Periapical dental granuloma
DESCRIPTION: The dental granuloma is a foci of chronic inflammation around the apex of a tooth root and is a sequela of pulpitis. Radiographically it appears as a periapical radiolucency. The border is usually distinct but this cannot be relied upon. The overlying tooth is ordinarily insensitive to electric pulp testing. While sensitivity to percussion may be present, many patients are asymptomatic. An acute infectious episode will result in pain, and often results in a formation of an abscess with a draining sinus tract and/or parulis formation. Osteomyelitis and cellulitis are an ever present danger.
ETIOLOGY: Like the periapical cyst, the dental granuloma is a direct sequela of inflammation of a pulp that has extended into the surrounding periapical tissue. Pulpitis is usually caused by infection secondary to caries but may be caused by trauma.
TREATMENT: Treatment consists of endodontic therapy or extraction.
PROGNOSIS: Good
DIFFERENTIAL DIAGNOSIS: If the tooth is nonvital, the differential diagnosis includes radicular cyst and periapical abscess.
