Ch 3 Pulpal Pathology Flashcards by Austin Shackelford

Define pulpal necrobiosis

partial pulpal necrosis

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What is the other term for chronic hyperplastic pulpitis?

pulp polyp

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What type of dentin exhibits slow and gradual deposition that increases after the age of 35 to 40? What can advance this formation (esp in males)?

physiologic secondary dentin…calcification-related diseases (arthritis, gout, kidney stones, etc)

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What condition is assoiciated with early, widespread formation of secondary dentin?

progeria

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What is the term for significant traumatic injury that can lead to early obliteration of the pulp chamber and canal? What color might the tooth look clincally?

calcific metamorphosis…yellow

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Term for haphazardly organized new dentin in response to attrition, fracture, erosion, etc.

tertiary dentin

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What is the term for dentin formation due to mild/moderate stimulus? (more regular
in appearance)

reactionary dentin

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What is the term for dentin formation due to more severe stimulus causing death of odontoblasts?

reparative dentin (formed by new odontoblasts)

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What is the term for dentin that is the initial layer of reparative dentin and is atubular?

interface dentin (fibrodentin)

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What is the term for when odontoblasts die an their tubules are filled degenerated osteoblastic processes?

dead tracts

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How much time does it take to see excess dentin production on radiographs?

3 months to 1 year

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Histologically - where is tertiary dentin localized to?

the pulpal end of the odontoblastic process that was affected

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What are the three types of pulpal calcifications?

Denticles 2.Pulp stones 3. diffuse linear calcifications

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What type of pulpal calcification am I? a result of an epitheliomesenchymal interaction within the developing pulp…what “shape” do these make?

denticles! “thimble-shaped”

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What type of pulpal calcification am I? develop around a central nidus of pulp tissue (e.g., collagen fibril, ground substance, necrotic cell remnants)

pulp stones

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What type of pulpal calcification am I? exhibit areas of
fine, fibrillar, irregular calcification that often parallel the
vasculature…frequency increases with age

diffuse linear calcifications

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Which of the pulpal calcifications are NOT detectible radiographically?

diffuse linear calcifications

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What are the 7 disease processes associated with pulpal calcifications?

Dentin dysplasia Id
Dentin dysplasia II
Pulpal dysplasia
Tumoral calcinosis (calcium deposits around joints, dialysis)
Calcinosis universalis (deposits in skin, subcut, etc)
Ehlers-Danlos syndrome
End-stage renal disease

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What is the alternate name for a periapical granuloma?

chronic apical periodontitis

What is the term for the period of time when in the early stages of infection PMNs predominate and radiographic alterations are not present?

acute apical periodontitis

What is the term for secondary acute inflammatory changes within a periapical granuloma?

phoenix abscess

What condition has been synonymous with the now defunct “Garre Osetomyelitis?”

Osteomyelitis WITH proliferative periostitis (onion skinning)

What is a Russell body comprised of?

What are russell bodies associated with?

globules of gamma globulin lol

-Periapical granulomas

What are the basophilic particles sometimes seen in a periapical granuloma?

pyronine bodies

What size lesion generally indicates periapical endodontic surgery (apico)?

lesions larger than 2 cm

What bony deficiency can promote the formation of a periapical scar? What is the treatment?

When the buccal and lingual cortical plates have been lost..NOT indicated for repeat surgery

What are the 4 possible sources for the epithelial lining in a periapical cyst?

1. usually a rest of Malassez 2. crevicular epi 3. sinus lining 4. epi lining of sinus tract

What is the term for a periapical cyst still partially attached to a tooth root following extration?

periapical pocket cyst

What is the term for a periapical cyst that is separate from the tooth apex?

periapical true cyst

Do residual periapical cysts resolve?

"many" reduce in size and can spontaneously resolve (so I guess bx to verify its not OKC/Amelo, then leave it alone - or no biopsy if hx is known)

What is the term for linear or arch-shaped calcifications seen in the EPITHELIAL LINING of periapical cysts?

Rushton bodies (remember Russell bodies are in periapical granulomas)

What are the other two terms for pulse granulomas? What is their etiology?

1. hyaline bodies 2. giant-cell hyaline angiopathy extravasated serum that undergoes fibrosis and occasionally dystrophic calcification

What is the term for the PDL exhibiting acute inflammation, but no frank abscess formation?

acute apical periodontitis

Most dental-related abscesses perforate _______ because the bone is thinner on the this surface. Except for max lat inc, pal root max molars, mand 2nd and 3rd molars

buccally

What are a few conditions that put patients at higher risk for developing cellulitis s/p dental infection?

1. corticosteroid / cytotoxic meds 2. malignancy 3. DM 4. immunosuppressive (neutropenia, aplastic anemia, AIDS)

Latin origin for Ludwig angina

angere = to strangle (Ludwig was a German physician in 1836)

What % of cavernous sinus thrombosis cases are caused by dental infection?

10%

What % of Ludwig angina is caused by a mandibular molar abscess?

70% (the rest being peritonsillar or parapharyngeal abscesses, tongue piercing, oral lacerations, fractures of the mandible, or submandibular sialadenitis)

What is the term for protrusion of the tongue during Ludwig angina?

woody tongue

What is the term for enlargment and tenderness of the neck above the level of the hyoid bone during Ludwig angina?

bull neck

Proptosis (protrusion of eye), chemosis (blister in eye), and ptosis (upper eyelid drooping and covering pupil) are noted in greater than 90% of patients with what condition?

cavernous sinus thrombosis

5 steps in treatment of Ludwig angina

1. maintain airway (intubation, tracheotomy, tracheostomy) 2. eliminate original focus of infection 3. IV antibiotics (penicillin, clinda,metro) 4. Culture and sensitivity tests 5. +/- corticosterioids to help with swelling and abx

What is the mortality rate for Ludwig angina?

10% (complications such as pericarditis, pneumonia, mediastinitis, sepsis, empyema, and respiratory obstruction)

When are corticosteroids used to treat cavernous sinus thrombosis?

corticosteroids are used if pituitary insufficiency develops

What is the mortality rate for cavernous sinus thrombosis?

30%