CHAPTER VIII – TERMINAL STAGES OF PULP INFLAMMATION Flashcards
Death of the pulp without bacterial infection
NECROSIS
NECROSIS
CLINICAL FEATURES
- Tooth may appear discoloured
- Electric pulp test are negative
- Cold tests are negative
- X-ray reveals periapical change – thickened periodontal membrane
with abundance of serous
exudation
Moist gangrene
– due to insufficient blood supply
- Presence of ischemia
Dry gangrene
DISEASES OF THE PERIAPICAL TISSUES
A. ACUTE APICAL PERIODONTITIS
B. ACUTE PERIAPICAL ABSCESS
C. ACUTE DENTO-ALVEOLAR ABSCESS
- Acute inflammation of the soft tissues surrounding apical region of tooth especially the periodontal membrane
- Tissue injury and inflammation developed within the periodontal ligament
ACUTE APICAL PERIODONTITIS
ACUTE TRAUMATIC APICAL PERIODONTITIS
ETIOLOGY
Blow, kick or fall upon the face and teeth
Injuries during dental operation
Excessive occlusal stress
ACUTE CHEMICAL APICAL PERIODONTITIS
ETIOLOGY
Action of drugs introduced into pulp canal
Acute inflammation of periapical tissues due to pathogenic microorganisms that reached the apical foramen through the pulp canal and spreads into the periodontal tissues.
ACUTE INFECTIVE APICAL PERIODONTITIS
- Infiltration of periapical soft tissues
- With high virulence of bacteria, low resistance of tissue, lack of damage
- Breakdown of inflamed tissue
- Necrosis of tissue
- Necrotic cells liquefied by enzymes released by dead/dying leukocytes
- Pus accumulated around the root
- Acute periapical abscess
ACUTE PERIAPICAL ABSCESS
ACUTE PERIAPICAL ABSCESS
CLINICAL PATHOLOGY
- Tooth is often very sore
- Continuous pulsating pain
- Lymph nodes may be swollen and tender
- Drainage may be established by opening the tooth to relieve the pain
- Very rare type of cellulitis
- A serious type of cellulitis, bacterial infection that affects the mouth, the neck and the jaw, spreads rapidly to the infected area of the face underneath the tongue
LUDWIG’S ANGINA
“choke” Greek word
“angina”
means “strangle”
“ankhone”
- Refers to the feeling of strangling and choking, secondary to obstruction of the airway – the patient can die
- Most severe form of cellulitis
LUDWIG’S ANGINA
CHRONIC PERIAPICAL INFLAMMATION
FACTORS
- Low virulence of bacteria
- High body resistance
- Presence of drainage
TYPES OF CHRONIC PERIAPICAL INFLAMMATION
DENTAL GRANULOMA
- Mass of granulation tissue at periapical area as response to mild irritation
- Usually granulation tissue is a sign of healing but in the periapical area, it is a reaction to tissue injury or mild irritation
- Simplest form of chronic periapical
- inflammation.
DENTAL GRANULOMA
Inflammatory exudates near the apical foramen is confined at the center or within the fibrous wall of the granuloma
CLOSED GRANULOMA
Pus develops at the center of granuloma and succeeds in perforating through bone into the oral cavity forming a sinus where discharge exudate passes
DISCHARGING GRANULOMA
- Epithelium encloses the areas of necrotic granulation tissue or lining the inner surface of the abscess sac after the center has broken down.
- Epithelial cells derived from the epithelial rest of Malassez found in the periodontal ligament.
EPITHELIATED GRANULOMA
remnants of HERS (Hertwig’s Epithelial root Sheath has something to do with the root formation) involved in root formation that remains in the periodontal tissue
EPITHELIAL REST OF MALASSEZ
- Represents a healed abscess after infection has subdued
- Granulation tissue is replace by collagen fiber bundles
- Inflammatory cells disappear
SCLEROSED GRANULOMA
- Also known as root-end cyst, periapical cyst, or apical periodontal cyst
- Results from bacterial infection and necrosis of dental pulp
- Develop from epitheliated granuloma
RADICULAR CYST
- Originates from acute periapical abscess or granuloma
- Complaints of transient uneasiness
- May have slight nodule on gingiva
- Radioluscency in apical region
CHRONIC PERIAPICAL ABSCESS
