Endodontic Disease with Secondary Periodontic Involvement
This occurs in a non-vital tooth with retrograde periodontitis. Attention should be paid to diagnostic tests in order to make the correct lesion classification. Subjective information includes past history of spontaneous pain episodes localized in a particular area. Objective information includes a tooth with a deep cavity, large reconstruction or previous failing endodontic treatment; good buccal hygiene; or the presence of an intrasulcular fistula.
Clinical tests include a pulp test (negative) and periodontal probing: deep, narrow, "tunnel" probing. Probing should be performed under anesthesia.
Radiological evaluation should look for angular bone loss.
Rarely bacteria spread out to the periodontium, producing an inflammatory reaction of defence that will destroy the cementum, the fibers of the periodontal ligament, and the regional alveolar bone
Periodontal disease has a chronic infectious nature that causes a slow angular destruction of the attachment apparatus of various teeth in a coronal-apical direction. Periodontal probing should be wide.
The "perio pain" has a slow beginning, low intensity, is longlasting and hard to localize in a tooth. It is referred to a general area. Acute painful episodes are rare.
The pulp stays alive as long as the vascular network continues through the foramen, and only partial degenerative changes or calcifications will be produced. Bacterial flora is a mix of more than 300 differents aerobic and facultative anaerobic families.
The pulpitis symptoms observed in periodontal patients are mostly due to the treatment rather than the periodontal disease itself, because the treatment removes the radicular cement, exposing the dentinal tubules. However, if the periodontal disease or its treatment hinders the pulp vascular blood circulation through the apical foramen, then a pulp necrosis is produced and previous attachment apparatus damage will be increased dramatically.