1. Infection of the Jaw Flashcards
What are sources of infection in the jaw?
Apex of non-vital teeth
Marginal or furcational periodontium
Pericoronal space (partially inmpacted teeth)
Open injury
Hematogenous spread
S/S of acute periapical infection (periapical abscess)?
Pain
fever
malaise
swelling of soft tissues
sensitive in percussion (due to edema)
Are there radiographic signs of acute periapical inflammation?
NO
How is the periodontium affected in acute periapical inflammation?
Widening of PDL
thickening of lamina dura
Irregular trabeculae
What are two key radiographic features in chornic periapical inflammation?
Periapical granuloma
Radicular (periapical) cyst
What is periapical granuloma?
Extension of pulpitis in periapical tissues
How does periapical granuloma present?
relatively painless and slow progression
How can periapical granuloma evolve?
May involve into a periapical abscess or cyst
What is the most common cyst of the jaw?
Radicular cyst
How does a radicular cyst tend to arise?
Sequel of long-standing untreated periapical granuloma
Where does the epithelial lining in radicular cyst arise from?
rests of malassez (activated by inflammatory process, creating little cysts that begin growing and expanding)
how do periapical granuloma and radicular cyst compare radiographically?
Very similar radiographically when small
Eventually, cyst will become larger and have the apearance of a true cyst. At thispoint, the two are easily distinguishable esp with cone beam CT
Which apical periodontitis condition is not pathologic?
Osteosclerosis
Which kind of apical periodontitis does not require treatment?
Osteosclerosis
What is osteosclerosis?
Increase in bone density
Forms dense-bone islands composed of compact bone rather than trabecular bone
What are other names of apical periodontitis?
Periapical rarefying osteitis
Condensing osteitis
9 - widening of the PDL space; loss of lamina dura; irregular trabeculae
Lateral incisor - ill defined radiolucency in PA area
All the roots have abnormal bone: expansion of PDL space, loss continuity of floor of maxillary sinus.
Removing 3 could open a hole into maxillary sinus
Lesion at apex of premolar
May be described as PRO
Ill-defined PA dz
loss of lamina dura
widening of PDL space
Denser trabecular bone - marks extent of lesion (osteoblastic activity as yo umove away from lesion)
Carious lesion extending to pulp
widened PDL
increased bone density of trabecular bone
Increased density of trabecular bone
Two well-defined cortical radiolucencies at #7 and #10
Can suspect periapical cyst because of well corticated appearance
Cannot give definitive diagnosis from radiograph
Patient has enamel hypoplasia (see appearance of canine - increased risk of PA lesion in non crious teeth)
PA lesion on anterior tooth
definitive PA cyst beginning from #10
cyst arrested tooth development of both teeth (open apex)
Possibly from trauma
Lesion on pt’s right
possibly from extracting tooth without taing care of PA inflammation
Not stafne’s defect bc stafne’s is usually lower than mandibular canal
PA lesion on MB root of #15
Addt’l CT showed lesion actually encompassed all roots throughout maxilla. Widening PDL space
Osteosclerosis
PDL space is uniform
lamina dura is continuous
Osteosclerosis by the second premolar
Prof does not say anything about radiolucency.
How can you distinguish ostesclerosis opacity from ossifying fibromas or osteomas?
Osteosclerosis will be unfiromly opaque with normal adjacent bone
Hoes does an area of inner cortical bone from osteosclerosis affect a procedure such as implant placement?
The cortical bone will increase resistance from drilling which will caused increased heat during procedure.
The cortical bone also will have poor vascularity and cellularity so it wont adapt well to implant
Ostoesclerosis - unifromly dense radioopacity
To cofirm, check PDL (uniform), lamina dura (continuous) and tooth vitality. All should be normal
Socket sclerosis (socket fills up with compact bone rather than trabecular bone)
Prof does not mention radiolucnet area
What are pericoronal infections?
Infection of the tooth around the crown or follicle of a tooth
When does pericoronitis usally occur?
Usually around the crown of partially soft-tissue impacted teeth
What is folliculitis?
Apical or furcational infection of a primary tooth that involves follicle of permanent tooth.
May cause turner’s teeth - disturbance of normal crown development
Why is it easier for an infection to spread to the furcation area of a primary tooth?
Dentin of primary tooth is underdeveloped in comparison to permanent teeth
How does inflammation of primary teeth affect the permanent tooth in folliculitis?
Unerupted permanent tooth may have undeveloped crown. Ameloblasts function can be interrupted by the inflammation from the primary tooth
Normal PA radiograph
continuous follicular cortication around developing tooth
nice lamina dura
Secondary caries
Widening of PDL space at apex of the distal root of primary molar
Loss of follicular cortication of developing premolar #29
Infection from apex of primary tooth has gone int othe follicle of the developing tooth
Normal #20. Abnormal #21
PA disease of #21: loss of lamina dura, widening of PDL space
Fracture of distal root
Expansion of follicle - loss of trabeculation, loss of cortication
Crown has been exposed to inflammatory environment
Horizontally impacted premolar
Abscess has formed around crown of #21 that communicates with oral environment due to impact
Pericoronitis around #17 becauseo f lack of room
Follicular space has widened on distal
Why is it important to treat PA inflammation dz early?
It can spread to adjacent areas causing other damage
PA dz at #30
Widening of PDL space on mesial root
No fracture on distal root – line is not classic appearance of a fracture
What is osteomyelitis?
Inflammation of the bone and bone marrow
What is the difference between PRO/condensing osteitis and ostemyelitis?
PRO/condensing osteitis are inflammation of the bone but has not yet reached bone marrow. Maye have some trabecular destructoin but does not really affect BM
What are predisposing factors for osteomyelitis?
Systemic dz esp DM
immunosuppresion
decreased vascularity
How can an infection be introduced to cause osteomyelitis?
Through some tooth
PA or periodontal infection
Fracture of a tooth
break of soft tissue
What are the three kinds of chornic osteomyelitis?
chronic osteomyelitis
diffuse sclerosing ostemyelitis
proliferative periostitis (Garre’s osteo; reaction from periosteum)
S/S of acute ostemyelitis
Severe pain
soreness
loosening of teeth
regional lymphadenopathy
fever
Are there radiographic presentations of acute ostemyelitis?
not at initial stage. will see signs with progression
What are seein in radiographs of acute osteomyelitis?
widening of PDL
irregular, fuzzy, blurred trabeculae
solitary or multiple radiolucent foci
S/S of chornic osteomyelitis
tenderness
swelling
lymphadenopathy
low grade fever
mild leukocytosis
suppuration
fistulous tract formation
Does chornic ostemyelitis more often affect the mandible or maxillary?
Mandible
What is a possible complication from chronic osteomyelitis?
pathologic fracture
What are two hallmarks of osteomyelitis?
Sequestrum
Involcrum
What is a sequestrum?
Segments of necrotic bone separated from adjacent bone. On radiograph, will see an area of radiolucent bone around an area of necrosis
What is involcrum?
New periosteal bone formed in response to the inflammatory process
What are the radiographic features of chronic osteomyelitis?
lucent to mixed to mostly opaque
ill-defined borders usually sclerotic
loss of trabecular architecture (rugged, indistinct fuzzy irregular; no general pattern of formation)
changes in cortical outlines (thickening, irregularity, destruction)
sequestrae
periosteal reaction (involcrum)
fistulae tract formation
Acute osteomyelitis after extraction of #32
classic appearance of acute ostemyelitis
Trabeculae at mandibular border is a little indistinct
bit of irregular bone in the socket
cortication of the mandibular canal and inferior border of mandible are ok
can’t see much of what is going wrong
Chronic osteomyelitis
radiolucent foci
inferior border of mandible is interrupted
Cannot see superior and inferior border of mandibular canal
Established chornic osteomyelitis
ill-defined mixed radiolucency lesion on right mandible extending from the area of the canine to where #32 used to be
loss of cortication of the inferior border of the mandible, mandibular canal and alveolar crest
Some periosteal bone formation
Osteomyelitis extending from the left all the way to the right with sequestrum in mandibular right
Sequestrum
Fistulation and pus
Fistula tract formation from bone into soft tissue through skin and out to neck area for drainage
17 area all the way to coronoid process and inferiorly to the angle and anteriorly to the premolar area (radiolucency)
Patient with 3rd molar extractions
Increased density around area of radiolucency anterior to premolars and back to ramus
periosteal bone formation on patients left mandible all the way up to the coronoid process
Double outline of the inferior border of the mandible
Further inferior, periosteal bone formation
Mucoperiosteal bone formation on the buccal of the arch
PANX looks fine
Normal PA
nice extraction socket
Osteomyelitis extending all the way to the condylar and coronoid process
Infectoin spread from condyle to temporal bone
Pt developed ankyloses of condyle – couldnt open mouth
