Periodontitis: when inflammation leaves the tooth
Pulpitis hurts on its own — sharply, throbbing, at night. Periodontitis hurts differently: when you bite down. The tooth feels as if it has grown taller and gets in the way when you close your jaws, touching it with the tongue is unpleasant, and sometimes a bump appears on the gum. It means the infection has already passed beyond the root tip into the bone. Here is how periodontitis differs from pulpitis, why it does not resolve on its own, and what the dentist does about it.
Pulpitis or periodontitis: how to tell
Both are complications of decay, but they are different stages and are treated differently.
Pulpitis is inflammation of the nerve inside the tooth. The pain is spontaneous, often at night, throbbing, triggered by cold or heat, radiating to the temple or ear — and people frequently cannot say which tooth is actually hurting.
Periodontitis is inflammation beyond the root tip, in the bone. The pain is different: sharp, local, on biting. The patient usually points at one specific tooth. The feeling that the tooth «has grown» comes from swelling around the apex, which pushes the tooth slightly out of its socket.
Periodontitis can also be entirely painless: the chronic form gives no symptoms for years and is found by chance on an X-ray before prosthetic work. Meanwhile a granuloma or cyst may be forming inside the bone.
Where it comes from
The commonest route is a single one: decay reached the nerve, the nerve became inflamed and died, and the infection travelled down the canal and out into the bone through the apical opening.
- Poorly treated canals. If a canal was filled short of the apex or one canal was missed, infection stays inside and sustains the inflammation for years.
- Trauma. A blow to a tooth can kill the nerve with no decay at all — the tooth later darkens and starts reacting to biting.
- Overload. A filling or crown left high, constant load on one tooth.
So periodontitis is often not a «new» tooth but one that has been treated before. In our experience these are exactly the teeth that end up needing retreatment.
What the dentist does
The goal is one: remove the infection from the canals and seal them tightly so the bone around the apex can heal on its own. Bone is capable of that — provided the source is removed.
- An X-ray. Without it neither the size of the lesion nor the quality of previous canal work is visible. Complex cases need a 3D CT, which shows the lesion in volume rather than as a patch on a flat image.
- Access and unfilling. If the canals were treated before, the old material is removed first. Sometimes a fragment of an instrument left by earlier treatment has to be retrieved.
- Canal preparation. Mechanical and antiseptic, under a microscope: the point is to find every canal, including those invisible to the naked eye.
- Temporary filling with a medicated paste for several weeks — it acts against the infection in the bone.
- Permanent filling of the canals and rebuilding of the tooth.
If conservative treatment does not work or the lesion is large, microsurgery remains: apical resection. The root tip with the lesion is removed through a small access while the tooth is kept.
How long it takes and how many visits
Periodontitis is rarely treated in one visit. Typically it is two or three appointments with two-to-four-week gaps: the bone needs time to respond to the medicated paste.
Control X-rays are taken after six months and after a year. The lesion shrinks gradually — that is normal, bone does not rebuild in a week.
One more thing worth knowing in advance: after root canal treatment a tooth becomes more brittle, having lost its supply from inside. A back tooth after that almost always needs a crown — otherwise it splits and the whole treatment is lost.
What it costs
- Consultation with a specialist — UAH 690.
- CT of both jaws at the Houston 3D centre — UAH 1,290.
- Pulpitis treatment (1 visit) — from UAH 7,100.
- Periodontitis treatment (1 visit) — from UAH 8,900.
- Preparation for endodontic treatment — from UAH 2,200.
- Retrieving an instrument from a canal — UAH 1,950–3,250.
- Canal microsurgery (resection) — from UAH 16,500.
- Zirconia crown on the restored tooth — from UAH 7,200.
Prices are valid until 31 August 2026. The exact figure is given by the dentist after examination and an X-ray, before treatment starts.
What not to do
- Warming the cheek. Heat spreads the inflammation further through the tissue — that is how a local lesion turns into a flux.
- Starting antibiotics on your own. They mute the symptoms without removing the cause and blur the picture for the dentist.
- Waiting for it to «pass». The pain really can fade — that is not recovery but a shift into the chronic form.
- Putting a tablet on the gum. That is a chemical burn of the mucosa on top of the existing problem.
What to do before the appointment: an ordinary painkiller strictly per the leaflet, cold from outside for 10–15 minutes, no chewing on that side. More detail in the article on acute toothache.
Frequently asked questions
How does periodontitis differ from pulpitis?
Pulpitis is inflammation of the nerve inside the tooth: spontaneous pain, often at night, triggered by cold and heat. Periodontitis is inflammation already beyond the root tip, in the bone: it hurts on biting, the tooth feels taller, and a bump may appear on the gum.
Why does it hurt when I bite?
Because the inflammation sits around the root tip. When you bite, the tooth presses on exactly that area. The sense that the tooth «has grown» comes from swelling that pushes it slightly out of the socket.
Can periodontitis go away on its own?
No. The pain can fade, and that is the most dangerous moment — it feels resolved. In reality the process turns chronic and quietly destroys bone around the root until it flares up again.
Can a tooth with periodontitis be saved?
In most cases yes. The canals are retreated, the lesion is removed and the bone heals on its own. Extraction is considered when there is a root fracture, the tooth is destroyed below gum level, or it has lost stability.
How many visits does it take?
Usually two or three, with two-to-four-week gaps while a medicated paste works inside the canals. Control X-rays are taken after six months and a year — the lesion shrinks gradually.
What does periodontitis treatment cost in Dnipro?
At Houston clinic — from UAH 8,900 per visit, compared with UAH 7,100 for pulpitis. Preparation for endodontic treatment from UAH 2,200 and a crown from UAH 7,200 may be needed on top. The exact figure is given after an X-ray.
Why a CT scan if there is already an X-ray?
A flat image shows the lesion as a patch and gives no sense of its volume or of how the roots run. A 3D CT shows everything in volume — which is critical for retreatment and before microsurgery. CT of both jaws costs UAH 1,290.
Is a crown mandatory after root canal treatment?
For back teeth, practically always. A tooth without a nerve gets no supply from inside and becomes brittle, while the chewing load on it is the highest. Without a crown such a tooth usually splits and the canal treatment is wasted.
Chief doctor at Houston clinic. Restorative dentistry and endodontics under a microscope, treatment of canals, cysts and granulomas, cosmetic restoration.
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The dentist will see whether the tooth can be saved and give you a plan with exact figures before work starts. Consultation — UAH 690; with a treatment plan — UAH 1,000.
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Get an X-ray and find out the tooth's prognosis
The dentist will see whether the tooth can be saved and give you a plan with exact figures before work starts. Consultation — UAH 690; with a treatment plan — UAH 1,000.
Book now