Dental nodule treatment
Find out more about dental nodule screening
and treatment
Below we have collected the questions that our patients ask most about dental gum and its consequences!
What is dental nodule treatment?
The first thing to clarify is what a dental abscess is: a dead tooth with a bacterial infection in its root canal system. This bacterial infection spreads to the root tip and forms a chronic inflammation, or nodule. From this nodule, as a dental nodule, bacteria flow out through the interstitial fluid into the blood vessels, spreading to other areas and organs of the body. In other organs, such as the skin or joints, secondary disease, i.e. symptoms of the nodule, appear, for example in the form of skin disease or arthritis.
The treatment of a dental abscess is therefore primarily aimed at eliminating the existing infection. Root canal treatment offers the possibility of doing this. If this is not an option, removal of the infected tooth may be necessary. The treatment of dental abscess can be based on an accurate diagnosis.
If I have a filled tooth, is it a dental nodule?
Not necessarily! If the tooth is alive, and most crowded teeth are alive, then the tooth is not a dental calculus. A tooth becomes a pulp when it is dead, i.e. there is no living blood vessel or nerve tissue in the root canal system. However, bacteria can enter the cavity canal system and maintain infection. If the infection gets through to the tip of the root, it can cause tissue inflammation there, and then the infection escapes to other areas of the body in the bloodstream. This is called a secondary nodular disease and the tooth is now a dental nodule.
If a tooth has a nodule, do I have to have it extracted?
No! We distinguish between several categories, and we also have to consider the severity of the symptoms caused by the infection, whether there may be a focus elsewhere in the body, or whether we should only look for the problem in the mouth. For example, if the cardiologist asks for a so-called “decontamination” before a serious heart operation, the procedure is quite different, since a so-called “survivor”, i.e. a tooth that is free of symptoms but still visibly infected on X-ray, can be life-threatening.
So, if there is time for treatment and there is no serious, life-threatening pathology, it may be worthwhile to have the tooth root canaled or revisited, i.e. to have the root canal done again if it has been done in the past. However, we cannot expect an immediate result here. On the one hand, the treatment itself is long and, on the other hand, it takes months after the root canal or re-root canal to demonstrate that the inflammation of the root canal has disappeared.
Can you tell without an X-ray whether a tooth is a nodule or not?
No. X-rays are an essential part of the dental gum examination, as they help you to “see inside” the bone. We mainly take panoramic X-rays. In fact, modern imaging tools such as 3D CBCT X-rays can help to determine with even greater accuracy whether or not a tooth is decayed. In some cases, a lesion seen on a panoramic X-ray can give a false positive or false negative result. So a tooth may be alive, even though the x-ray shows a dark lesion, or it may be dead, even though the panoramic x-ray shows nothing. So the panoramic X-ray should in most cases be complemented by an intraoral X-ray or a 3 D CBCT scan and of course the combination of the oral examination and the X-ray analysis will give the final diagnosis.
What happens if I don't get a root canal treatment for a tooth that has a nodule?
If left untreated, nodular inflammation in the bone will further destroy the periodontium. This means localised bone loss. In the long term, this is not beneficial – even if it is often painless – because valuable bone tissue around the nodulated tooth is destroyed. If this tooth is extracted over time, much less bone remains in its place. This, in turn, limits the options for further tooth replacement, which may not be possible or may require bone grafting.
In some cases, inflammation around a previously chronic, silent nodular tooth can become acute, causing the patient severe pain and inflammation. Such a flare-up often requires antibiotics and, in the case of an immune deficiency, can even lead to sepsis, a serious infection in the tissues.
At an organ level, there is also no benefit from an untreated tooth. In fact, from a nodular infection, bacteria are constantly flooding the blood vessels and spreading to other tissues, skin, joints, heart valves, etc. This may not be a problem for a while, as it is an invisible burden on the immune system. But in the long term, the damage causes serious organ problems.
A nodulated tooth should therefore be treated:
- close, six-monthly x-ray monitoring in the case of a symptom-free, well-functioning, well-closed, so-called surviving tooth
- in the case of a tooth with a complaint, root canal treatment, if possible, or re-root canal treatment
- in the case of an unsalvageable tooth – for example, due to severe coronal damage or other anatomical complications – tooth extraction
Not sure! But teeth that are dead or have been treated, but still harbour infection, could potentially be dental abscesses. So the obvious answer is: not sure, but it can! The question is not too difficult to find out:
- oral examination
- panoramic and intraoral X-rays
- if necessary, a 3D CBCT X-ray can be used to detect potentially infected teeth and provide an answer.
According to the rules of the profession, ALL CONTRACTED CUSTOMERS ARE POTENTIALLY TAKEN AS GUESTS! So, if you suspect you have a root canal disease, e.g. hair loss, joint problems, skin problems, etc., and you know you have a root canal, see your dentist and ask for a dental root canal screening or treatment! Even if your tooth was root canaled a long time ago and you have no complaints at all! X-rays, and even more so a 3 D CBCT scan, can reveal an infection at the root apex of a tooth that has no complaints.
There are several aspects to consider:
First and foremost, what does the Patient want? How much time and energy are you willing to invest in this if the success rate of the treatment, according to scientific research, is around 80%? In other words, do you accept that you are entering into a treatment process that will take time, energy and money, but that you know from the outset that there is an 80% chance of success? By the way! What is success and what is survival in root canal treatment?
Success is when after the root canal the tooth is in the mouth, aesthetically and functionally functioning perfectly, completely free of complaints and no inflammation around the root apex is visible on X-ray analysis. Survival has a slightly different wording: the tooth is in the mouth, aesthetically and functionally functioning, free of complaints, but X-rays show a crack in the bone tissue surrounding the root tip. Such a tooth, if there are no other nodal symptoms or general organ complaints, can be considered a survivor (i.e. not a complete success) and is checked every six months. So it is not necessarily revised (i.e. re-treated) and not necessarily removed, but it is known and controlled.
If the tooth is causing complaints, the structural condition of the tooth is otherwise good and the patient feels they are trying to save their tooth, in which case it is worth investing time and energy in re-root canal treatment. After all, a root canal tooth is your own tooth. It is like having your own implant.
It’s worth taking the plunge, especially as there are much better and more effective methods of disinfection available today, and microscopic root canal treatment can achieve a much higher success rate.
A decayed tooth is not necessarily root canal treated, it may have developed a periodontal necrosis (necrosis) under an old filling, which has been silent and the tooth has been free of symptoms. However, the vital blood vessels and nerve tissue inside the tooth have been destroyed and the internal canal system, fed by deep decay, has become infected. This process is chronic for a long time, the bacteria get to the root tip, where they develop inflammation, but the patient does not feel this for some time. The pain becomes an “experience” when the chronic process becomes an acute process. This may be due to, for example, a reduction in the immune system’s defences or changes in the quality or quantity of infectious bacteria.
In the case of a root canal treated tooth that is also infected, the tooth itself is not painful, as there is no sensory nerve, but the inflammation at the tip of the root becomes painful through the nerve endings in the periosteum.
Well, at a basic level, you brush your teeth so thoroughly that they don’t come out, so you don’t need dental fillings. If you already have fillings, be aware that they need to be checked every year and replaced from time to time.
If you have root canals, they should also be checked every year, even if there are no complaints. A tooth that has had a root canal is considered successful 4 years after treatment!
It’s important to know that there are very modern tools and materials to avoid root canal treatment, even for painful, deeply cavitated teeth. It is important to note that even a deeply decayed tooth can be saved from root canal treatment if it is in good hands, in time, in the hands of a skilled professional. Once a tooth has been root canaled, it is potentially a pulp, so prevention is the key!
Steps for dental nodule screening and treatment
Hair loss, skin conditions or joint pain are the most common reasons we are contacted to look for a tooth that could be a potential abscess. Before more serious surgery, the doctor will also ask for a foci test.
What would you like?
X-ray tests
Verification
Prognosis
Sufficient time
IMPORTANT! If your doctor asks you for a dental check-up before surgery, please allow enough time for this! If a tooth has a potential abscess, the quick treatment is just tooth extraction! If you want to save it, root canal treatment is the way to go, but it takes more time!
Treatment
A tooth identified as a nodule is either just observed or treated. The quick treatment is to remove the tooth. If we save the tooth, we root-treat it, if it is already rootless, we perform a revision, i.e. re-root-treatment.
Panoramic X-ray
Intraoral X-ray
3-dimensional CBCT
Bacteria in the canals
Nosocomial disease
Inflammation in the bone
Cyst or inflammation on the root
Although all root tip infections are potentially infectious, not every cyst is definitely a dental nodule, nor does it cause a nodular disease. Nevertheless, the screening and treatment of suspected cysts is an important task of the root canal dentist.
Decontamination protocol
Micro CT scans have revealed that due to the anatomy of the tooth, it is impossible to reach 100% of the root canals with the root canal needles. Therefore, more recently, disinfection procedures have been introduced that are more chemically effective in disinfecting the canals, thus reducing the chance of infection remaining inside.
Re-treatment
Severe inflammation of the gums
Tartar build-up on the gums irritates the tissues that support the teeth, over time gingivitis develops, and if left untreated, periodontitis develops and the bone supporting the tooth atrophies. A pocket forms between the gum and the tooth. Imagine if you put the inner surfaces of the pockets around the teeth together, you get a “scar” the size of the palm of your hand, constantly covered in bacteria.
Hand-sized inflammation invisible
Through the mucous membranes of inflamed gum pockets, bacteria and their toxins are constantly entering the bloodstream and therefore any part of the body. This can cause a gum disease in exactly the same way as an inflamed tooth root.
“Hair loss, joint problems and skin conditions can be caused by dental plaque. All root canal treated, dead teeth are potentially considered as foci. Focal examination consists of an oral examination and analysis of x-rays. The dentist determines whether or not a particular tooth is a potential source of a calculus. “
Dr. Pattogató Rita
Specialist in conservative dentistry and prosthodontics
How much does the nodule screening cost?
In our clinic, screening consists of a health check and X-ray examinations. The doctor issues a certificate with the results. A treatment plan is drawn up for the necessary treatments.
