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BDS4 Oral Surgery > Diseases of the pulp > Flashcards

Diseases of the pulp Flashcards

1
Q

Draw out the connection between the diseases of the pulp

A
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2
Q

What is caries

A
  • demineralisation of the tooth due to acid attack created by bacteria in the mouth as they metabolise sugars
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3
Q

What can caries result in

A

pulp hyperaemia

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4
Q

What is pulp hyperaemia

A
  • increase of blood supply in the pulp chamber
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5
Q

What are the outcomes of pulp hyperaemia

A
  • recovery
  • acute pulpitis
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6
Q

What is acute pulpitis

A

sudden onset of pulpal inflammation

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7
Q

What are the 2 outcomes of acute pulpitis

A
  • chronic pulpitis (can go back and forth between these two states)
  • acute apical periodontitis
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8
Q

What is acute apical periodontitis

A
  • The infection can spread outside of the pulp chamber where it then becomes acute apical periodontitis and this will be accompanied by a change in symptoms
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9
Q

What are the outcomes of acute apical periodontitis if untreated

A
  • acute apical abscess

or

  • jump straight to chronic apical infection (granuloma)
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10
Q

What is an acute apical abscess

A

a collection of pus

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11
Q

What are the outcomes of acute apical abscess if untreated

A
  • can go back and forth of being a chronic sinus
  • can go back and forth of being a chronic apical infection (granuloma)
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12
Q

What can a chronic sinus turn into if untreated

A
  • can go back to being and forth with being an acute apical abscess
  • can go back and forth with being a chronic apical infection
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12
Q

What can a chronic sinus turn into if untreated

A
  • can go back to being and forth with being an acute apical abscess
  • can go back and forth with being a chronic apical infection
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13
Q

What is a chronic sinus

A
  • infection perforates bone and soft tissue to drain
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14
Q

What can a granuloma turn into

A
  • an apical cyst which are not painful but can grow into large sizes
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15
Q

When does a apical cyst become painful

A

If it turns into an infected apical radicular cyst

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16
Q

What is a periapical granuloma

A

not a true granuloma as there is no epithelioid histiocytes mixed with the lymphocytes and giant cells. Instead it is a mass of chronically inflamed granulation tissue at the apex of the tooth (containing plasma cells, lymphocytes and few histiocytes with fibroblasts and capillaries)

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17
Q

What is a radicular cyst

A

a radicular cyst is defined as a cyst arising from epithelial residues (cell rests of Malassez) in the PDL as a consequence of inflammation, usually following the death of the dental pulp

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18
Q

What are causes of periapical radicular cysts

A
  • Caries, trauma, periodontal disease
  • Death of dental pulp
  • Apical bone inflammation
  • Dental granuloma
  • Stimulation of epithelial rests of Malassez
  • Epithelial proliferation
  • Periapical cyst formation
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19
Q

What are the clinical features of pulp hyperaemia

A

Pain is sharp and only lasting for seconds

Pain stimulated by hot/cold or sweet foods

Pain resolves after stimulus

Usually caries can be seen approaching the pulp but the tooth can still be restored

20
Q

What is the tx for pulp hyperaemia

A

Restore and monitor

21
Q

What are the clinical features of acute pulpitis

A

Constant severe pain

Reacts to thermal stimuli

Poorly localised pain

No response to analgesia

Open pulpitis symptoms are less severe

22
Q

How will acute pulpitis respond to percussion

A

Unlikely to be TTP because the periodontal ligament is not inflamed yet

23
Q

How will acute pulpitis respond to pulp testing

A

Pulp testing will not show much

24
Q

What diagnostic tool can be useful for acute pulpitis

A

diagnostic LA to help localise pain

25
Q

What are the clinical features of acute periodontitis

A

Pain is easier to localise

Tooth is non-vital (unless traumatic)

26
Q

How will acute periodontitis respond to percussion

A

will be very TTP

27
Q

What sort of mobility may we see with acute periodontitis

A

Slight increase in mobility

28
Q

What will a radiograph of a tooth with acute periodontitis show

A
  • Loss of clarity of lamina dura
  • May not see a lot around the apex as it is only just spreading to the apex
  • If large radiolucency seen, it is more likely to be an old lesion
  • Can sometimes see widening of the PDl space / root resorption
29
Q

What is traumatic periodontitis caused by

A

Caused by parafunction e.g tooth clenching/grinding

30
Q

What are the clinical findings of a tooth with traumatic periodontitis

A

Clinical examination of occlusion

TTP

Normal vitality

31
Q

What may we see on a radiograph of a tooth with traumatic periodontitis

A

May see generalised widening of PDL space (because of increased pressure)

32
Q

What is the tx for a tooth with traumatic periodontitis

A

Occlusal adjustment

Therapy for parafunction

33
Q

What are the clinical features of a tooth with acute apical abscess prior to perforating bone

A

Clinical features similar to acute apical periodontitis

Severe unremitting pain

Acute tenderness in function

Acute tenderness on percussion

Should be no swelling, redness or heat however

34
Q

What is the treatment for acute apical abscess (prior to perforation of bone)

A

Drainage (should only require intra-oral incision at this stage)

Remove cause:

  • XLA
  • RCT
  • Periradicular surgery

Possible AB

35
Q

What are the need of antibiotics for an acute apical abscess based on

A
  • Severity
  • Absence of adequate drainage
  • Patient’s medical condition
36
Q

What are the clinical features of acute apical abscess (post perforation of bone)

A
  • Initially, there is pain relief due to the relief of pressure (unless it has perforated into the palate)
  • After this, swelling, redness and heat in the soft tissues become increasingly apparent
  • Pain returns as swelling increases
37
Q

What are the clinical findings of a tooth with an acute apical abscess (post perforation)

A

Initial reduction in TTP of tooth as pus escapes into the soft tissue

38
Q

What is the site of swelling dependent on

A
  • Position of tooth in arch
  • Root length
  • Muscle attachments
  • Potential spaces in proximity to lesion
39
Q

What is tx for acute apical abscess (post perforation)

A

Drainage (intra or extra oral incision)

Remove cause:

  • XLA
  • RCT
  • Periradicular surgery
40
Q

What is open pulpitis

A

cases of pulpitis where the inflamed pulp tissues are in direct communication with the oral environment due to a large carious lesion or fracture of the tooth exposing the pulp. Can be less painful as open cavity relieves pulpal pressure

41
Q

What are causes of dental abscesses

A
  • acute apical abscess
  • periodontal abscess
  • pericoronitis
  • sialadentitis
42
Q

What is an acute apical abscess

A
  • caused by infection of the root canal
43
Q

What is a periodontal abscess

A
  • develops directly in the periodontium, not related to the pulp, related to periodontal disease but has the same symptoms as a periapical abscess
44
Q

What is pericoronitis

A

inflammation around the crown, usually partially erupted teeth

45
Q

What is sialadenitis

A
  • infection of glands (usually it is the major salivary glands that get infected which results in a facial swelling, redness, and pus pouring out)
46
Q

What local factors should we look at when assessing for AB prescription

A
  • toxicity
  • airway compromisation
  • dysphagia
  • trismus
  • lymphadenitis
  • location (floor of mouth)
47
Q

What are systemic factors that require consideration for AB prescription

A
  • immunocompromised
  • diabetes
  • extremes of age
48
Q

What is lymphadenitis

A

enlargement of one or more lymph nodes, usually due to infection

BDS4 Oral Surgery (15 decks)

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