2 pulpal + periapical diseases Flashcards
periapical granuloma
not actually a granuloma, just a mass of granulation tissue
apical periodontitis
periapical granuloma
where is a periapical granuloma?
apex of NON-VITAL tooth
where are most periapical granulomas found?
radiographic examination
parulis aka
gum boil
parulis
inflamed granulation tissue at intra-oral opening of sinus tract
appearance of a parulis
dome-shaped yellow pink papule
What is rarely hyperplastic, soft tissue mass that may mimic pyogenic granuloma or other pathology
parulis
where is a parulis located?
usually on ginigiva facial to non-vital tooth
will a parulis exhibit active suppuration?
it may or may not
radiographic features of a periapical granuloma
- no lamina dura
- radiolucent
- root resorption possible
- radiographically indistinguishable from a periapical cyst
example of a periapical granuloma
parulis
hitopathologic features of periapical granulomas
granulation tissue surrounded by fibrous CT
what will the lymphocytic infiltrate be mixed with in the histology of a periapical granuloma?
neutrophils, plasma cells, histiocytes, and occasionally mast cells or eosinophils
treatment of periapical granuloma
root canal therapy with follow up at 1 and 2 year intervals
persistent periapical granuloma lesions treated with
periapical surgery AND SUBMISSION OF TISSUE for microscopic examination
non-restorable teeth with periapical granuloma treated with
extraction and currettage of apical tissue
periapical fibrous scar may form in area of
defect, especially if cortical plates have been lost
cyst
pathologic cavity lined by epithelium
periapical cyst
fibrous CT and granulation tissue + epithelium + lumen
peri-apical cyst aka
apical radicular cyst
what is the most common odontogenic cyst?
peri-apical cyst
What forms the cystic lining of a peri-apical cyst
epithelium at apex of non-vital tooth may be stimulated to form cystic lining
What is the cystic lining of a peri-apical cyst usually derived from?
- rests of malassez
- lateral variant may develop along lateral aspect of root at orifice of accessory canal
- mimics lateral periodontal cyst
residual
remaining after the greater part or quantity has gone.
can a peri-apical cyst be residual?
yes
clinical periapical cyst
generally asymptomatic
-swelling and tooth mobility my develop
offending tooth of periapical cyst is
non-vital
what cyst may be associated with primary teeth?
periapical cyst
radiograph of periapical cyst
- radiographically identical to periapical granuloma
- no lamina dura
- root resorption
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”
histology of periapical cyst
lumen of cyst may be filled with fluid or cellular debris
lining of periapical cyst composed of
stratified squamous epithelium
What may demonstrate exocytosis, spongiosis, or hyperplasia?
periapical cyst
wall of periapical cyst consists of
dense fibrous tissue with inflammatory infiltrate
periapical cyst may contain
- linear or arch shaped calcifications (Rushton bodies)
- cholesterol clefts
- RBCs or hemosiderin
- multinucleated giant cells
what are rushton bodies associated with
periapical cyst
linear or arch shaped calcifications
treatment of periapical cyst
same as periapical granuloma= endodontic therapy or extraction and curettage
curretage
use of a curette to remove tissue by scraping or scooping
periapical scar may form after
treatment of periapical cyst
untreated cysts may give rise to
squamous cell carcinoma
-rationale for tx of ALL paeriapical pathology
periapical abcess
accumulation of acute inflammatory cells at the apex of a non-vital tooth
what may arise as initial form of pathosis or form of acute exacerbation of chronic periapical inflammatory lesion (phoenix abcess)
periapical abcess
nonspecific symptoms of periapical abcess
- headache, fever, malaise, and chills
- tenderness of affected tooth
osteomyelitis
abcess spread though bone
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
periapical abcess treatment and prognosis
- drainage
- elimination of infection
- antibiotics for medically compromised patients
chronic hyperplastic pulpitis
pulp polyp
unique pattern of pulpitis sometimes seen in children and young adults with large pulp exposures (usually molars)
chronic hyperplastic pulpitis
what happens in the pulp chamber during chronic hyperplastic pulpitis
hyperplastic granulation tissue extrudes
extrudes
thrust or force out
chronic hyperplastic pulpitis is usually
asymptomatic
cellulitis
- acute and edematous spread of acute inflammatory process through fascial planes of soft tissues
- numerous patterns may result from spread of dental infection
ludwig angina
- cellulitis of submandibular region
- most seen in immunocompromised patients
ludwig angina is usually associated with infection from which tooth
mandibular molar
clinical features of ludwig angina
bilateral swelling of sublingual, submandibular, and submental spaces
what is woody tongue or bull neck associated with?
ludwig angina
treatment of ludwig angina
maintain airway, incision and drainage, antibiotic therapy, eliminate original infection
What does the cavernous sinus contain
carotid artery
CN 3, 4, 5 (V1, V2), + 6
cavernous sinus thrombosis results from infection of which teeth
maxillary posterior teeth
cavernous sinus thrombosis
edematous periorbital enlargement with involvement of eyelids and conjunctiva
conjunctiva
the mucous membrane that covers the front of the eye and lines the inside of the eyelids.
lateral nose and medial eye during cavernous sinus thrombosis may be affected if infection involves what?
canine space
proptosis
bulging of the eye anteriorly out of the orbit.
What is seen in 90% of patients with cavernous sinus thrombosis
protosis, chemosis, and ptosis
prosis
is a drooping or falling of the upper eyelid
chemosis
is the swelling (or edema) of the conjunctiva. It is due to exudation from abnormally permeable capillaries
cavernous sinus thrombosis treatment
- drainage
- antibiotics
- extraction of offending tooth
mortality rate of cavernous sinus thrombosis
30%
suppurative osteomyelitis
-acute or chronic infection of bone
what is typically seen in the setting of bacterial infection secondary to fractures or odontogenic infections
suppurative osteomyelitis
suppurative osteomyelitis has formation of what?
suppuration and sequestrum
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
involocrum
sheath of new bone forming around sequestrum
acute osteomyelitis
necrotic bone, baacterial colonization and acute inflammatory cell infiltrate
chronic osteomyelitis
- inflamed fibrous CT
- sequestra
- chronic inflammatory cell infiltrate
treatment of acute suppurative osteomyelitis
- resolve infection
- establish drainage
- debride infected bone
- culture
treatment of chronic osteomyelitis
- surgical removal of infected tissue
- IV antibiotics
condensing osteitis aka
focal sclerosing osteitis
what is a localized area of bone sclerosis
condensing osteitis
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
idiopathic
relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.
condensing osteitis is most often seen in
children and young adults
clinical condensing osteitis
- no swelling
- often seen in posterior mandible
- adjacent to apices of teeth with caries, fractures, or large restorations
condensing osteitis radiograph
radiopaque lesion WITHOUT radiolucent border
treatment of condensing osteitis
endodontic therapy or extraction of offending tooth
proliferative periostitis aka
periostitis ossificans
proliferative periostitis
reactive lesion characterized by subperiosteal formation of bone
improperly associated with garre
proliferative periostitis
onion skin pattern
proliferative periostitis
proliferative periostitis
parallel laminations of bone in onion skin pattern
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
pulp stones
- form after tooth formation
- coronal portion of pulp
- free or attached
diffuse linear calcifications
fine irregular calcifications that parallel vasculature
pulpal calcifications need treatment?
no treatment required, although endodontics may be more challenging
alveolar osteitis aka
dry socket or fibrinolytic alveolitis
what is a post-operative complication of tooth extraction
alveolar osteitis
what causes alveolar osteitis
premature fibrinolysis
increased incidence of alveolar osteitis associated with
- smoking
- oral contraceptives
- pre-operative infections
- traumatic extractions
- inadequate irrigation
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
greatest likelihood of development of alveolar osteitis
between ages 40-45
