Chapter 3 Pulpal and periapical disease Flashcards
Do you need a root canal to treat reversible pulpitis?
-No
What are four sequelae of periapical pathology?
- Sinus tract
- Osteomyelitis
- Cellulitis
- Condensing osteitis
If you have a non vital pulp with a PA abscess that is an acute inflammation with drainage what do you have?
-Sinus tract
What is a periapical cyst from?
-Rest of malassez
What is the earliest change of a periapical pathology?
-Widening of the PDL (lamina dura)
What are the four localized periapical pathologies?
- Periapical granuloma
- Apical periodontal cyst
- Periapical abscess
- Periapical scar
What is the most common periapical pathosis?
-Periapical granuloma (aka apical periodontitis)
What type of inflammation is a periapical granuloma associated with?
-Chronic
What is a secondary acute inflammatory changes within a periapical granuloma?
-Phoenix abscess
What does a periapical granuloma appear as radiographically?
- Radiolucent lesion
- Symmetrical
- Well defined
- Variable in size
How do you treat a periapical granuloma?
- Conventional endodontic treatment
- Surgical endodontic treatment
- Extraction
What do you get if you have inflammatory stimulation of epithelium in the area (rests of malassez)?
-Periapical cyst
What does a periapical cyst appear as radiographically?
- Radiolucent
- Symmetrical
- Well defined
What is an accumulation of acute inflamatory cells at the apex of a nonvital tooth?
-Periapical abscess
What does an abscess appear as histologically?
-full of neutrophils
What is it known as when the defect created by periapical inflammatory lesions that may fill with dense collagenous tissue?
-Periapical Scar
What is the classic pattern of an apical periapical cyst?
Found at the root tip
What is the lateral periapical cyst?
-Found on the side of the root
What is a residual periapical cyst?
-Cyst that remains after tooth has been extracted due to prior infection
If you have a spiderweb pattern at the root of the tooth in a histologic slide what do you have?
-Periapical cyst
T/F A periapical abscess may be symptomatic or asymptomatic
True
When does a periapical scar most commonly occur?
-Surgical endodontic therapy
T/F Periapical scars occur when the facial and lingual cortical plates have been lost?
-True
If you have an ill-defined radiolucent lesion in the periapical region what do you think of?
-Periapical abscess
Chronic hyperplastic pulpitis is what?
-When the inflammation in the pulp is a mass that comes out of the coronal portion of the tooth
Epulis granulomatosa is what?
-Hyperplastic granulation tissue coming out of an extraction site within days of extraction (this appears similar to metastatic cancer)
What are two common forms of cellulitis?
- Ludwigs angina
- Cavernous sinus thrombosis
What is a sinus tract?
-Periapical abscess with pus formation
T/F Sinus tracts (fistula) tend to follow the path of least resistance
True
An intraoral sinus tract is also known as what?
- Parulis
- Gum boil
What are the two types of intraoral sinus tract?
- Hole with surrounding redness
- Enlarged nodular mass
What is a cutaneous sinus tract?
-Typically an enlarged nodular mass
What teeth usually cause a cutaneous sinus tract?
-Mandibular teeth
What does osteomyelitis result in?
- Expanding lytic destruction
- Suppuration
- Sequestra formation
When do most cases of osteomyelitis arise from?
-Odontogenic infections or traumatic fracture
Where in the arch do most cases of osteomyelitis occur?
-Mandible
What type of osteomyelitis doesn’t produce xray changes?
-Acute
In acute infection fragments of necrotic bone may become surrounded by new, vital bone is known as what?
-Involucrum
What is inflammation of the soft tissue spaces known as?
-Cellulitis
T/F The purulence is unable to establish a drainage point in cellulitis
True
Where does Ludwig’s angina occur?
-Cellulitis of the submandibular region
Rapid swelling of the sublingual, submandibular, and submental spaces is associated with what?
-Ludwig’s angina
What can occur with ludwigs angina?
-May extend to the spaces around the throat and close off the airway leading to death
If you have ludwigs angina in the submandibular space what does spread of the infection cause?
-Enlargement and tenderness of the neck
If the sublingual space is involved in ludwigs angina what occurs?
-Swelling and elevation of the tongue
What leads to cavernous sinus thrombosis?
-Abscess of a maxillary anterior or premolar tooth
What is the most often source of the infection for cavernous sinus thrombosis?
-Canine
What does a cavernous sinus thrombosis appear as?
- Edematous periorbital enlargement
- Swelling present along the lateral border of the nose
What is condensing osteitis aka?
-Focal sclerosing osteomyelitis
What is a localized area of bone sclerosis assocaited with apices of teeth with pulpitis?
-Condensing osteitis
In an xray is condensing osteitis separated from apex of the tooth?
-No it is not separated
If a tooth is asymptomatic and appears like condensing osteitis what else might it be?
-Idiopathic osteosclerosis
