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Dr. Murrahs class > Chapter 3: Pulpal and Periapical Disease > Flashcards

Chapter 3: Pulpal and Periapical Disease Flashcards

1
Q

what are the three types of pulpitis?

A

reversible pulpitis, irreversible pulpitis, or chronic hyperplastic pulpitis

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2
Q
A

chronic hyperplastic pulpitis

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3
Q
A

chronic hyperplastic pulpitis

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4
Q

what are the 3 types of periapical pathologies?

A

periapical granuloma, apical periodontal cyst, periapical abscess

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5
Q

what are the 4 sequelae of periapical pathology?

A

sinus tract, osteomyelitis, cellulitis, condensing osteitis

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6
Q

95% of all lesions found at the periapical region are ___ in etiology

A

pulpal

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7
Q

what are the localized lesions of periapical pathology?

A

periapical granuloma, apical periodontal cyst, periapical abscess, periapical scar

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8
Q
A

periapical abscess

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9
Q

how does the beginning of any inflammation of the PDL present radiographically?

A

widening of the lamina dura (PDL space)

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10
Q

what is the most common periapical pathosis?

A

periapical granuloma

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11
Q

periapical granuloma is also called ___

A

apical periodontitis

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12
Q

a ___ is a mass of inflamed granulation tissue at the apex of a nonvital tooth

A

periapical granuloma

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13
Q

a periapical granuloma may be found in transition from ___ and/or ___

A

periapical abscess and/or apical periodontal cyst

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14
Q

what is described as secondary acute inflammatory changes within a periapical granuloma?

A

phoenix abscess

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15
Q

what is the clinical presentation of a periapical granuloma?

A
  • most are asymptomatic
  • tooth not typically mobile
  • usually not sensitive to percussion
  • tooth does not respond to thermal or electric pulp tests
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16
Q

what is the radiographic presentation of periapical granuloma?

A
  • radioluscent lesion
  • variable size
  • symmetrical
  • well-defined
  • punched out border most often
  • may be somewhat diffuse
  • loss of lamina dura at the root tip in the area of the radioluscency
  • root resorption can be seen
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17
Q

most periapical granulomas are discovered how?

A

on routine radiographic survey

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18
Q

what is the treatment for periapical granuloma?

A
  • conventional endodontic treatment
  • surgical endodontic treatment
  • extraction
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19
Q

what are two other names for apical peridontal cyst?

A
  • periapical cyst
  • radicular cyst
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20
Q

what is the result of inflammatory stimulation of epithelium in the area (rests of malassez)

A

apical periodontal cyst

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21
Q

the radiographic presentation of an apical periodontal cyst is the same as ___

A

periapical granuloma

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22
Q

what is the radiographic presentation of an apical peridontal cyst?

A
  • radioluscent lesion
  • variable size
  • may show static behavior or very slow growth
  • symmetrical
  • well-defined
  • punched out border most often
  • loss of lamina dura in the area of the lesion is usually present
  • root resorption can be seen
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23
Q

___ is the accumulation of acute inflammatory cells at the apex of a nonvital tooth

A

periapical abscess

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24
Q

___ is a defect created by periapical inflammatory lesions that may fill with dense collagenous tissue

A

periapical scar

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25
Q

periapical scars occur most frequently when both the ___ and ___ have been lost

A

facial and lingual cortical plates

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26
Q

periapical scars occur most commonly following ___

A

surgical endodontic therapy

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27
Q

what are the two types of cellulitis that are sequelae of periapical pathology (dangerous types associated with dental infections)?

A

ludwig’s angina and cavernous sinus thrombosis

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28
Q
A

periapical granuloma

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29
Q
A

periapical granuloma

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30
Q
A

periapical granuloma

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31
Q
A

periapical granuloma

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32
Q
A

periapical fibrous scar

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33
Q
A

periapical cyst

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34
Q
A

periapical cyst

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35
Q
A

periapical cyst

radioluscency extends from mandibular frist molare to the contralateral first molar

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36
Q
A

periapical cyst

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37
Q
A

lateral radicular cyst

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38
Q
A

lateral radicular cyst

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39
Q
A

residual periapical cyst

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40
Q
A

periapical abscess

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41
Q

all four maxillary incisors exhibit pulpal necrosis

A

periapical abscess

42
Q
A

intraoral sinus tract aka parulis or “gum boil”

43
Q

___ is a periapical abscess with pus formation; the pus dissects through the bone and destroys the bone; perforates the cortical plate of bone, extending into soft tissue; finds a point of exit and drains purulent material

A

sinus tract

44
Q

___ tend to follow the path of least resistance

A

sinus tract

45
Q

sinus tracts may have ___ drainage

A

intermittent

46
Q

what does the location of a sinus tract depend on?

A

the involved tooth and path of least resistance

47
Q

an intraoral sinus tract is also called ___

A

parulis or “gum boil”

48
Q

intraoral sinus tracts mark what?

A

the exit point of the sinus tract on the oral mucosa

49
Q

___ is typically an enlarged nodular mass that presents as a red lesion with other shades of yellow, white, or purple

A

cutaneous sinus tract

50
Q

cutaneous sinus tract affect which teeth most commonly?

A

mandibular teeth

51
Q
A

periapical abscess

52
Q
A

cutaneous sinus tract

53
Q
A

intraoral sinus tract aka parulis aka gum boil

54
Q

hint: this is an aggressive and rapidly spreading form of cellulitis that involves the sublingual, submandibular, and submental spaces bilaterally

A

ludwig angina

55
Q
A

acute osteomyelitis

56
Q
A

acute osteomyelitis with sequestrum

57
Q
A

pulp stones

58
Q
A

diffuse sclerosing osteomyelitis

59
Q
A

osteitis

60
Q

what is the concern associated with pulp stones?

A

they can occlude the pulp canal, creating issues with endodontic therapy

61
Q

___ is described as acute or chronic inflammation in bone, usually due to bacterial infection

A

osteomyelitis

62
Q

what 3 things can result from osteomyelitis?

A
  • expanding lytic destruction
  • suppuration
  • sequestra formation
63
Q
A

epulis granulomatosa

64
Q

is osteomyelitis common in developed countries?

A

no

65
Q

what is an epulis granulomatosa?

A

hyperplastic granulation tissue post-extraction

66
Q

most cases of osteomyelitis arise after what?

A

odontogenic infections or traumatic fracture

67
Q

75% of osteomyelitis cases are in ___(males/females)___, and mostly occur in the ___(maxilla/mandible)___

A
  • males
  • mandible
68
Q

what are symptoms of acute osteomyelitis infection?

A
  • fever
  • lymphadenopathy
  • sensitivity
  • soft tissue swelling
69
Q

will an acute osteomyelitis infection produce radiographic changes?

A

no

70
Q

what is an involucrum?

A

during an acute osteomyelitis infection, fragments of necrotic bone may become surrounded by new, vital bone

71
Q

___ occurs when the purulence from an infection perforates the cortex and spreads diffusely through the overlying soft tissue; the purulence is unable to establish a drainage point

A

cellulitis

72
Q

how does the purulence spread in cellulitis?

A

it begins to spread through soft tissues, typically through tissue layers

73
Q

___ is cellulitis of the submandibular region

A

ludwig’s angina

74
Q

70% of ludwig’s angina cases develop from what?

A

abscess of a mandibular molar tooth

75
Q

ludwig’s angina involves the rapid swelling of the ___ spaces, which may extend to the spaces around the ___

A
  • sublingual, submandibular, and submental spaces
  • throat (may cut off airway)
  • creates a massive swelling of the neck

*DEATH CAN OCCUR

76
Q

ludwig’s angina with sublingual invovlement causes ___

A

swelling and elevation of the tongue (“woody tongue”)

77
Q

ludwig’s angina that spreads to the submandibular space causes ___

A

enlargement and tenderness of the neck (“bull neck”)

78
Q

what are symptoms of ludwig’s angina with submandibular space involvement?

A
  • pain
  • restricted neck movement
  • dysphagia, dysphonia, dysarthria
  • drooling
  • sore throat
  • respiratory obstruction
79
Q

what are the signs of ludwig’s angina with submandibular space involvement?

A
  • tachypnea
  • dyspnea
  • tachycardia
  • stridor
  • restlessness
  • patients need to maintain an erect position
  • fever and chills
80
Q

are obvious collections of pus present in ludwig’s angina?

A

no

81
Q

what is the treatment (in order) for ludwig’s angina?

A
  1. maintenance of the airway
  2. incise and drain
  3. antibiotic therapy
  4. elimination of original focus of infection
82
Q

___ typically results from abscess of a maxillary anterior or premolar tooth

A

cavernous sinus thrombosis

83
Q

which tooth is most often the source of infection in cavernous sinus thrombosis?

A

canine

84
Q

cavernous sinus thrombosis appears as an ___

A

edematous periorbital enlargement

85
Q

in cavernous sinus thrombosis, swelling typically is present where?

A

along the lateral border of the nose

86
Q

what are the possible 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
87
Q

is death possible in cases of cavernous sinus thrombosis?

A

yes

88
Q

what is the treatment of cavernous sinus thrombosis?

A

surgical drainage and high-dose antibiotics

89
Q
A

cavernous sinus thrombosis

90
Q

condensins osteitis is also called ___

A

focal sclerosing osteomyelitis

91
Q

___ is described as a localized area of bone sclerosis associated with apices of teeth with pulpitis

A

condensing osteitis

92
Q

association with ___ is critical in the diagnosis of condensing osteitis

A

inflammation (aka pulpitis)

radiographically identical to idiopathic osteosclerosis

93
Q

what are radiographic changes seen in condensing osteitis?

A
  • increased radio-opacity adjacent to tooth apex that has thickened PDL or apical inflammatory lesion
  • no radioluscent border (distinguishes from focal cemento-osseous dysplasia)
  • not separated from apex (distinguishes from idiopathic osteosclerosis)
94
Q

in condensing osteitis, there is no clinical ___ of bone

A

expansion

95
Q

tooth is symptomatic

A

condensing osteitis

96
Q

85% of condensing osteitis cases regress after ___ is eliminated

A

odontogenic infection

97
Q

these teeth are asymptomatic

A

idiopathic osteosclerosis

98
Q

residual areas of condensing osteitis are called ___

A

bone scars

99
Q

includes plasma cells, lymphocytes, and some PMNs

A

periapical granuloma

100
Q
A

periapical fibrous scar

101
Q
A

periapical cyst

102
Q

tons of PMNs

A

periapical abscess

Dr. Murrahs class (17 decks)

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