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OPath Block 2 > 1. Infection of the Jaw > Flashcards

1. Infection of the Jaw Flashcards

1
Q

What are sources of infection in the jaw?

A

Apex of non-vital teeth

Marginal or furcational periodontium

Pericoronal space (partially inmpacted teeth)

Open injury

Hematogenous spread

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2
Q

S/S of acute periapical infection (periapical abscess)?

A

Pain

fever

malaise

swelling of soft tissues

sensitive in percussion (due to edema)

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3
Q

Are there radiographic signs of acute periapical inflammation?

A

NO

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4
Q

How is the periodontium affected in acute periapical inflammation?

A

Widening of PDL

thickening of lamina dura

Irregular trabeculae

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5
Q

What are two key radiographic features in chornic periapical inflammation?

A

Periapical granuloma

Radicular (periapical) cyst

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6
Q

What is periapical granuloma?

A

Extension of pulpitis in periapical tissues

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7
Q

How does periapical granuloma present?

A

relatively painless and slow progression

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8
Q

How can periapical granuloma evolve?

A

May involve into a periapical abscess or cyst

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9
Q

What is the most common cyst of the jaw?

A

Radicular cyst

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10
Q

How does a radicular cyst tend to arise?

A

Sequel of long-standing untreated periapical granuloma

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11
Q

Where does the epithelial lining in radicular cyst arise from?

A

rests of malassez (activated by inflammatory process, creating little cysts that begin growing and expanding)

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12
Q

how do periapical granuloma and radicular cyst compare radiographically?

A

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

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13
Q

Which apical periodontitis condition is not pathologic?

A

Osteosclerosis

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14
Q

Which kind of apical periodontitis does not require treatment?

A

Osteosclerosis

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15
Q

What is osteosclerosis?

A

Increase in bone density

Forms dense-bone islands composed of compact bone rather than trabecular bone

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16
Q

What are other names of apical periodontitis?

A

Periapical rarefying osteitis

Condensing osteitis

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17
Q
A

9 - widening of the PDL space; loss of lamina dura; irregular trabeculae

Lateral incisor - ill defined radiolucency in PA area

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18
Q
A

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

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19
Q
A

Lesion at apex of premolar

May be described as PRO

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20
Q
A

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)

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21
Q
A

Carious lesion extending to pulp

widened PDL

increased bone density of trabecular bone

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22
Q
A

Increased density of trabecular bone

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23
Q
A

Two well-defined cortical radiolucencies at #7 and #10

Can suspect periapical cyst because of well corticated appearance

Cannot give definitive diagnosis from radiograph

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24
Q
A

Patient has enamel hypoplasia (see appearance of canine - increased risk of PA lesion in non crious teeth)

PA lesion on anterior tooth

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25
Q
A

definitive PA cyst beginning from #10

cyst arrested tooth development of both teeth (open apex)

Possibly from trauma

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26
Q
A

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

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27
Q
A

PA lesion on MB root of #15

Addt’l CT showed lesion actually encompassed all roots throughout maxilla. Widening PDL space

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28
Q
A

Osteosclerosis

PDL space is uniform

lamina dura is continuous

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29
Q
A

Osteosclerosis by the second premolar

Prof does not say anything about radiolucency.

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30
Q

How can you distinguish ostesclerosis opacity from ossifying fibromas or osteomas?

A

Osteosclerosis will be unfiromly opaque with normal adjacent bone

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31
Q

Hoes does an area of inner cortical bone from osteosclerosis affect a procedure such as implant placement?

A

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

32
Q
A

Ostoesclerosis - unifromly dense radioopacity

To cofirm, check PDL (uniform), lamina dura (continuous) and tooth vitality. All should be normal

33
Q
A

Socket sclerosis (socket fills up with compact bone rather than trabecular bone)

Prof does not mention radiolucnet area

34
Q

What are pericoronal infections?

A

Infection of the tooth around the crown or follicle of a tooth

35
Q

When does pericoronitis usally occur?

A

Usually around the crown of partially soft-tissue impacted teeth

36
Q

What is folliculitis?

A

Apical or furcational infection of a primary tooth that involves follicle of permanent tooth.

May cause turner’s teeth - disturbance of normal crown development

37
Q

Why is it easier for an infection to spread to the furcation area of a primary tooth?

A

Dentin of primary tooth is underdeveloped in comparison to permanent teeth

38
Q

How does inflammation of primary teeth affect the permanent tooth in folliculitis?

A

Unerupted permanent tooth may have undeveloped crown. Ameloblasts function can be interrupted by the inflammation from the primary tooth

39
Q
A

Normal PA radiograph

continuous follicular cortication around developing tooth

nice lamina dura

40
Q
A

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

41
Q
A

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

42
Q
A

Horizontally impacted premolar

Abscess has formed around crown of #21 that communicates with oral environment due to impact

43
Q
A

Pericoronitis around #17 becauseo f lack of room

Follicular space has widened on distal

44
Q

Why is it important to treat PA inflammation dz early?

A

It can spread to adjacent areas causing other damage

45
Q
A

PA dz at #30

46
Q
A

Widening of PDL space on mesial root

No fracture on distal root – line is not classic appearance of a fracture

47
Q

What is osteomyelitis?

A

Inflammation of the bone and bone marrow

48
Q

What is the difference between PRO/condensing osteitis and ostemyelitis?

A

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

49
Q

What are predisposing factors for osteomyelitis?

A

Systemic dz esp DM

immunosuppresion

decreased vascularity

50
Q

How can an infection be introduced to cause osteomyelitis?

A

Through some tooth

PA or periodontal infection

Fracture of a tooth

break of soft tissue

51
Q

What are the three kinds of chornic osteomyelitis?

A

chronic osteomyelitis

diffuse sclerosing ostemyelitis

proliferative periostitis (Garre’s osteo; reaction from periosteum)

52
Q

S/S of acute ostemyelitis

A

Severe pain

soreness

loosening of teeth

regional lymphadenopathy

fever

53
Q

Are there radiographic presentations of acute ostemyelitis?

A

not at initial stage. will see signs with progression

54
Q

What are seein in radiographs of acute osteomyelitis?

A

widening of PDL

irregular, fuzzy, blurred trabeculae

solitary or multiple radiolucent foci

55
Q

S/S of chornic osteomyelitis

A

tenderness

swelling

lymphadenopathy

low grade fever

mild leukocytosis

suppuration

fistulous tract formation

56
Q

Does chornic ostemyelitis more often affect the mandible or maxillary?

A

Mandible

57
Q

What is a possible complication from chronic osteomyelitis?

A

pathologic fracture

58
Q

What are two hallmarks of osteomyelitis?

A

Sequestrum

Involcrum

59
Q

What is a sequestrum?

A

Segments of necrotic bone separated from adjacent bone. On radiograph, will see an area of radiolucent bone around an area of necrosis

60
Q

What is involcrum?

A

New periosteal bone formed in response to the inflammatory process

61
Q

What are the radiographic features of chronic osteomyelitis?

A

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

62
Q
A

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

63
Q
A

Chronic osteomyelitis

radiolucent foci

inferior border of mandible is interrupted

Cannot see superior and inferior border of mandibular canal

64
Q
A

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

65
Q
A

Osteomyelitis extending from the left all the way to the right with sequestrum in mandibular right

66
Q
A

Sequestrum

67
Q
A

Fistulation and pus

68
Q
A

Fistula tract formation from bone into soft tissue through skin and out to neck area for drainage

69
Q
A

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

70
Q
A

periosteal bone formation on patients left mandible all the way up to the coronoid process

71
Q
A

Double outline of the inferior border of the mandible

Further inferior, periosteal bone formation

72
Q
A

Mucoperiosteal bone formation on the buccal of the arch

73
Q
A

PANX looks fine

74
Q
A

Normal PA

nice extraction socket

75
Q
A

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

OPath Block 2 (10 decks)

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