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oral pathology > 2 pulpal + periapical diseases > Flashcards

2 pulpal + periapical diseases Flashcards

1
Q

periapical granuloma

A

not actually a granuloma, just a mass of granulation tissue

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2
Q

apical periodontitis

A

periapical granuloma

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3
Q

where is a periapical granuloma?

A

apex of NON-VITAL tooth

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4
Q

where are most periapical granulomas found?

A

radiographic examination

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5
Q

parulis aka

A

gum boil

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6
Q

parulis

A

inflamed granulation tissue at intra-oral opening of sinus tract

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7
Q

appearance of a parulis

A

dome-shaped yellow pink papule

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8
Q

What is rarely hyperplastic, soft tissue mass that may mimic pyogenic granuloma or other pathology

A

parulis

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9
Q

where is a parulis located?

A

usually on ginigiva facial to non-vital tooth

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10
Q

will a parulis exhibit active suppuration?

A

it may or may not

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11
Q

radiographic features of a periapical granuloma

A
  • no lamina dura
  • radiolucent
  • root resorption possible
  • radiographically indistinguishable from a periapical cyst
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12
Q

example of a periapical granuloma

A

parulis

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13
Q

hitopathologic features of periapical granulomas

A

granulation tissue surrounded by fibrous CT

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14
Q

what will the lymphocytic infiltrate be mixed with in the histology of a periapical granuloma?

A

neutrophils, plasma cells, histiocytes, and occasionally mast cells or eosinophils

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15
Q

treatment of periapical granuloma

A

root canal therapy with follow up at 1 and 2 year intervals

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16
Q

persistent periapical granuloma lesions treated with

A

periapical surgery AND SUBMISSION OF TISSUE for microscopic examination

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17
Q

non-restorable teeth with periapical granuloma treated with

A

extraction and currettage of apical tissue

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18
Q

periapical fibrous scar may form in area of

A

defect, especially if cortical plates have been lost

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19
Q

cyst

A

pathologic cavity lined by epithelium

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20
Q

periapical cyst

A

fibrous CT and granulation tissue + epithelium + lumen

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21
Q

peri-apical cyst aka

A

apical radicular cyst

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22
Q

what is the most common odontogenic cyst?

A

peri-apical cyst

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23
Q

What forms the cystic lining of a peri-apical cyst

A

epithelium at apex of non-vital tooth may be stimulated to form cystic lining

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24
Q

What is the cystic lining of a peri-apical cyst usually derived from?

A
  • rests of malassez
  • lateral variant may develop along lateral aspect of root at orifice of accessory canal
  • mimics lateral periodontal cyst
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25
Q

residual

A

remaining after the greater part or quantity has gone.

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26
Q

can a peri-apical cyst be residual?

A

yes

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27
Q

clinical periapical cyst

A

generally asymptomatic

-swelling and tooth mobility my develop

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28
Q

offending tooth of periapical cyst is

A

non-vital

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29
Q

what cyst may be associated with primary teeth?

A

periapical cyst

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30
Q

radiograph of periapical cyst

A
  • radiographically identical to periapical granuloma
  • no lamina dura
  • root resorption
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31
Q

resorption

A

-the process or action by which something is reabsorbed.
“the resorption of water”

-the absorption into the circulation of cells or tissue.
“bone resorption”

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32
Q

histology of periapical cyst

A

lumen of cyst may be filled with fluid or cellular debris

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33
Q

lining of periapical cyst composed of

A

stratified squamous epithelium

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34
Q

What may demonstrate exocytosis, spongiosis, or hyperplasia?

A

periapical cyst

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35
Q

wall of periapical cyst consists of

A

dense fibrous tissue with inflammatory infiltrate

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36
Q

periapical cyst may contain

A
  • linear or arch shaped calcifications (Rushton bodies)
  • cholesterol clefts
  • RBCs or hemosiderin
  • multinucleated giant cells
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37
Q

what are rushton bodies associated with

A

periapical cyst

linear or arch shaped calcifications

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38
Q

treatment of periapical cyst

A

same as periapical granuloma= endodontic therapy or extraction and curettage

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39
Q

curretage

A

use of a curette to remove tissue by scraping or scooping

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40
Q

periapical scar may form after

A

treatment of periapical cyst

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41
Q

untreated cysts may give rise to

A

squamous cell carcinoma

-rationale for tx of ALL paeriapical pathology

42
Q

periapical abcess

A

accumulation of acute inflammatory cells at the apex of a non-vital tooth

43
Q

what may arise as initial form of pathosis or form of acute exacerbation of chronic periapical inflammatory lesion (phoenix abcess)

A

periapical abcess

44
Q

nonspecific symptoms of periapical abcess

A
  • headache, fever, malaise, and chills

- tenderness of affected tooth

45
Q

osteomyelitis

A

abcess spread though bone

46
Q

periapical abcess

A

abcesses may spread through bone (osteomyelitis) or perforate cortex and spread through soft tissue (cellulitis)

  • parulis
  • soft tissue infections may present as swelling or drain through a sinus tract
47
Q

periapical abcess treatment and prognosis

A
  • drainage
  • elimination of infection
  • antibiotics for medically compromised patients
48
Q

chronic hyperplastic pulpitis

A

pulp polyp

49
Q

unique pattern of pulpitis sometimes seen in children and young adults with large pulp exposures (usually molars)

A

chronic hyperplastic pulpitis

50
Q

what happens in the pulp chamber during chronic hyperplastic pulpitis

A

hyperplastic granulation tissue extrudes

51
Q

extrudes

A

thrust or force out

52
Q

chronic hyperplastic pulpitis is usually

A

asymptomatic

53
Q

cellulitis

A
  • acute and edematous spread of acute inflammatory process through fascial planes of soft tissues
  • numerous patterns may result from spread of dental infection
54
Q

ludwig angina

A
  • cellulitis of submandibular region

- most seen in immunocompromised patients

55
Q

ludwig angina is usually associated with infection from which tooth

A

mandibular molar

56
Q

clinical features of ludwig angina

A

bilateral swelling of sublingual, submandibular, and submental spaces

57
Q

what is woody tongue or bull neck associated with?

A

ludwig angina

58
Q

treatment of ludwig angina

A

maintain airway, incision and drainage, antibiotic therapy, eliminate original infection

59
Q

What does the cavernous sinus contain

A

carotid artery

CN 3, 4, 5 (V1, V2), + 6

60
Q

cavernous sinus thrombosis results from infection of which teeth

A

maxillary posterior teeth

61
Q

cavernous sinus thrombosis

A

edematous periorbital enlargement with involvement of eyelids and conjunctiva

62
Q

conjunctiva

A

the mucous membrane that covers the front of the eye and lines the inside of the eyelids.

63
Q

lateral nose and medial eye during cavernous sinus thrombosis may be affected if infection involves what?

A

canine space

64
Q

proptosis

A

bulging of the eye anteriorly out of the orbit.

65
Q

What is seen in 90% of patients with cavernous sinus thrombosis

A

protosis, chemosis, and ptosis

66
Q

prosis

A

is a drooping or falling of the upper eyelid

67
Q

chemosis

A

is the swelling (or edema) of the conjunctiva. It is due to exudation from abnormally permeable capillaries

68
Q

cavernous sinus thrombosis treatment

A
  • drainage
  • antibiotics
  • extraction of offending tooth
69
Q

mortality rate of cavernous sinus thrombosis

A

30%

70
Q

suppurative osteomyelitis

A

-acute or chronic infection of bone

71
Q

what is typically seen in the setting of bacterial infection secondary to fractures or odontogenic infections

A

suppurative osteomyelitis

72
Q

suppurative osteomyelitis has formation of what?

A

suppuration and sequestrum

73
Q

sequestrum

A

is a piece of dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication (sequela) of osteomyelitis

74
Q

involocrum

A

sheath of new bone forming around sequestrum

75
Q

acute osteomyelitis

A

necrotic bone, baacterial colonization and acute inflammatory cell infiltrate

76
Q

chronic osteomyelitis

A
  • inflamed fibrous CT
  • sequestra
  • chronic inflammatory cell infiltrate
77
Q

treatment of acute suppurative osteomyelitis

A
  • resolve infection
  • establish drainage
  • debride infected bone
  • culture
78
Q

treatment of chronic osteomyelitis

A
  • surgical removal of infected tissue

- IV antibiotics

79
Q

condensing osteitis aka

A

focal sclerosing osteitis

80
Q

what is a localized area of bone sclerosis

A

condensing osteitis

81
Q

what are radiopaque lesions associated with apices of teeth with pulpitis or pulpal necrosis?

A
  • condensing osteitis

- these may be mistaken for idiopathic osteosclerosis or cementoosseus dysplasia

82
Q

idiopathic

A

relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.

83
Q

condensing osteitis is most often seen in

A

children and young adults

84
Q

clinical condensing osteitis

A
  • no swelling
  • often seen in posterior mandible
  • adjacent to apices of teeth with caries, fractures, or large restorations
85
Q

condensing osteitis radiograph

A

radiopaque lesion WITHOUT radiolucent border

86
Q

treatment of condensing osteitis

A

endodontic therapy or extraction of offending tooth

87
Q

proliferative periostitis aka

A

periostitis ossificans

88
Q

proliferative periostitis

A

reactive lesion characterized by subperiosteal formation of bone

89
Q

improperly associated with garre

A

proliferative periostitis

90
Q

onion skin pattern

A

proliferative periostitis

91
Q

proliferative periostitis

A

parallel laminations of bone in onion skin pattern

92
Q

denticles

A
  • form during root developemnt
  • occur adjacent to furcation areas of multi rooted teeth
  • believed to form around epithelial strands orginating from rooth sheat
  • most become attched to or become embedded in dentinal walls
93
Q

pulp stones

A
  • form after tooth formation
  • coronal portion of pulp
  • free or attached
94
Q

diffuse linear calcifications

A

fine irregular calcifications that parallel vasculature

95
Q

pulpal calcifications need treatment?

A

no treatment required, although endodontics may be more challenging

96
Q

alveolar osteitis aka

A

dry socket or fibrinolytic alveolitis

97
Q

what is a post-operative complication of tooth extraction

A

alveolar osteitis

98
Q

what causes alveolar osteitis

A

premature fibrinolysis

99
Q

increased incidence of alveolar osteitis associated with

A
  • smoking
  • oral contraceptives
  • pre-operative infections
  • traumatic extractions
  • inadequate irrigation
100
Q

clinical features of alveolar osteitis

A

-most common in posterior mandible
-no gender predilectoin
-1-3% of all extractions
25-30% of imkpacted mandibular 3rd molars

101
Q

greatest likelihood of development of alveolar osteitis

A

between ages 40-45

oral pathology (6 decks)

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