Incidence of Periapical Lesions in Patients Visiting a Private Dental Institute - A Dental Hospital Based Retrospective Study
Rinieshah Nair R. Baskaran1, Vivek Narayan2, Balaji Ganesh S3, Vivek Narayan4*
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 77, India.
2 Senior lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 77, India.
3 Senior Lecturer, Department of Periodontology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 77, India.
4 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, PH Road, Chennai - 600077, Tamil Nadu, India.
*Corresponding Author
Vivek Narayan,
Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha
University, 162, PH Road, Chennai - 600077, Tamil Nadu, India.
Tel: +919962866419
E-mail: viveknarayan@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 17, 2021
Citation:Rinieshah Nair R. Baskaran, Vivek Narayan, Balaji Ganesh S, Vivek Narayan. Incidence of Periapical Lesions in Patients Visiting a Private Dental Institute - A Dental Hospital Based Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):3827-3831. doi: dx.doi.org/10.19070/2377-8075-21000784
Copyright: Vivek Narayan©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Periapical lesions are caused due to progression of pulpal infection/inflammation to the periapical region. There are many causes of pulp tissue inflammation which includes dental caries, trauma, heat during cavity preparation, galvanic shock and deep restorations. The aim of this study is to assess the incidence of periapical lesions in patients attending a private dental institute. This is a retrospective study. Data was collected as 1000 intraoral periapical radiographs and were reviewed for periapical lesions from the time period of June 2019 to July 2019. The data was entered in Microsoft excel spreadsheet and subsequently transferred to SPSS Version 22 for statistical analysis. Chi square test was done to find the association between different variables. In this study, the incidence of periapical lesions among patients visiting a private dental institute is 100 per 1000 per year or 10%. Within the limits of the study, the incidence of periapical lesions was found to be considerably high among patients visiting the dental institute. Statistically significant association was seen between age and periapical lesions, age and types of periapical lesions and gender and types of periapical lesions (p < 0.05). The association between gender and periapical lesion was not statistically significant (p > 0.05) yet a female predilection was seen. This observation must be given importance and appropriate measures must be taken to curtail the rising incidence of periapical lesions.
2.Introduction
3.Conclusion
4.References
Keywords
Periapical Lesions; Periapical Cyst; Periapical Abscess; Incidence.
Introduction
A tooth consists of 4 different and distinct layers that play a pivotal
role in the maintenance of the dentition [20]. They include
enamel (outermost layer), dentin (layer beneath enamel), cementum
(outermost layer in the root portion) and pulp (innermost
layer) [54]. The enamel is the hardest substance in the human
body and is made up of 99% inorganic substances [8]. The primary
mineral is hydroxyapatite which gives the enamel maximum
strength [45]. Dentin is a yellowish white tissue that lies beneath
the enamel layer (‘Therapeutic Management of Demineralized
Dentin Surfaces Using a Mineralizing Adhesive To Seal and Mineralize
Dentin, Dentinal Tubules, and Odontoblast Processes’, no
date). It is harder than bone but softer than enamel and contains
apatite crystals of calcium and phosphate [14]. Cementum is a
specialized calcified substance at the root surface[5]. It is part of
the periodontium and is attached to the periodontal ligament[2-
3].
The pulp is highly vascularized with a network of vessels and innervated
tissue [29]. The dental pulp is compressed in a chamber
surrounded by the dentin [22]. It has pulp horns and pulp canals
that vary in size depending on the tooth, and a circulatory access
through the apical foramen in the apex [9]. It is a defense centre
for the tooth especially against dental caries [44]. Periapical diseases
are mostly preceded by pulpal diseases [24].
Polymicrobial infection is commonly the cause of periapical inflammatory
disease [47] and is most commonly due to dental caries. The infection affects the pulpal tissue and it spreads depending
on the virulence of the microorganism [35]. A healthy
local immune response forms granulation tissue around the apex
and mounts a defense against the invading microorganisms[33].
On the contrary, a poor local immune response will lead to tissue
damage, inflammation with suppuration leading to bone loss and
spread of infection [37]. The common examples of periapical diseases
include periapical periodontitis, periapical abscess, periapical
cyst, periapical granuloma and condensing osteitis [24].
Other causes of periapical diseases include trauma, heat generated
during cavity preparation, deep cavity preparation, deep
restorations, micro leakage of oral fluids through faulty restorations,
host immune response and galvanic shock [7 - 27]. Periapical
diseases can be managed by endodontic and minor surgical
treatments [1]. One of the endodontic treatments is the root canal
treatment which is the most common treatment modality for
periapical lesions [49]. Other techniques include decompression
technique, aspiration - irrigation technique, lesion sterilization and
repair therapy and calcium hydroxide method [22]. Surgical treatments
are recommended for more severe cases that would lead to
surgical management of the affected teeth.
Previously our team has a rich experience in working on various
research projects across multiple disciplines. (Jain, 2017 [16]); (Varghese,
Ramesh and Veeraiyan, 2019 [50]); (Ashok and Ganapathy,
2019 [4]); (Padavala and Sukumaran, 2018 [30]); (Ke et al., 2019
[17]),(Ezhilarasan, 2018 [10]); (Krishnan et al., 2018 [19]); (Ezhilarasan,
Sokal and Najimi, 2018 [12]); (Pandian, Krishnan and Kumar,
2018 [32]); (Ramamurthy and Mg, 2018 [39]); (Gupta, Ariga
and Deogade, 2018 [15]); (Vikram et al., 2017 [53]); (Paramasivam,
Vijayashree Priyadharsini and Raghunandhakumar, 2020 [34]);
(Palati et al., 2020 [31]); (Samuel, Acharya and Rao, 2020 [43]).
Now the growing trend in this area motivated us to pursue this
project.
The aim of this study is to determine the incidence of periapical
lesions among patients visiting a private dental institute.
Materials And Methods
Study design:
This is a retrospective study conducted in a private dental institution.
The patient case records were reviewed for the necessary
information by a trained examiner. In the present study the case
records used were digital Intraoral Periapical Radiographs otherwise
known as Radio Visio Graphy (RVG). Among patients who
have visited the dental clinic of the institution between June 2019
and July 2019, the RVGs of 1000 patients were inspected for the
presence of periapical lesions. A wide age range is selected for
the study. The institutional ethical committee provided approval
for the study (SDC/SIHEC/2020/DIASDATA/0619-0320).
Inclusion criteria
1. Patient RVGs having periapical lesions such as periapical periodontitis,
periapical abscess, periapical cyst, periapical granuloma
etc.
2. Both radiolucent and radiopaque lesions.
3. Patients from < 20 years to > 60 years of age
Exclusion criteria
1. Incomplete patient data.
2. Duplicate patient data.
3. Patient RVG having periapical lesions coexisting with other radiolucent/
radiopaque lesions.
4. Radiographs with errors.
Sampling
A total of 1000 RVGs of patients who visited the dental institution
were inspected for periapical lesions and the RVGs are randomly
selected with no specificity to any tooth or region. Convenient
sampling method was used to select the patient RVGs for
the study. The data was obtained from the archives of the radiology
department and were cross verified with patient case records.
Data collection
All the data after thorough checking for duplicates, incomplete
entries and cross verification with patient case records were entered
in Microsoft excel spreadsheet in order to organise the data.
The variables obtained from the data included age, gender, periapical
lesions, different types of periapical lesions. Here the age
and gender were the independent variables and the periapical lesions
were the dependent variable.
Statistics
The statistical analysis of the obtained data was performed by the
SPSS software version 23.0. The data from the excel spreadsheet
was transferred to SPSS software for analysis. Chi square tests
were employed in order to find the association between different
variables and p value < 5% was considered to be statistically significant.
The final results are presented in the form of graphs for
further interpretation and discussion.
Results & Discussion
Among the 1000 RVGs inspected for periapical lesions, 100
RVGs had the presence of periapical lesions. Hence the incidence
of the periapical lesions of the patients visiting the dental institute
is 100 per 1000 per year or 10%. This incidence rate is considerably
higher and shows a significant amount of patients suffering
from periapical lesions. In contrast to the present study, Gesi A et
al has found a slightly higher incidence of 16% [13] in their study
and the reason for the variation might be due to sample size.
Among the 1000 patient RVGs, 2.80% of males and 7.20% of
females had the presence of periapical lesions [figure 1]. The
graph shows a female predilection for periapical lesions and the
chi square analysis revealed that the association between the gender
and periapical lesions were not statistically significant (p value
- 0.09; p > 0.05). In contrast to the present study, Marmary Y et
al [23] found that there was no predilection for either gender. The
sampling method might be the reason behind the observation of
sex predilection of the study by Marmary Y et al.
The distribution of periapical lesions across different age groups
for male and female patients were studied. The maximum number of periapical lesions were seen in the age group 21 - 30 years with
a female predilection of 19% and males were 16%. Male predilection
was 4%, 9% and 5% seen in age groups < 20 years, 51 - 60
years and > 60 years respectively. Males and females were equally
distributed as 7% in the 41 - 50 age group [figure 2]. The association
between age groups and periapical lesions were statistically
significant (p value - 0.036; p < 0.05). Marmary Y et al. [23] found
that about 44% of patients belonged to 20 - 29 years which is in
accordance with our study. In a study by Pandolfo L et al, there
was no significant association between age and periapical lesions
[33] this was in contrast to the present study and the sample size
and geographical location may have caused this difference in the
observation.
The different types of periapical lesions across different age
groups were studied. The only periapical lesions seen were periapical
abscess and periapical cyst. Periapical abscess was highest
in patients of age group 21- 30 years which was 32% followed
by 23% in 31 - 40 years and an equal distribution of 11% in age
groups 41 - 50 and 51 - 60 years and the least amount of lesion
was found in < 20 years with 5%. Periapical cyst was present at a
maximum of 3% and equally in the age groups 21 - 30 and 41 - 50 years. It was least present in the > 60 years age group and was 1%
[figure 3]. The finding of periapical abscess being the most common
lesion is in accordance with the study done by Nair PNR
et al. [28] where he demonstrated 35% of periapical abscess and
15% of periapical cysts.
The different types of periapical lesions across different genders
were studied. It was seen that periapical abscess was the predominant
lesion with a male predilection of 46% and a slightly lesser
occurrence of 44% in females. Periapical cyst was 5% and was
equally distributed in males and females [figure 4]. A study conducted
by Muthanandham S et al. [26], concluded that periapical
cyst was more common in the female population . This observation
was in contrast to the present study and it may be due to the
difference in the characteristics of the sample.
Our institution is passionate about high quality evidence based
research and has excelled in various fields (Pc, Marimuthu and
Devadoss, 2018 [36]; Ramesh et al., 2018 [40]; Vijayashree Priyadharsini,
Smiline Girija and Paramasivam, 2018 [52]; Ezhilarasan,
Apoorva and Ashok Vardhan, 2019 [11]; Ramadurai et al., 2019
[38]; Sridharan et al., 2019 [46]; Vijayashree Priyadharsini, 2019
[51]; Chandrasekar et al., 2020 [6]; Mathew et al., 2020 [25]; R et
al., 2020 [41]; Samuel, 2021 [42]). We hope this study adds to this
rich legacy.
The limitations of this study include a small sample size and
therefore cannot be generalized to a larger population. Future
scope of the study can include prospective study design with a
larger sample size and other variables such as distribution of periapical
lesions according to teeth and the etiological factors behind
the periapical lesions can also be assessed.
Figure 1 represents the association between gender and the presence (pink) and absence (maroon) of periapical lesions. X-axis represents gender and Y-axis represents the total number of patients. About 28 male patients (2.8%) and 72 female patients (7.2%) out of 1000 patients had periapical lesions. However, this was statistically not significant (p-value = 0.09 >0.05).
Figure 2 represents the association between age and periapical lesions among males (orange) and females (red). X-axis represents age and the Y-axis represents the number of patients with periapical lesions. The female patients (19%) and male patients (16%) between age groups 21-30 is more common compared to female patients (1% ) and male patients (4%) of age group less than 20. The maximum patients are seen in the age group 21-30 years. This is statistically significant (p-value = 0.036 <0.05).
Figure 3 represents the association between age and types of periapical lesions (periapical abscess - blue; periapical cyst - green). X-axis represents age and Y-axis represents the number of patients with periapical lesions. Periapical abscess is the most common between age groups 21-30 (32%) and least common among patients of age groups less than 20 (5%). The association between age and type of periapical lesions were statistically significant (p-value = 0.036 <0.05).
Figure 4 represents the association between gender and type of periapical lesions (periapical abscess - blue; periapical cyst - green). X-axis represents gender and Y-axis represents number of patients with periapical lesions. Periapical abscess is most commonly seen in male patients (46%) and least in female patients (44%), while periapical cyst is common in both male and female patients (5%). The association between gender and type of periapical lesions. was statistically significant (p-value = 0.022 <0.05).
Conclusion
From the present study it is apparent that the incidence of periapical
lesions is considerably high in patients visiting the dental
institute. A female predilection was seen even though the association
between gender and periapical lesion was not statistically
significant. The most commonly affected age group was 21 - 30
years. Patients should be educated and made aware about the importance
of periodic dental check ups which can help in preventing
the progression of dental caries into a periapical lesion. On
the other hand careful and proper treatment planning for teeth with dental caries can eliminate the occurrence of periapical lesions
due to iatrogenic reasons.
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