multi-rooted tooth and the root is completely destroyed.

Includes a number of the following activities:

root removal;
cleaning and filling the cavity with material;
installation of a crown;
X-ray control.

Removal

Prescribed if filling and crown installation have not brought any significant results. After elimination, the neoplasm disappears.

Folk remedies

Actively fight purulent inflammation, the following recipes for decoctions and tinctures from herbs, plants, sea salt, honey.

Let's present some recipes for decoctions and tinctures for the treatment of granuloma:

sage with oak bark– a good anti-inflammatory antiseptic; rinse the gums with a warm decoction several times a day. For the decoction you need: chopped sage and oak bark - 4g, a glass of water - 100g. Cook for 10 minutes;
sea salt– relieves acute pain from using the prepared product. To prepare the medicine you need: egg, 1 tsp sea salt, 1 liter cold boiled water. Rinsing is carried out 5-7 times a day after meals;
celandine with glycerin– relieves inflammation of the gums, serves good antiseptic and softening. You must have: celandine tincture – 30%, glycerin or vegetable oil– 5 g. Mix in a 1:1 ratio, apply compresses to the affected area with a cotton swab 2 times a day.

Preparation of medicinal tinctures

To the most popular medicinal tinctures relate:

calendula and eucalyptus– good to use for the prevention of dental diseases of the oral cavity;
propolis and calamus root– relieve pain and relieve inflammation of the gums. The mixture is used as a mouth rinse.

There are many more folk recipes therapy, usually herbal infusions are used as antiseptics and temporarily disinfect and anesthetize the diseased area.

Forecast

Is granuloma on the root of a tooth treatable or not? – a question that worries patients with this problem. The answer is simple - it is possible to cure, but it all depends on the stage or advanced stage of the disease. Most often, therapy consists of tooth extraction or surgical intervention on the gum.

Disease progression

When the problem is advanced, the patient experiences the development of purulent, discomfort and severe complications on vital organs, causes infective endocarditis which may result in premature death.

If you have symptoms of illness, you should visit immediately dental office. Hot compresses are strictly prohibited, and rinsing - all these actions will only aggravate the process of periodontal inflammation.

Numerous positive reviews indicate that granuloma is completely curable. However, it is easier for dentists to combat it in the early stages of education.

Video on the topic

And a positive ending - a video about the treatment of cysts and granulomas in one visit to the dentist:

Dental diseases are distinguished by the fact that most of them can occur in both pronounced and latent forms. Diseases that do not have clear symptoms in the initial stages of development are usually diagnosed at a rather dangerous time. acute period when intense pain begins to appear. One of these pathologies is granuloma on the root of the tooth. This disease is fraught with serious and even dangerous consequences for the body.

What is a dental granuloma?

Anatomically, a tooth consists of a visible part - the crown, covered with enamel, and an internal part, represented by the root. If this disease occurs pathological process occurs under the gum. Penetration of infection into the root of a tooth eventually leads to the formation of a neoplasm from connective tissue with purulent fluid inside. This formation is a granuloma. Most often, this tumor is localized on the upper part of the tooth root. Its spread leads to the destruction of healthy tissue and, as a result, complete destruction.

Reasons for development

Dental granuloma, as a rule, is a complication of neglected or untreated caries, or pulpitis. In this regard, these diseases are considered the basis for the development of granuloma. They also highlight more detailed list reasons influencing the occurrence of this pathology.

Unprofessional and low-quality dental treatment. Using old equipment medications. Insufficient treatment during treatment or filling with antiseptics and anti-inflammatory drugs.
Traumatic effects on dental tissues with the subsequent occurrence of an inflammatory process.
An advanced form of caries disease, accompanied by periodontitis, that is, inflammation in the tissues surrounding the tooth.
Lack of treatment for chronic and acute forms of pulpitis affecting the dental nerve.

In addition, there are factors under which dental granuloma occurs most intensely:

reduced immunity;
regular hypothermia;
chronic diseases of the cardiovascular and excretory systems;
excessive physical exertion;
prolonged exposure to stressful situations.

In the presence of these causes and factors, the risk of developing this dental disease is quite high.

The mechanism of pathology formation

Tooth granuloma is considered a kind of protection of the body against the effects of pathogenic microorganisms. The capsule formed from connective tissue acts as a barrier, preventing bacteria from penetrating into unaffected areas. The mechanism of development of this pathology includes 3 mandatory stages.

Advanced dental disease: caries, periodontitis, periodontitis, which subsequently causes an increase and significant accumulation of microorganisms. As a result, under the influence of bacteria, an inflammatory process develops and pulp cells begin to gradually die. As a result, the ridges of the tooth become significantly exposed and it becomes mobile.
Active reproduction of pathogenic microorganisms allows the infection to penetrate the bone tissue. After which a formation begins to form around the perimeter of the affected area.
At the last stage, the granuloma itself is formed from the connective tissue. Within this neoplasm there is an interaction immune cells with bacteria. Pus at the root of a tooth is a consequence of the death of pathogenic microorganisms.

If a sick person has problems with immune system, there is a risk of granuloma rupture, and as a result, inflammation spreads to the gum and tooth root. That is why, when a purulent formation appears, it is important to seek medical help in a timely manner.

Symptoms

Granuloma in the early stages of development does not have obvious manifestations, so it is quite difficult to identify it. In some cases, the neoplasm reaches enormous sizes and is easy to identify even during the initial examination. In addition, as the disease progresses, other symptoms begin to appear:

slight swelling of the cheeks;
intense and prolonged pain syndrome;
the affected area becomes darker;
increase in body temperature;
dizziness and headache;
discharge of pus;
flux formation;
feeling constant fatigue, weakness.

If left untreated, this pathology can transform into a cyst and cause severe fever. For dental granuloma, the symptoms are varied and, most often, hidden. However, having discovered signs of the development of the disease, comprehensive medical treatment must be started in a timely manner.

Diagnostics

It is possible to detect granuloma in the early stages of development, however, for this it is necessary to undergo regular dental examinations. Because the professional doctor able to diagnose the disease with normal preventive examination. In this case, the dentist may notice a slight swelling of the gums or a “bulge” of bone against the top of the tooth root.

To confirm the granuloma, the doctor prescribes an x-ray examination, based on the results of which a final diagnosis is made. Only after this the specialist prescribes treatment for dental granuloma.

Note! Self-therapy of any dental disease is harmful to the entire body.

Main directions of therapy

The most pressing question after diagnosis is how to treat dental granuloma? Only the treating specialist can answer this, since therapy depends on the stage of development of the disease and individual characteristics the patient's body. However, there is one irrefutable rule: the earlier treatment begins, the higher the chances of keeping the tooth intact. In addition, modern dentists identify two main methods used to solve this problem: conservative therapy and surgical intervention.

Conservative therapy is used if the pathology is detected in the early stages of development. For granuloma on the root of a tooth, treatment includes taking non-steroidal anti-inflammatory drugs, antibiotics, and painkillers. In addition, the conservative method also involves the use of fillings and daily rinses with antibacterial solutions.

Surgical tooth extraction

Unfortunately, conservative methods are not always effective. That is why, in some cases, surgery is the only way fight against granuloma. Performing surgery to treat this disease involves using one of three methods.

Excision of the root apex. At the first stages of the procedure, the surgeon “opens” the tooth, thoroughly cleans the canals, and treats them with a special medical preparation. After which the tumor and the affected tooth root are directly removed. Next, the tooth is properly filled.
Hemisection. This method is used when the granuloma has affected many of the roots of the tooth, and there is no way to preserve the integrity of the root. Carrying out hemisection involves resection of the tooth root and a small area of the coronal part, treatment with a special drug and further prosthetics. After the operation, regular monitoring of the condition of the tooth is carried out for some time.
Removal of a tooth with granuloma. Such a procedure is an extreme step, used when the inflammatory process is detected at a late stage, there is obvious tooth decay or the development of periodontitis. The operation is performed under local anesthesia and involves several repeat visits to the dentist.

Carrying out surgical intervention granulomas of the teeth involve treatment with antibiotics as one of the components of the therapeutic complex.

Note! The sooner a granuloma is identified and treatment is started, the higher the chances of preventing tooth extraction.

Possible complications

Absence or not professional treatment granulomas can lead to the development of quite serious complications.

Complete resection of the tooth, that is, its loss, since granuloma can completely destroy the root.
Transformation into a dental cyst, which can subsequently become malignant.
Extensive distribution of pus is the basis for the development of osteomyelitis.
Untreated granuloma negatively affects not only the oral cavity, but also the body as a whole. Therefore, various forms of sinusitis, pyelonephritis and others often occur. inflammatory diseases internal organs.
If the infection spreads to maxillary sinuses further, the risk of developing encephalitis and meningitis increases.

In order to prevent the formation of the above negative consequences granulomas, it is necessary to undergo comprehensive professional treatment and follow recommendations for the prevention of complications.

Pyogenic granuloma of the gums

One of the most common neoplasms. Occurs mainly among people young, adolescents and women during pregnancy. A characteristic feature of granuloma on the gum is that, by its nature, it cannot always be given a similar name.

This education- the body's reaction to chronic irritation, in this case, an area of fibrous connective tissue is formed with a large number of capillaries and without the formation of pus. This neoplasm is formed due to improper cavity hygiene, hormonal imbalances, as a consequence of poor quality dental treatment. Therapy for pyogenic granuloma includes the use of anti-inflammatory drugs and complex multivitamins.

Granuloma is one of the secretive dental diseases that does not have characteristic and obvious symptoms in the early stages of development. That is why this disease is usually detected when there is significant damage to the tooth. At the slightest manifestation of this disease, it is important to consult a specialist in time. In order to reduce the risk of tooth loss and serious complications.

Granuloma is a clearly defined inflammatory focus of growing granulation tissue, fused to the apex of the tooth root. Its other names are apical or periapical granuloma. This tumor does not resolve on its own and therefore requires treatment.

Dental granuloma is a dental disease that occurs in a latent form. Pathology is diagnosed only after acute, pronounced development has been achieved.

Granulation tissue is a new, actively growing tissue that replaces dying areas of periodontal tissue at the site of inflammation. The proliferation of granulation tissue occurs in response to an inflammatory process at the root.

A granuloma looks like a small 5-8 mm sac of granulation tissue, capable of quickly suppurating and enlarging, spreading the infection to healthy adjacent tissues. In rare cases, there are quite large granulomas - up to 12 mm in diameter - that are confused with a cystic structure.

Dental granuloma and cystogranuloma are successive phases of development of complications of the inflammatory process in the periodontium. Cystogranuloma is a transitional form between granuloma and cyst, but there are no clear guidelines for distinguishing these stages in dentistry yet.

How is it different from granuloma? Cystic neoplasms- These are most often painless capsules with serous-bloody or purulent fluid, covered with a sheath of connective tissue. They are formed due to suppuration in the periodontium (tissue around the tooth) and reach 10–12 mm or more. Granuloma is not a cavity, but a dense, continuous formation consisting of granulation tissue covered connective tissue. This pathology festeres much more often, leading to acute pain when biting.

Why is it necessary to differentiate these two anomalies?

The treatment program and further prognosis depend on the exact diagnosis - dental granuloma or other formation. Conservative therapy is considered the main method of treating granulomas, since medications and physical therapy are often sufficient for the abnormal focus to be eliminated. more often it is necessary to carry out radical methods with tissue excision.

The mechanism of granuloma formation involves several stages:

Due to inflammation of the tissue at the apex of the tooth root (periodontitis), the pulp (nervous tissue) becomes inflamed and destroyed.
Due to impaired blood supply and infection at the apex of the tooth, suppuration occurs and bacteria penetrate into the periodontium and bone.
The periodontium around the root suppurates, the bone tissue gradually resolves and a dense formation forms around the source of infection - a granuloma, which isolates bacteria, pus and dying tissue fragments inside itself.
Next, there is a gradual proliferation of granulomatous tissue.

Causes of granuloma formation on the tooth root

Among the causes of granuloma on the root of a tooth, the main one is considered to be the introduction of pathogenic bacteria into the periodontium (the tissues that hold the tooth in the socket) and its inflammation. This occurs in the following abnormal conditions and pathologies:

untreated caries or pulpitis (chronic);
improper filling of root canals - microbes begin to multiply in a poorly sealed cavity at the apex;
gum injuries and tooth fracture;
introduction of infectious agents during the treatment of dental diseases (failure to maintain sterility);
piercing the top of the root canal as a result of a medical error when cleaning the canals or installing a pin;
periodontal disease, periodontitis;
an inflammatory process that begins at the root of the tooth under the crown;
penetration of pathogenic bacteria into the gingival socket after tooth extraction (including milk teeth).

Symptoms over time

For a long time (sometimes up to several years) granuloma grows without manifestation noticeable symptoms, which makes it difficult early diagnosis. In most patients, inflammation manifests itself against the background of decreased immune defense, acute illness, hypothermia, prolonged physical and mental stress.

However, it is possible to trace the increase in the symptoms of granuloma over time as the pathology progresses. Primary manifestations, the duration of which varies from 1 – 2 months to 2 years:

increased tooth sensitivity, painful, unpleasant sensations when biting hard pieces of food, chewing food;
darkening of the enamel of the affected tooth;
not too pronounced, short attacks of aching dull pain.

Symptoms of granuloma at the stage of acute inflammation:

pronounced toothache, worse when chewing food;
false feeling that the tooth seems to have grown;
slight painless swelling of the facial tissues opposite the affected tooth.

If left untreated, acute suppuration develops, which is accompanied by:

acute throbbing pain that can radiate to lower jaw, in the infraorbital region, ear or neck;
swelling, redness and soreness of the gums;
discharge of pus from the gum pocket;
noticeable swelling of the face;
inflammation of nearby lymph nodes;
increased temperature;
headache, weakness.

Laboratory blood tests during suppuration of the apical formation show an increase in the erythrocyte sedimentation rate (ESR) and an increased content of leukocytes in the blood.

Diagnostics

Since visual changes do not occur at the early stage of granuloma, it is possible to recognize it only with obvious enlargement and suppuration of the already affected area. To detect granuloma in that phase of development when therapeutic treatment is still effective, a detailed examination is required.

To choose a treatment method, it is necessary to differentiate dental granuloma from other hilar neoplasms.

The condition of adjacent tissues around a granulomatous and cystic lesion may differ slightly. With a suppurating granuloma, the gum mucosa becomes very red, swollen and painful. However, these signs are indicative.

An accurate diagnosis is made based on two main methods:

radiography;
radiovisiography or computer x-ray (diagnostic method using digital radiographic equipment).

On an x-ray and radiovisiographic image, the granuloma will be visible as a darkened area with a clear outline at the apex of the diseased tooth.

Dimming size is only indirect sign, indicating the type of root formation. Depending on the size of the tumor, the darkening in the image is classified as follows:

size up to 5 mm: high probability of granuloma;
from 5 – 7 mm: possible cystogranuloma;
8 – 15 mm and more: cystic formation.

A large granuloma can also form (up to 10–12 mm), so in practice, the type of hilar formation can often be determined only by the results of a biopsy - an examination of a particle of tissue from an abnormal node.

It is necessary to distinguish between a hilar granuloma in a tooth and a gingival granuloma, which is a tumor-like benign vascular formation. It usually develops from the gingival papilla and occurs due to microtrauma of the gums, during hormonal imbalances (pregnancy, menopause). When a granuloma appears in the gum, it looks like a soft, smooth nodule 5–15 mm in size, dark red (sometimes purple) in color.

Complications

Abnormal root formation of a tooth is an active source of infection, therefore (if left without treatment), possible serious consequences. Among the common pathological conditions that untreated granuloma leads to:

further progression of periodontitis and fistula formation;
inflammation of the tissue of the tooth socket (alveolitis);
transition of the process to the periosteum with the development of a purulent abscess of flux (periostitis);
destruction and death of the bone marrow base of the tooth - osteomyelitis;
resorption (resorption) of periodontal and bone tissue, leading to tooth loss;
abscess, phlegmon (spread suppuration of the perimaxillary tissue in the oral cavity);
damage to organs remote from the tooth due to the penetration of infection from the source of suppuration into the lymph nodes (lymphadenitis), heart (endocarditis), liver, kidneys, brain tissue;
migratory granuloma of the tooth root, in which migration (spread) of the inflammation process occurs subcutaneous tissue persons with abscess formation and the formation of new lesions;
septic damage to the body when bacteria enter the bloodstream.

Removal of dental granuloma must be carried out as early as possible to avoid consequences. Therefore, at the first symptoms you need to consult a specialist.

Can a tooth granuloma resolve under the influence of rinses and lotions? By itself (without treatment) or only with the use of rinses, dental granuloma will not disappear, as many believe.

Completely remove the abnormal formation and save the tooth professional dentist capable at different stages of pathology, but can do it without surgery and with minimal adverse reactions only happens at an early stage.

Treatment of granuloma on the root of the tooth is carried out therapeutically and surgically. The choice of treatment method is determined by the size of the inflammatory focus, the degree of spread of infection and periodontal destruction, and the presence of complications.

To prevent exacerbation of the inflammatory-purulent process, any types of thermal effects on the granuloma are unacceptable (including compresses, heating pads, hot rinses and even eating hot food).

Conservative therapy

Unlike a dental cyst, a granuloma on the root of a tooth is more easily amenable to conservative therapy aimed at suppressing the infectious focus and preserving the crown. Therapeutically, the formation is treated at the initial stage of inflammation, until suppuration develops.

Treatment of granuloma through therapeutic methods includes complex measures: correct technique fillings, active disinfection, parallel administration of antibiotic drugs to eliminate pathogenic flora.

Very rarely, the formation disappears only through treatment with antibiotics (more often with injection). However, such a treatment program is only possible for small and non-festering formations.

Filling canals is not permissible without x-rays. The first image before treatment is mandatory and is diagnostic. The second radiograph - control - is performed to assess the correctness of the performed medical manipulations.

How is an abnormal formation removed using dental procedures? The treatment process consists of several stages:

Removing a previously placed filling or opening an unfilled tooth.
Mechanical cleaning of the dental canal with access to the granulomatous lesion (which creates conditions for the release of pus), elimination of abnormal tissue.
Sterilization of the canal by washing with disinfecting solutions, ultrasonic treatment or laser radiation.
Placing a medicinal substance with calcium hydroxide inside the canal and cavity of the granuloma, which suppresses bacterial activity, causing the growth of bone tissue behind the root apex, which is visible during radiovisiography approximately 20 days after administration.
Placement of a temporary filling.

After the doctor is convinced that the inflammatory process is suppressed and active tissue healing is occurring (confirmed by x-ray):

The medicinal paste is removed and the canals are re-treated with antibiotic drugs.
The final dense filling of the tooth is carried out. The best option is to use modern method vertical condensation. It consists in the fact that medical gutta-percha is heated and compacted in the root canal, filling all lateral (side) branches and precisely taking their shape.

When all stages have been completed, you can begin to restore the tooth crown.

Antibiotic drugs

For granuloma, antibiotics are prescribed to stop the activity of bacteria in the lesion, avoid further spread of the process, and prevent complications and relapses.

The selection of specific antimicrobial agents is carried out only by a doctor who can really assess the severity of the abnormal process and the extent of the granuloma. Most often for successful treatment granulomas use: Amoxiclav, Abaktal (Pefloxacin), Flemoxin, Tsifran, Sumamed (azithromycin), Doxycillin, Ciprofloxacin.

To suppress inflammation and relieve pain, along with antibiotics, drugs such as Nurofen, Ketonal, Voltaren, Nise, Tempalgin may be required.

As a result of complete complex therapy, the granulomatous lesion is completely destroyed, bone and gum tissue are gradually restored. If the dynamics are positive, after 2 – 3 months X-ray confirms complete cure.

Laser method

Laser treatment of dental granuloma is part of conservative treatment, which is used at the stage of root canal sterilization. It is carried out after opening the tooth, cleaning the canals and removing pus.

To completely clean the canal walls and granulomatous lesion from microorganisms, a laser beam is used, evaporating abnormal cells and completely disinfecting the treatment area. Unfortunately, this is an expensive procedure and its use is only possible with non-curved canals.

Removal of tooth granuloma

Treatment by surgery must be used if conservative treatment turns out to be ineffective, which more often occurs with serious destructive processes in the periodontium and bone tissue. All surgical procedures are performed only under local or general anesthesia.

There are several techniques for performing the operation, but at stage 1, surgical opening of the gums is required to drain the purulent contents. Then drainage is introduced into the lesion, leaving it for up to 3 days for the gradual release of pus.

At the same time, treatment with antibiotics, anti-inflammatory and painkillers is prescribed.

Cystectomy.

Cystectomy involves resection (excision) of the root apex. First, a piece of gum tissue is peeled off, providing access to the top of the tooth, after which the granuloma is removed along with part of the root.

After resection of the root apex, the resulting cavity is filled with synthetic tissue substitutes, and the tooth is filled. The operation lasts about an hour.

Cystotomy.

This method is suitable for removing large granulomas and involves gradual removal of the lesion. First, an artificial channel is created between the source of suppuration and the oral cavity, through which all the pus comes out and is absorbed into cotton swabs. After complete cleansing, active antibacterial treatment of the cavity is carried out, and sutures are applied. Bone tissue gradually grows, filling the cavity freed from pus. The procedure is lengthy, but is tolerated quite easily by patients.

Hemisection.

The procedure is performed only on multi-rooted teeth. With this surgical technique The granuloma is eliminated along with the removal of the root and crown fragment. The operation is considered uncomplicated and allows partial preservation of the tooth and its functions, which makes it possible to further carry out full aesthetic prosthetics.

The method is indicated only if the remaining roots and crown are able to withstand the intended load.

Removal of a tooth

They try to remove a tooth with a granuloma in extreme cases, and only if other measures are ineffective, in the following conditions:

destruction or cracks in the root;
pronounced destruction of the pulp and crown;
dense filling of root canals.

After the tooth is extracted, all the contents from the source of suppuration exit through the hole in the socket, that is, the resulting granuloma is completely eliminated after tooth extraction and antiseptic treatment. At the site of the removed root and tooth, the wound tightens and full recovery periodontal tissues. After a few months (you should wait for complete healing to occur), you can put a pin for the new tooth.

Surgical treatment is accompanied by the simultaneous use of:

antibacterial and painkillers in tablets or injections;
local anti-inflammatory and painkillers: dental gels Metrogyl Denta, Cholisal, Oralcept spray;
rinsing antiseptic solutions(Romazulan, Chlorhexidine).

Period after surgery

After treatment, it is completely normal if the gums hurt for 5 to 7 days, swelling and redness are observed. The above-mentioned anti-inflammatory and analgesic medications and rinses help relieve pain and swelling.

But if all the unpleasant postoperative manifestations intensify, the gums continue to hurt, the swelling does not subside for longer than 7–10 days, the temperature rises or the lymph nodes are swollen, you should immediately go to your doctor.

Oral care after granuloma surgery

It is necessary to follow the rules to prevent the secondary introduction of infection:

Do not eat or rinse your mouth for 3 – 4 hours. It is advisable to drink only through a “straw”.
Smoking and drinking alcohol are not allowed for 3 days.
Hard foods, spicy, spicy, hot foods and drinks are prohibited for at least 10 days.
Chewing food is allowed on the side of the mouth where there is no wound.
Do not brush your teeth until the gums in the area have completely healed. surgical treatment(from 30 to 60 days).
For 2–3 weeks (or longer), gentle mouth rinses 3–4 times are recommended.
For 2 months, anti-aging facial procedures are excluded, including massages, bio-reinforcement, injections, peelings.
It is necessary to avoid baths, hot baths, saunas, swimming pools and swimming in ponds for 2 - 3 weeks.

Folk remedies

It is not possible to cure dental granuloma at home using only folk remedies. Because lotions and solutions do not come into contact and do not interact with the source of inflammation located in the thickness of the tissue.

However, treatment of dental granuloma with folk remedies is used in the following cases:

to enhance the effect of drug and surgical treatment, additional disinfection of the oral cavity;
to alleviate postoperative symptoms;
to accelerate tissue healing and increase local immune defense;
for prevention purposes.

At home (with the permission of your doctor), you can use the following recipes:

Take 2 tablespoons of calamus root and propolis, pour the raw materials separately in different bottles with high-quality vodka, leave in the dark for 14 days. After straining, use to rinse up to 3 times a day. Before rinsing, mix the solutions in equal parts (a tablespoon of each type of tincture), add 2 tablespoons of boiled water. Do not keep in mouth for more than 30 seconds.
Dissolve three tablets of natural mummy in a glass of warm water and rinse your mouth throughout the day.
Dissolve a teaspoon of salt (table salt, sea salt, iodized) in a glass of warm boiled water and rinse your mouth 5-6 times a day. You can add the same amount of soda and 3 drops of iodine (if there is no allergy).

It should be taken into account that in the postoperative period (especially after tooth extraction), active rinsing is unacceptable in order to avoid washing away the protective blood clot in the wound area.