2 pulpal + periapical diseases Flashcards
1
Q
periapical granuloma
A
not actually a granuloma, just a mass of granulation tissue
2
Q
apical periodontitis
A
periapical granuloma
3
Q
where is a periapical granuloma?
A
apex of NON-VITAL tooth
4
Q
where are most periapical granulomas found?
A
radiographic examination
5
Q
parulis aka
A
gum boil
6
Q
parulis
A
inflamed granulation tissue at intra-oral opening of sinus tract
7
Q
appearance of a parulis
A
dome-shaped yellow pink papule
8
Q
What is rarely hyperplastic, soft tissue mass that may mimic pyogenic granuloma or other pathology
A
parulis
9
Q
where is a parulis located?
A
usually on ginigiva facial to non-vital tooth
10
Q
will a parulis exhibit active suppuration?
A
it may or may not
11
Q
radiographic features of a periapical granuloma
A
- no lamina dura
- radiolucent
- root resorption possible
- radiographically indistinguishable from a periapical cyst
12
Q
example of a periapical granuloma
A
parulis
13
Q
hitopathologic features of periapical granulomas
A
granulation tissue surrounded by fibrous CT
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
15
Q
treatment of periapical granuloma
A
root canal therapy with follow up at 1 and 2 year intervals
16
Q
persistent periapical granuloma lesions treated with
A
periapical surgery AND SUBMISSION OF TISSUE for microscopic examination
17
Q
non-restorable teeth with periapical granuloma treated with
A
extraction and currettage of apical tissue
18
Q
periapical fibrous scar may form in area of
A
defect, especially if cortical plates have been lost
19
Q
cyst
A
pathologic cavity lined by epithelium
20
Q
periapical cyst
A
fibrous CT and granulation tissue + epithelium + lumen
21
Q
peri-apical cyst aka
A
apical radicular cyst
22
Q
what is the most common odontogenic cyst?
A
peri-apical cyst
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
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
25
residual
remaining after the greater part or quantity has gone.
26
can a peri-apical cyst be residual?
yes
27
clinical periapical cyst
generally asymptomatic
| -swelling and tooth mobility my develop
28
offending tooth of periapical cyst is
non-vital
29
what cyst may be associated with primary teeth?
periapical cyst
30
radiograph of periapical cyst
- radiographically identical to periapical granuloma
- no lamina dura
- root resorption
31
resorption
-the process or action by which something is reabsorbed.
"the resorption of water"
-the absorption into the circulation of cells or tissue.
"bone resorption"
32
histology of periapical cyst
lumen of cyst may be filled with fluid or cellular debris
33
lining of periapical cyst composed of
stratified squamous epithelium
34
What may demonstrate exocytosis, spongiosis, or hyperplasia?
periapical cyst
35
wall of periapical cyst consists of
dense fibrous tissue with inflammatory infiltrate
36
periapical cyst may contain
- linear or arch shaped calcifications (Rushton bodies)
- cholesterol clefts
- RBCs or hemosiderin
- multinucleated giant cells
37
what are rushton bodies associated with
periapical cyst
| linear or arch shaped calcifications
38
treatment of periapical cyst
same as periapical granuloma= endodontic therapy or extraction and curettage
39
curretage
use of a curette to remove tissue by scraping or scooping
40
periapical scar may form after
treatment of periapical cyst
41
untreated cysts may give rise to
squamous cell carcinoma
| -rationale for tx of ALL paeriapical pathology
42
periapical abcess
accumulation of acute inflammatory cells at the apex of a non-vital tooth
43
what may arise as initial form of pathosis or form of acute exacerbation of chronic periapical inflammatory lesion (phoenix abcess)
periapical abcess
44
nonspecific symptoms of periapical abcess
- headache, fever, malaise, and chills
| - tenderness of affected tooth
45
osteomyelitis
abcess spread though bone
46
periapical abcess
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
periapical abcess treatment and prognosis
- drainage
- elimination of infection
- antibiotics for medically compromised patients
48
chronic hyperplastic pulpitis
pulp polyp
49
unique pattern of pulpitis sometimes seen in children and young adults with large pulp exposures (usually molars)
chronic hyperplastic pulpitis
50
what happens in the pulp chamber during chronic hyperplastic pulpitis
hyperplastic granulation tissue extrudes
51
extrudes
thrust or force out
52
chronic hyperplastic pulpitis is usually
asymptomatic
53
cellulitis
- acute and edematous spread of acute inflammatory process through fascial planes of soft tissues
- numerous patterns may result from spread of dental infection
54
ludwig angina
- cellulitis of submandibular region
| - most seen in immunocompromised patients
55
ludwig angina is usually associated with infection from which tooth
mandibular molar
56
clinical features of ludwig angina
bilateral swelling of sublingual, submandibular, and submental spaces
57
what is woody tongue or bull neck associated with?
ludwig angina
58
treatment of ludwig angina
maintain airway, incision and drainage, antibiotic therapy, eliminate original infection
59
What does the cavernous sinus contain
carotid artery
| CN 3, 4, 5 (V1, V2), + 6
60
cavernous sinus thrombosis results from infection of which teeth
maxillary posterior teeth
61
cavernous sinus thrombosis
edematous periorbital enlargement with involvement of eyelids and conjunctiva
62
conjunctiva
the mucous membrane that covers the front of the eye and lines the inside of the eyelids.
63
lateral nose and medial eye during cavernous sinus thrombosis may be affected if infection involves what?
canine space
64
proptosis
bulging of the eye anteriorly out of the orbit.
65
What is seen in 90% of patients with cavernous sinus thrombosis
protosis, chemosis, and ptosis
66
prosis
is a drooping or falling of the upper eyelid
67
chemosis
is the swelling (or edema) of the conjunctiva. It is due to exudation from abnormally permeable capillaries
68
cavernous sinus thrombosis treatment
- drainage
- antibiotics
- extraction of offending tooth
69
mortality rate of cavernous sinus thrombosis
30%
70
suppurative osteomyelitis
-acute or chronic infection of bone
71
what is typically seen in the setting of bacterial infection secondary to fractures or odontogenic infections
suppurative osteomyelitis
72
suppurative osteomyelitis has formation of what?
suppuration and sequestrum
73
sequestrum
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
involocrum
sheath of new bone forming around sequestrum
75
acute osteomyelitis
necrotic bone, baacterial colonization and acute inflammatory cell infiltrate
76
chronic osteomyelitis
- inflamed fibrous CT
- sequestra
- chronic inflammatory cell infiltrate
77
treatment of acute suppurative osteomyelitis
- resolve infection
- establish drainage
- debride infected bone
- culture
78
treatment of chronic osteomyelitis
- surgical removal of infected tissue
| - IV antibiotics
79
condensing osteitis aka
focal sclerosing osteitis
80
what is a localized area of bone sclerosis
condensing osteitis
81
what are radiopaque lesions associated with apices of teeth with pulpitis or pulpal necrosis?
- condensing osteitis
| - these may be mistaken for idiopathic osteosclerosis or cementoosseus dysplasia
82
idiopathic
relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.
83
condensing osteitis is most often seen in
children and young adults
84
clinical condensing osteitis
- no swelling
- often seen in posterior mandible
- adjacent to apices of teeth with caries, fractures, or large restorations
85
condensing osteitis radiograph
radiopaque lesion WITHOUT radiolucent border
86
treatment of condensing osteitis
endodontic therapy or extraction of offending tooth
87
proliferative periostitis aka
periostitis ossificans
88
proliferative periostitis
reactive lesion characterized by subperiosteal formation of bone
89
improperly associated with garre
proliferative periostitis
90
onion skin pattern
proliferative periostitis
91
proliferative periostitis
parallel laminations of bone in onion skin pattern
92
denticles
- 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
pulp stones
- form after tooth formation
- coronal portion of pulp
- free or attached
94
diffuse linear calcifications
fine irregular calcifications that parallel vasculature
95
pulpal calcifications need treatment?
no treatment required, although endodontics may be more challenging
96
alveolar osteitis aka
dry socket or fibrinolytic alveolitis
97
what is a post-operative complication of tooth extraction
alveolar osteitis
98
what causes alveolar osteitis
premature fibrinolysis
99
increased incidence of alveolar osteitis associated with
- smoking
- oral contraceptives
- pre-operative infections
- traumatic extractions
- inadequate irrigation
100
clinical features of alveolar osteitis
-most common in posterior mandible
-no gender predilectoin
-1-3% of all extractions
25-30% of imkpacted mandibular 3rd molars
101
greatest likelihood of development of alveolar osteitis
between ages 40-45
