7. Infection Symposium - Diseases of Pulp & Periodontium

Question 1

What are the clinical features of pulp hyperaemia ?

Answer 1

Pain lasting seconds.
Stimulated by hot/cold or sweet.
Resolves after stimulus.
Caries approaching pulp but restoration still possible without pulp tx.

Question 2

What are the special investigation results for acute periodontitis ?

Answer 2

+ TTP
Non-vital
Increased mobility

Question 3

What radiographic changes are seen in acute periodontitis ?

Answer 3

Loss of clarity of lamina dura.
Radiolucent shadow.
Delay in changes at apex of tooth.
Root resorption.
Widening of PDL at apice.

Question 4

What is the cause of traumatic periodontitis ?

Answer 4

Parafunctional habits - clenching or grinding.

Question 5

What are the special investigation results for traumatic periodontitis ?

Answer 5

+ TTP
Normal vitality

Question 6

What are the radiographic changes seen in traumatic periodontitis ?

Answer 6

Generalised widening of periodontal space.

Question 7

What are the two treatment options for traumatic periodontitis ?

Answer 7

Occlusal adjustment.
Therapy for parafunction.

Question 8

What is the most common pus producing infection ?

Answer 8

Acute apical abscess.

Question 9

What organisms are most commonly associated with dental abscess ?

Answer 9

Anaerobes.

Question 10

What are the key symptoms of acute apical abscess (which is still contained within the bone) ?

Answer 10

Severe unremitting pain.
Acute tenderness in function and on percussion.
No swelling.

Question 11

Why is swelling, redness or heat not seen in an acute apical abscess ?

Answer 11

Infection is still contained in the bone. Perforation of bone will lead to swelling.

Question 12

What are the 5 cardinal signs of inflammation ?

Answer 12

Heat, redness, swelling, pain, loss of function.

Question 13

What are the key symptoms of acute apical abscess (which is not contained within the bone) ?

Answer 13

Pain remits.
Swelling, redness and heat becomes increasingly apparent.
Initial reduction in tenderness as pus escapes.

Question 14

What are the four things which will impact the site of swelling in an acute apical abscess ?

Answer 14

Position of tooth in arch.
Root length.
Muscle attachments.
Potential spaces in proximity to lesion.

Question 15

What are the treatment options for acute apical abscess ?

Answer 15

Provide drainage.
Need for antibiotics ?

Question 16

What are three considerations which should be given prior to prescribing antibiotics for acute apical abscess ?

Answer 16

Severity of infection.
Absence of adequate drainage.
Patient’s medical condition.

Question 17

What are the possible local factors which will indicate antibiotic prescription for acute apical abscess ?

Answer 17

Toxicity.
Airway compromisation.
Dysphagia.
Trismus.
Lymphadenitis.
Location of swelling.

Question 18

What location of swelling in the mouth indicates medical emergency and need for antibiotic prescription ?

Answer 18

Floor of the mouth due to compromisation of airway.

Question 19

Acute apical abscess - name medical conditions which might render a patient immunocompromised.

Answer 19

HIV
Steroid treatment.
Cytostatic drug treatment.
Leukaemias.
Diabetes.
Extremes of age.

Question 20

Define reversible pulpitis.

Answer 20

A level of inflammation in which returning to a normal state is possible if noxious stimuli is removed.

Question 21

Define irreversible pulpitis.

Answer 21

Higher level of inflammation in which dental pulp has been damaged beyond point of recovery.

Question 22

What are the symptoms related to reversible pulpitis ?

Answer 22

Mild-moderate pain on stimulation.
No pain without stimuli.
Subsides in seconds.
No mobility.
No TTP.

Question 23

What are the symptoms related to irreversible pulpitis ?

Answer 23

Sharp, throbbing, severe pain.
Within stimulation.
Spontaneous pain.
Pain persists >5 seconds after removal of stimuli.

Question 24

What are the treatment options for irreversible pulpitis ?

Answer 24

RCT or XLA

Question 25

Describe a periapical granuloma i.e. chronic apical periodontitis.

Answer 25

Mass of chronically inflamed granulation tissue at apex of tooth.

Question 26

What cells are associated with chronic apical periodontitis.

Answer 26

Plasma cells.
Lymphocytes.
Histiocytes.
Fibroblasts.
Capillaries.

Question 27

Why is a chronic apical periodontitis not a true granulomatous lesion ?

Answer 27

No granulomatous inflammation - no epithelioid histiocytes mixed with lymphocytes and giant cells.

Question 28

How does a periapical (radicular) cyst form ?

Answer 28

Caries, trauma, PD disease.
Pulpal necrosis.
Apical bone inflammation.
Dental granuloma.
Stimulation of epithelial rests of Malassez.
Epithelial proliferation.
Periapical cyst formation.