What is dental granuloma and how to cure it?

When a tooth has deep caries and is not treated in time, it risks a more serious inflammatory process: pulpitis, an inflammation of the dental pulp. After a period of more or less expressed pain, the nerve contained in the pulp of the tooth goes into necrosis: the tooth no longer hurts, but the carious lesion remains, and the pulp contained in the roots fills with bacteria that proliferate and reach the root tip. 

Consequently, inflammation goes into the alveolus, which is the jaw bone that contains the roots of the dental elements. Our body reacts to the infection by limiting it to the space near the apex of the root, where granuloma, a sign of dental pulp degeneration, forms. It is an inflammatory form that becomes chronic, often without symptoms.

Granuloma is discovered in many cases with an X-ray that shows a dark, usually roundish area of the bone surrounding the root. Usually the tooth does not respond to thermal stimuli because the nerve has degenerated.

Sometimes granulomas can also be found in already devitalized teeth. How is it possible? It is possible that after devitalization (cleaning and filling root canals) there remains a proportion of bacterial load that supports the formation of the apical granuloma of the treated tooth.

A granuloma can remain silent for years and flare up due to an increased bacterial load. In this case, antibiotic therapy combined with root canal treatment of the affected tooth is indicated. If the visible part of the tooth, which is called the crown, is intact enough to be reconstructed, the treatment involves: 

• disinfection of canals;
• closure of canals;
• crown reconstruction.

An apical granuloma can grow to a conspicuous size and can evolve into a cyst, a benign lesion that often requires surgery for its removal. Frequently, removal of the cyst is followed by removal of the involved root tip (apicoectomy).

A flare-up of it frequently leads to the development of an abscess with intense pain and swelling. This eventuality is avoidable by treating the lesion through early diagnosis using endoradiography images.

Prevention of granuloma formation is closely linked to caries prevention: thus, periodic check-ups, including x-rays, are the key to never incurring granuloma. Check-ups should be thorough and consider asymptomatic teeth and previous denture work, which sometimes conceal inadequate devitalizations, often a breeding ground for silent apical granulomas.