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305 > 17. Dental caries, pulp, and periapical diseases > Flashcards

17. Dental caries, pulp, and periapical diseases Flashcards

1
Q

What are dental caries?

A

They are progressive, irreversible bacterial damage of the tooth structure exposed to the oral environment

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2
Q

What are dental caries characterized by?

A

They are characterized by demineralization of the inorganic portion and destruction of the organic substances of the tooth

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3
Q

What are the signs and symptoms of dental caries?

A

They are termed white spot lesions. with time, will turn brown before frank cavitation.

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4
Q

What are the 4 main reasons dental caries can form?

A

1.) Acid and time
2.) Carbohydrates
3.) Micro-organisms
4.) Susceptible tooth surface

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5
Q

What are the treatment ranges of dental caries?

A

1.) Non-surgical intervention (remineralization)
2.) Restorative dentistry
3.) Endodontics - root canal
4.) Surgery - extraction

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6
Q

What is attrition?

A

It is the physiological wear of the teeth due to tooth on tooth contact

  • It increases with age: cumulative wear on teeth
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7
Q

How is attrition affected by?

A

1.) By diet, dentition, habits
2.) Coarse foods aggravates this condition
3.) Parafunction and bruxism leading to more wear
4.) Leds to deposition of secondary dentin, preventing pulp exposure

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8
Q

What is abrasion?

A

It is the pathologic wear of teeth as a result of an abnormal habit or abrasive substance

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9
Q

What are some examples from which abrasion can arise from?

A

1.) Pipe smoking
2.) Tobacco chewing
3.) Aggressive toothbrushing

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10
Q

What is the most common example of abrasion?

A

Tooth brush abrasion: which is is seen at the cervical portion of the tooth

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11
Q

What is demastication referred to when abrasion occurs?

A

It is abrasion that arises from chewing an abrasive substance

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12
Q

What is abfraction?

A

It is the loss of tooth structure from tooth flexure: when constant flexing leads to pieces of enamel slowly chipping away.
- areas can be sensitive

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13
Q

What is a risk factor of abfraction?

A

Decreased saliva.

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14
Q

What occurs to the enamel in abfraction?

A

It breaks away from dentin at point of loading.

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15
Q

Where is abfraction typically seen clinically?

A

On the facial and cervical regions.

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16
Q

What does this damage lead to an increase of?

A

An increase risk of erosion and abrasion.

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17
Q

What is erosion?

A

It is the loss of tooth structure from non-bacterial chemical process

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18
Q

How can erosion occur? what are the sources that can arise this?

A

1.) Occupation
2.) Diet
3.) Gastric acids (acid reflux, vomitus)

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19
Q

What is pulp calcification?

A

This is an age-related phenomenon in which an increased deposition of dentin as patients age is seen.
This is very common to see in elderly populations.

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20
Q

How do pulp calcifications appear as?

A

They appear as diffuse linear calcifications & nodular (pulp stones)

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21
Q

T or F, pulp calfications (pulp stones) cause pain

A

False, they do not cause pain. However, the clinical significance relates tot the increased difficulty in endodontic instrumentation

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22
Q

What is external root resorption?

A

When there is the destruction of the external root surface.

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23
Q

What cells mediate external root resorption?

A

The cells of the periodontal ligament.

  • Increases with age.
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24
Q

What causes external root resorption?

A

1.) Cysts/tumours
2.) Dental trauma
3.) Excessive mechanical forces (ortho)
4.) Herpes zoster in bone
5.) Periapical inflammation
6.) Pressure from impacted teeth
7.) Reimplantation of teeth

25
Q

What are treatment methods of external root resorption?

A

1.) Eliminate pressure on tooth
2.) Remove source

26
Q

What is internal resorption?

A

1.) It is the destruction of the canal or dentin on chamber wall which may lead to root perforation

27
Q

How does internal resorption appear as?

A

As a “thistle tube” shape

28
Q

How does internal root resorption affect the crown of the tooth?

A

It turns it pink aka (Pink tooth of mummery)

etiology: pulpal inflammation

29
Q

How is internal resorption resolved/treated?

A

Treated with root canal therapy.

30
Q

What are the outcomes of untreated pulp necrosis?

A

1.) Periapical inflammation
2.) Periapical abscess
3.) Periapical granuloma
4.) Periapical cyst

31
Q

What can arise from a periapical granuloma?

A

A periapical cyst

32
Q

What is a periapical granuloma?

A

It is a mass of granulation tissue with a variable number of chronic inflammatory cells

33
Q

How is inflammation from a periapical granuloma formed?

A

It is created by the pulp and its subsequent degradation.

34
Q

What does the inflammation of periapical granuloma lead?

A

It leads to the activation of enzymes which lead to bone destruction.

35
Q

What are the two main activators leading to bone destruction in a periapical granuloma?

A

1.) Collagenase
2.) Osteoclast-activating factor

36
Q

How does a periapical granuloma present itself radiographically?

A

1.) As a radiolucency in the periapical region of a necrotic tooth.

37
Q

What can a periapical granuloma progress to?

A

It can progress into a cyst, or which may be an acute exacerbation leading to an abscess.

38
Q

Histologically, what is unique about a periapical granuloma?

A

It does not have an epithelial lining, which means that it is not a cyst.

39
Q

T or F, we can differentiate between a periapical granuloma from a periapical cyst.

A

False. it is impossible to differentiate them through a radiograph. This means that this can only be assessed histologically.

40
Q

How can we differentiate between a periapical granuloma from a periapical cemento-osseosus dysplasia?

A

If a tooth has vitality.

A periapical granuloma will be a NON-VITAL tooth.

41
Q

What are the treatment methods for a periapical granuloma?

A

1.) Extraction & must curette the extraction site well
2.) Root canal therapy

42
Q

How can a periapical cyst be a true cyst?

A

1.) A true cyst because it has an epithelium-lined cavity within its connective tissue.
It represents up to 75% of all jaw cysts.

43
Q

What is the epithelium source of a periapical cyst?

A

Rests of Massez.

44
Q

What can occur after the pathologic cavity is formed in a periapical cyst?

A

The epithelial rests can grow into the cavity, and form a lining.

45
Q

What are some characteristics of periapical cysts in relation to x-rays imaging?

A

1.) Does not expand bone
2.) Not clinically evident
3.) Hard to differentiate between periapical granuloma and periapical cyst
4.) Large lesion = likely a cyst

46
Q

What are the treatments needed for periapical cysts?

A

1.) Extraction with curettage

2.) Root canal therapy: cysts tend not to heal as well as granulomas due to the epithelial lining.

47
Q

What is a periapical abscess?

A

1.) It is a collection of pus (neutrophils + bacteria)

48
Q

What association with a periapical abscess does an acute and chronic abscess have?

A

Pain and pressure for acute abscesses & asymptomatic symptoms with a chronic abscess

49
Q

How does an acute abscess often show on a radiograph?

A

Shows on a radiograph with little to no radiographic change. It has a widened PDL which may be the only sign

50
Q

How is the direction of spread for an abscess dictated?

A

It is dictated by the location of the root. It takes the path of least resistance.

51
Q

What can a periapical abscess often proliferate on the surface of the gingiva?

A

A parulis (fistula) can develop onto the surface.

52
Q

What does treatment of a periapical abscess encompass?

A

1.) Involves drainage of the abscess through incision, extraction or root canal treatment.
- root canal therapy + extraction is required to remove the source of the infection

2.) Antibiotics are only indicated for systemic infections

53
Q

What does the path of a periapical abscess depend on?

A

It depends on the muscle insertions and specific fascial planes (4 spaces)

54
Q

What are the 4 spaces an abscess can spread to?

A

1.) Vestibular space
2.) Submandibular space
3.) Sublingual space
4.) Buccal space

55
Q

What does the Ludwig’s angina space of abscess involve?

A

it is specific space infection involving the bilateral:
- submandibular space
- submental space
- sublingual space

  • life threatening infection
56
Q

What are the outcomes of a periapical abscess?

A

1.) Bloodstream infection (Bacteremia)

2.) Spread to soft tissues:
- Abscess
- Cellulitis

3.) Spread through jaw/bones:
- Osteomyelitis
- Periostitis

4.) Chronicity

57
Q

What is the definition of osteomyelitis?

A

It is the inflammation of bone and bone marrow. Most often related to a bacterial infection.

58
Q

What are the 3 types of osteomyelitis?

A
  • acute osteomyelitis
  • chronic osteomyelitis
  • focal sclerosing osteomyelitis

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