Ch 3 Pulpal Pathology Flashcards
Define pulpal necrobiosis
partial pulpal necrosis
What is the other term for chronic hyperplastic pulpitis?
pulp polyp
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)
What condition is assoiciated with early, widespread formation of secondary dentin?
progeria
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
Term for haphazardly organized new dentin in response to attrition, fracture, erosion, etc.
tertiary dentin
What is the term for dentin formation due to mild/moderate stimulus? (more regular
in appearance)
reactionary dentin
What is the term for dentin formation due to more severe stimulus causing death of odontoblasts?
reparative dentin (formed by new odontoblasts)
What is the term for dentin that is the initial layer of reparative dentin and is atubular?
interface dentin (fibrodentin)
What is the term for when odontoblasts die an their tubules are filled degenerated osteoblastic processes?
dead tracts
How much time does it take to see excess dentin production on radiographs?
3 months to 1 year
Histologically - where is tertiary dentin localized to?
the pulpal end of the odontoblastic process that was affected
What are the three types of pulpal calcifications?
- Denticles 2.Pulp stones 3. diffuse linear calcifications
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”
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
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
Which of the pulpal calcifications are NOT detectible radiographically?
diffuse linear calcifications
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
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?
- usually a rest of Malassez
- crevicular epi
- sinus lining
- 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?
- hyaline bodies
- 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?
- corticosteroid / cytotoxic meds
- malignancy
- DM
- 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
- maintain airway (intubation, tracheotomy, tracheostomy)
- eliminate original focus of infection
- IV antibiotics (penicillin, clinda,metro)
- Culture and sensitivity tests
- +/- 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%
