Most Untreated Tooth Infections Stay Quiet, Study Finds

Aim To prospectively investigate the incidence of symptoms and changes in the size of the apical bone destruction in symptom-free root-filled teeth with persistent apical periodontitis (AP) over 1 year without treatment.Methodology Patients referred to two specialist endodontic clinics in V & auml;stra G & ouml;taland, Sweden, with asymptomatic periapical bone destructions (summing to <= 10 mm in diameter, when measured in two dimensions) on intraoral radiographs were invited. After informed consent, participants underwent cone-beam computed tomography (CBCT). Patients with bone destructions beyond cortical boundaries were excluded. A 1-year follow-up included recording subjective symptoms, clinical findings and estimating bone destruction size.Results Of 187 eligible patients, 171 (91.4%) participated. After CBCT, four were excluded, and 10 were lost to follow-up. Among 157 patients, three developed symptomatic AP and were treated, and one tooth was lost due to fracture. Of the 153 patients with complete follow-up, eight (5.2%) reported mild pain or discomfort but did not seek care. Lesion size changes were small (M = 0.059 mm), with the mean increasing from 7.25 mm (SD 2.11) to 7.31 mm (SD 2.33), which was not statistically significant.Conclusion The findings align with previous studies, suggesting that patients with symptom-free root-filled teeth with apical periodontitis rarely experience exacerbation or significant increase in size of bone destruction in the short term. Longer follow-up is needed to identify potential risk factors.