Classification, Diagnosis, And Clinical Manifestations Of Apical Periodontitis Flashcards
What are some examples of long-term insults?
Any break in the integrity of the external tooth surface by dental caries, chemical erosion, or cracks.
Most cases of periapical perioidontitis are associated with some form of pulpal diasese. How can the factors implicated be grouped?
Short-term insults
Trauma
Long-term insults
The presence of bacteria within the root system will cause a periapical inflammatory response (apical periodontitis) as the body’s response to irritation. What exactly causes this?
Irritation from the bacteria themselves as well as their by-products such as exotoxins and LPS.
Periapical inflammatn is the direct result of interactions between the bacteria in an untreated infected root canal system and the hosts defense or immune system.
Although bacteria is the most common cause of pulpal diasease, what other reasons may cause pulpal necrosis?
Trauma in which the apical blood vessels are severed. However, it should be not that in such cases, the resence of a necrotic puplp does not in itself imply that a chronic periapical inflammatory reaction will occur.
Apical periodontitis may develop without the root canal system being infected. What other causes might there be?
1) Traumatic occlusiion can result in inflammation of PDL. This can result in a long-term inflammation which causes a non-healing bone resorptive process.
2) Trauma such as avulsion and luxation injuries.
3) Extensive periodontal disease may appear like periapical periodontitis on a PA.
4) Pulpitis may also cause symptoms of apical periodontitis. MOre common with irreversible pulpitis but can occur with reversible pulpitis. However, this may just be an extension of the pulpal inflammatory process out through the apical foramen.
In general terms, what is the difference between chronic and acute apical periodontitis?
Chronic periapical inflamation represents a balance between the bacteria in the tooth and the host response. An acute periapical inflammation develops once the ‘balance’ is disturbed.
How can the status of periradicular tissues be classified according to abbott?
1) clinically normal
2) apical periodontitis
- acute (primary/ secondary)
- chronic
3) periapical cyst
- true cyst
- pocket cyst
4) periapical abcess
- acute
- chronic
5) facial cellulitis
6) extra-radicular infection
7) foreign body reaction
8) periapical scar
9) external root resorption
With regards to extnal root resorption, what are the different variations?
Surface Inflammatory Rplacement Invasive Pressure Orthodontic Physiological
What do the terms acute and chronic mean with rgards to the classification of the status of periradicular tissues?
Acute - moderate to severe symptoms
Chronic - no or mild symptoms
What is primary acute periapical periodontitis?
The initial peeriapical response (acute inflammatory response) to bacterial presence within the canal. It occurs in a previously healthy periapical region.
If no treatment is provided to a primary acute apical periodontotis, what are the possible sequalae?
Healing (only if no further irritation and no microorganisms within the canal) Further intensification Abcess formation (primary apical abcess) Sinus tract formation Cellulitis Cyst formation May become chronic
What is secondary acute apical perioidontitis?
An acute exacerbation of an already existing chronic apical periodontitis lesion. This may occur in the form of an abcess where the bateia migrate out of the confines of the root canal to infect the periapical tissues.
What would happen if treatment is not provided to the infected root canal?
The initial acute inflammation gradually shifts to a chronic inflammatory reaction.
What are the two types of periapical cysts defined by nair and what are the differences?
1) periapical pocket cyst
Sac like epitheliulined cavity open to and continuous with the root canal
2) periapical true cyst
Completely enclos by the epithelial lining without communicaqtion with the root canal
These cyst fail to heal even after removel of bacteria from root canal. Requires surgical removal.
What are the symptoms and clinical signs primary acute apical periodontitis?
Very marked tenderness to percussion and pain with pressure
Radiographically, PDL and lamina dura may appear normal or may have some loss
Increased mobility
