The misunderstood disease
The anatomic connections between the tooth nerve and the gum and bone around the tooth provide a pathway for combined Gum-Nerve disease through apical foramina (the orifice at the end of the root through which the nerve and the blood vessels pass through from surrounding tissue to keep the tooth vital and alive). This pathway facilitates the nerve disease to spread out from the tooth to the surrounding bone and gum tissue, vice versa the gum disease can affect the tooth nerve through the same pathway.
These lesions can be classified as:
Primary Nerve Infection / Lesion
This lesion originates from the dental pulp (tooth nerve inside the root) due to decay (cavity), As a result, the nerve tissue can be completely necrotic (dead), there is destruction of the bone attached to the root, swelling, fistula (small infection drainage by the tooth) usually located close to the root apex (the tip of the root).
Primary Nerve / Secondary Gum Lesion
This develops from long-standing apical pathology/primary nerve infection (infection on the tip of the root of the tooth). Expansion of the infection up along the root destroy the gum fibers and adjacent jaw bone surrounding the tooth until reaching up to the gum by the crown surface (the visible part of the tooth).
Primary Gum Lesion
This lesion originates from the gum margins up by the tooth and spreads down destroying the gum fibers causing mobility (movement) in the tooth and infection pockets around the tooth. However, the tooth nerve stays vital. This happens usually in people with poor Oral Hygiene.
Primary Gum/ Secondary Nerve Lesion
This lesion results from spread of the infection gum pockets along the root surface down to the apical foramina (the orifice at the root tip). In this case, the tooth nerve will become necrotic (die).
True Combined Lesion
This is a product of independent gum and nerve lesions. Usually, this happens to people with bad oral hygiene, multiple decayed teeth (cavities), that ignore their dental health and recall dental visits. This clinically represents as widespread gum infection pockets and necrotic nerve tissues.
Careful assessment of patient history, clinical exam, and radiographic exams (x-rays) are all required to accurately differentiate between gum lesion, nerve lesion, or combined Gum-Nerve lesion.
Although, root canal treatment removes the bacteria from inside the tooth (root), the overall prognosis depends on the remaining diseased gum tissue attached to the root surface. Yet, root canal treatment should be performed PRIOR to any gum therapy. The control of the nerve infection is important to the success of the gum therapy following. Upon completion of the root canal treatment, gum therapy will start first with a deep cleaning followed by gum surgery as needed.
After 3-6 months, re-evaluation of the gum therapy for periodic maintenance. These therapies promote the formation of a new layer of cementum (the layer of the tooth covering the root surface) which facilitate the growth of gum fibers for better attachment of the tooth root to the surrounding bone.
Wishing you all best oral health as it affects your overall body health.
Nahla Wadie-Salem, B.D.S., D.D.S. is an adjunct clinical instructor in the Restorative Department at the University of Detroit Mercy Dental School.