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Oral Pathology > Chapter 3 - Periapical Lesions > Flashcards

Chapter 3 - Periapical Lesions Flashcards

1
Q

3 types of pulpitis

A

Reversible

Irreversible

Chronic Hyperplastic

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2
Q
A

Chronic Hyperplastic Pulpitis

Inflammation causes the pulpal tissue to bulge up and out into the crown

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3
Q

4 most likely Periapical Pathologies

A

Periapical Granuloma

Apical periodontal cyst

Periapical Abscess

Bone scar

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4
Q

What is the most common and most likely periapical pathology?

A

Periapical granuloma

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5
Q

What is the LEAST common periapical pathology?

A

Bone Scar

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6
Q

Sequelae of Periapical Pathology (4)

A

Sinus Tract

Osteomyelitis

Condensing Osteitis

Cellulitis

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7
Q
A

Parulis“Gum Boil”

Intraoral sinus tract exit - on oral mucosa

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8
Q

Osteomyelitis

A

Chronic or acute infection of the bone - bone marrow

Bacterial infection

Results in:

* Expanding lytic destruction

* Suppuration

* Sequestra Formation - bone pieces floating in the infection

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9
Q
A

Condensing Osteitis

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10
Q

What is the earliest change in the periodontium resulting from periapical pathology.

A
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11
Q

Periapical Granuloma

A

Most common periapical pathosis

Chronically inflamed granulation tissue - nonvital tooth

Usually asymptomatic

Histology - plasma cells and lymphocytes

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12
Q

Phoenix Abscess

A

Secondary acute inflammatory changes within a periapicla granuloma

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13
Q

Clinical Presentation of Periapical Granuloma

A

Asymptomatic

Tooth not typically mobile

Usually not sensitive to percussion

Does not respond to thermal or electrical pulp testing

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14
Q

Periapical Granuloma Treatment

A

Conventional endodontic treatment

Surgical endodontic treatment

Extraction

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15
Q

Periapical Periodontal Cyst

A

* Periapical cyst or Radicular Cyst*

Inflammatory stimulation of epithelium in the area – Rests of Malassez

Radiograhically –> Slow growth, punched out border

Histology –> Spiderweb pattern, epithelium lined

Patterns:

* Classical

* Lateral Apical Periodontal

* Residual apicl periodontal cyst

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16
Q

Classical Pattern of Periodontal Cyst

A

Lesion surrounds the root tip

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17
Q

Lateral Apical Periodontal Cyst

A

Lesion lateral to root tip

Lateral canal

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18
Q

Residual Apical Periodontal Cyst

A

Toot was extracted but the cyst remains

19
Q

Periapical abscess

A

Acute inflammatory cells at the apex of a nonvital tooth

Symptomatic or asymptomatic

Histology –> large accumulation of inflammation

Earlies manifestation with widening of the PDL - when pulpal involvement

20
Q

Periapical abscess treatment

A

Endo Treatment

Extraction

Pain Killers

21
Q

Periapical Scar

A

Defect created by periapical inflammatory lesions may fill with DENSE collagenous tissue

Common – Following surgical endodontic therapy

When facial and lingual cortical plates have been lost

Histology –> Collagen (all pink, no blue), Fibroblasts

RADIO-Translucent

22
Q

Sequelae or Periapical Pathology (4)

A

Sinus Tract

Osteomyelitis

Cellulitis

Condensing Osteitis

23
Q

Sinus Tract

A

Pus dissects through the bone – destroying the bone

Perforates the cortical plate of bone extending into soft tissue

Follows the path of least resistance

Drains purulent material – may be intermittent drainage

Location of tract depends on involved tooth and path of least resistance

24
Q
A

Parulis (Gum boil)

Intraoral sinus tract exiting through oral mucosa

Hole with red halo

Pustule (large pimple)

*Fistula*

25
Q

Cutaneous Sinus Tract

A

Cutaneous Sinus Tract

Enlarged Nodular Mass

Red lesion with shades of Yellow, White, Purple

Mandibular teeth - most common

26
Q

Osteomyelitis

A

Acute or Chronic inflammation in bone

Bacterial Infection

Results in:

* Expanding lytic destruction

* Suppuration (pus)

* Sequestra formation – bone pieces floating around in the infection

arise after odontogenic infections or traumatic fracture - not common in developed countries

27
Q

Symptoms of acute infection of osteomyelitis

A

Fever

Lymphadenopathy

Sensitivity

Soft tissue swelling

DOESN’T produce x-ray changes

28
Q

Involucrum

A

** During acute infection fragments of necrotic bone may become surrounded by new vital bone **

29
Q

Cellulitis

A

Purulence perforates the cortex and spreads diffusely through the overlying soft tissue

Unable to establish a drainage point

Weaves through muscle bundles

30
Q
A

Ludwig’s Angina

Cellulitis of the submandibular region

No previous treatment has been performed, infection has persisted (Infection from mandibular molar tooth)

Rapid swelling of sublingual, submandibular, and submental spaces

Death can occur – strangling

Woody Tongue

Bull Neck

31
Q

Woody Tongue

A

Ludwig’s Angina

Sublingual involvment causes swelling and elevation of the tongue

32
Q

Bull Neck

A

Ludwigs Angina

Submandibular space spread causes enlargment and tenderness of the neck

33
Q

Ludwig Angina Symptoms and Signs

A

Obvious collections of pus are NOT present - no fistulas tract

Pain

Restricted Neck movement

Dysphagia, Dysphonia, Dysarthria

Drooling

Sore Throat

Respiratory Obstruction

SIGNS: Tachypnea,dyspnea, tachycardia, stridor, restlessness

34
Q
A
35
Q

Ludwig Angina Treatment

A

Call 911

Maintain airway

incise and drain

Antibiotic therapy

Eliminate orginal focus of infection

36
Q
A

Cavernous Sinus Thrombosis

Abscess of a maxillary anterir or premolar tooth (canine - most common)

*Edematous periorbital enlargement – swelling along the lateral border of the nose*

37
Q

Possibe sequelae of Cavernous Sinus Thrombosis

A

Protrusion and fixation of the eyeball

Pupil dilation with photophobia

Excessive lacrimation (tearing)

Loss of sight in the involved eye

Meningitis

Brain abscess

Death*

38
Q

Cavernous Sinus Thrombosis Treatment

A

Surgical drainage

High dose antibiotics

39
Q
A

Condensing Osteitis - Focal Sclerosing ostemyelitis

Bone sclerosis associated with the apex of teeth with pulpitis

Associated with inflammation - radiographically identical to idiopathic osteosclerosis

No clinical expansion of bone

40
Q

X ray changes of Condensing Osteitis

A

* Increased radio-opacity near toot apex

* Thickened PDL or apical inflammatory lesion

* No radio-lucent border (distinguishes from focal cemento-osseous dysplasia)

* Not separated from apex (distinguishes from idopathic osteosclerosis)

41
Q

Condensing osteitis vs cemento-osseous dysplasia

A

Xray of condensing osteitis has NO radio-lucent border

42
Q

Condensing osteitis vs idopathic osteosclerosis

A

Condensing osteitis lesion is NOT separated from apex

43
Q
A

Idiopathic osteosclerosis

*NOT associated with a carious tooth*

Normal tooth with radiolucent mass

Oral Pathology (17 decks)

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