Editing Toothache (section)

=====Apical periodontitis=====
[[File:Abscessed tooth periapical radiograph.jpg|thumb|Apical abscess associated with roots of a lower molar.]]
[[Apical periodontitis]] is acute or chronic inflammation around the apex of a tooth caused by an [[immune response]] to bacteria within an infected pulp.<ref name=Segura-Egea2012>{{cite journal|vauthors=Segura-Egea JJ, Castellanos-Cosano L, Machuca G, Lopez-Lopez J, Martin-Gonzalez J, Velasco-Ortega E, Sanchez-Dominguez B, Lopez-Frias FJ |title=Diabetes mellitus, periapical inflammation and endodontic treatment outcome|journal=Medicina Oral Patología Oral y Cirugia Bucal|date=January 1, 2012|pages=e356–e361|doi=10.4317/medoral.17452|pmc=3448330|pmid=22143698|volume=17|issue=2}}</ref> It does not occur because of pulp necrosis, meaning that a tooth that tests as if it's alive (vital) may cause apical periodontitis, and a pulp which has become non-vital due to a [[Sterilization (microbiology)|sterile]], non-infectious processes (such as trauma) may not cause any apical periodontitis.<ref name=Hargreaves2011 />{{rp|225}} Bacterial [[cytotoxin]]s reach the region around the roots of the tooth via the apical foramina and lateral canals, causing [[vasodilation]], sensitization of nerves, [[osteolysis]] (bone resorption) and potentially abscess or cyst formation.<ref name=Hargreaves2011 />{{rp|228}}

The periodontal ligament becomes inflamed and there may be pain when biting or tapping on the tooth. On an X-ray, bone resorption appears as a [[Radiodensity|radiolucent]] area around the end of the root, although this does not manifest immediately.<ref name=Hargreaves2011 />{{rp|228}} Acute apical periodontitis is characterized by well-localized, spontaneous, persistent, moderate to severe pain.<ref name=Scully2013 />{{rp|125–135}} The alveolar process may be tender to [[palpation]] over the roots. The tooth may be raised in the socket and feel more prominent than the adjacent teeth.<ref name=Scully2013 />{{rp|125–135}}