Apical periodontitis

The changes in the periodontal ligament around the apical foramina cause an increased pressure, producing sensitivity to percussion, occasional elevation of the tooth in its socket, creating trauma and pain on chewing.

The complications of apical periodontitis may occur in four forms: the periapical granuloma, the apical periodontal cyst, the periapical abscess, and osteomyelitis. The granuloma grows slowly and produces few clinical signs. The same is true of the apical periodontal cyst until it becomes so large that it expands the cortex of the maxilla or mandible. Both are readily seen on radiographs.

Apical periodontitis and its sequelae are treated by endodontic therapy or extraction of the tooth. When this condition is accompanied by systemic symptoms, antibiotic therapy may precede the definitive dental therapy.

Periodontal disease and diabetes

Periodontal diseases affect the soft tissues and bone that support the teeth. Gingivitis or inflamed gums, is the early form of periodontal disease. If left unchecked, gingivitis can progress to a more severe condition called periodontitis. This infection, caused by harmful bacteria, eventually destroys the bone and ligament which hold the teeth in place. Sound teeth may become loose and, if untreated, can be lost.

For people with diabetes mellitus, periodontitis can be a major complication of their disease. Periodontal infection can upset blood sugar control, and loose or missing teeth can make eating the right foods difficult.

What causes periodontal disease?

Dental plaque plays a major role in the development of gingivitis and other periodontal diseases. Plaque, a sticky film containing millions of bacteria, attaches to the teeth. Only certain types of bacteria, however, are suspected of causing gum disease. Dental scientists are studying these and other harmful organisms to determine the exact roles they play in periodontal problems.

Other factors that contribute to gum diseases include poor nutrition, inherited defects in infection-fighting cells, hormonal changes in pregnancy, and certain diseases such as diabetes mellitus.

Periodontal diseases are a problem for many people. In fact, the majority of the population above the age of 40 probably has some form of the disease, ranging from mild gum inflammation to severe periodontal infection. Although most of the damage from gum disease occurs after the age of 35, dental scientists believe that the disorder has its beginnings in youth. Most school children have gingivitis, and some even have the more destructive form of periodontal disease.

A guide to dentistry

•  Lasers - used instead of drills to treat soft tissues (like gums), although they can't cut through dental enamel.

•  Infra-Oral Cameras - pen-shaped devices used to take snaps of your teeth. The image can be flipped onto a monitor to explain treatment.

•  Porcelain Laminates - the veneer material that most closely resembles natural tooth. Surface details, colour and texture look natural. Veneers can be made as thin as 0.5mm yet last for 15 years.

•  Resin Laminates - slightly cheaper than porcelain but don't look as good or last as long, say dentists. Resin is porous, takes up stains and has to be replaced every 2 - 4 years like white fillings, making it more expensive in the long run.

•  Dental patches - an alternative method of pain control. They stick to gums like a plaster and administer a dose of anaesthetic. Great for injection phobics, although they can be tricky to keep in place, according to dentists.

•  Glass Ionomer Fillings - bond chemically to the tooth and act as a fluoride source, but they can't be used on biting surfaces.

•  Injections - needles are getting finer and less painful.