7. Infection Symposium - Diseases of Pulp & Periodontium Flashcards
What are the clinical features of pulp hyperaemia ?
Pain lasting seconds.
Stimulated by hot/cold or sweet.
Resolves after stimulus.
Caries approaching pulp but restoration still possible without pulp tx.
What are the special investigation results for acute periodontitis ?
+ TTP
Non-vital
Increased mobility
What radiographic changes are seen in acute periodontitis ?
Loss of clarity of lamina dura.
Radiolucent shadow.
Delay in changes at apex of tooth.
Root resorption.
Widening of PDL at apice.
What is the cause of traumatic periodontitis ?
Parafunctional habits - clenching or grinding.
What are the special investigation results for traumatic periodontitis ?
+ TTP
Normal vitality
What are the radiographic changes seen in traumatic periodontitis ?
Generalised widening of periodontal space.
What are the two treatment options for traumatic periodontitis ?
Occlusal adjustment.
Therapy for parafunction.
What is the most common pus producing infection ?
Acute apical abscess.
What organisms are most commonly associated with dental abscess ?
Anaerobes.
What are the key symptoms of acute apical abscess (which is still contained within the bone) ?
Severe unremitting pain.
Acute tenderness in function and on percussion.
No swelling.
Why is swelling, redness or heat not seen in an acute apical abscess ?
Infection is still contained in the bone. Perforation of bone will lead to swelling.
What are the 5 cardinal signs of inflammation ?
Heat, redness, swelling, pain, loss of function.
What are the key symptoms of acute apical abscess (which is not contained within the bone) ?
Pain remits.
Swelling, redness and heat becomes increasingly apparent.
Initial reduction in tenderness as pus escapes.
What are the four things which will impact the site of swelling in an acute apical abscess ?
Position of tooth in arch.
Root length.
Muscle attachments.
Potential spaces in proximity to lesion.
What are the treatment options for acute apical abscess ?
Provide drainage.
Need for antibiotics ?
What are three considerations which should be given prior to prescribing antibiotics for acute apical abscess ?
Severity of infection.
Absence of adequate drainage.
Patient’s medical condition.
What are the possible local factors which will indicate antibiotic prescription for acute apical abscess ?
Toxicity.
Airway compromisation.
Dysphagia.
Trismus.
Lymphadenitis.
Location of swelling.
What location of swelling in the mouth indicates medical emergency and need for antibiotic prescription ?
Floor of the mouth due to compromisation of airway.
Acute apical abscess - name medical conditions which might render a patient immunocompromised.
HIV
Steroid treatment.
Cytostatic drug treatment.
Leukaemias.
Diabetes.
Extremes of age.
Define reversible pulpitis.
A level of inflammation in which returning to a normal state is possible if noxious stimuli is removed.
Define irreversible pulpitis.
Higher level of inflammation in which dental pulp has been damaged beyond point of recovery.
What are the symptoms related to reversible pulpitis ?
Mild-moderate pain on stimulation.
No pain without stimuli.
Subsides in seconds.
No mobility.
No TTP.
What are the symptoms related to irreversible pulpitis ?
Sharp, throbbing, severe pain.
Within stimulation.
Spontaneous pain.
Pain persists >5 seconds after removal of stimuli.
What are the treatment options for irreversible pulpitis ?
RCT or XLA
Describe a periapical granuloma i.e. chronic apical periodontitis.
Mass of chronically inflamed granulation tissue at apex of tooth.
What cells are associated with chronic apical periodontitis.
Plasma cells.
Lymphocytes.
Histiocytes.
Fibroblasts.
Capillaries.
Why is a chronic apical periodontitis not a true granulomatous lesion ?
No granulomatous inflammation - no epithelioid histiocytes mixed with lymphocytes and giant cells.
How does a periapical (radicular) cyst form ?
Caries, trauma, PD disease.
Pulpal necrosis.
Apical bone inflammation.
Dental granuloma.
Stimulation of epithelial rests of Malassez.
Epithelial proliferation.
Periapical cyst formation.
