Diseases of the pulp Flashcards
Draw out the connection between the diseases of the pulp
What is caries
- demineralisation of the tooth due to acid attack created by bacteria in the mouth as they metabolise sugars
What can caries result in
pulp hyperaemia
What is pulp hyperaemia
- increase of blood supply in the pulp chamber
What are the outcomes of pulp hyperaemia
- recovery
- acute pulpitis
What is acute pulpitis
sudden onset of pulpal inflammation
What are the 2 outcomes of acute pulpitis
- chronic pulpitis (can go back and forth between these two states)
- acute apical periodontitis
What is acute apical periodontitis
- 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
What are the outcomes of acute apical periodontitis if untreated
- acute apical abscess
or
- jump straight to chronic apical infection (granuloma)
What is an acute apical abscess
a collection of pus
What are the outcomes of acute apical abscess if untreated
- can go back and forth of being a chronic sinus
- can go back and forth of being a chronic apical infection (granuloma)
What can a chronic sinus turn into if untreated
- can go back to being and forth with being an acute apical abscess
- can go back and forth with being a chronic apical infection
What can a chronic sinus turn into if untreated
- can go back to being and forth with being an acute apical abscess
- can go back and forth with being a chronic apical infection
What is a chronic sinus
- infection perforates bone and soft tissue to drain
What can a granuloma turn into
- an apical cyst which are not painful but can grow into large sizes
When does a apical cyst become painful
If it turns into an infected apical radicular cyst
What is a periapical granuloma
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)
What is a radicular cyst
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
What are causes of periapical radicular cysts
- Caries, trauma, periodontal disease
- Death of dental pulp
- Apical bone inflammation
- Dental granuloma
- Stimulation of epithelial rests of Malassez
- Epithelial proliferation
- Periapical cyst formation
What are the clinical features of pulp hyperaemia
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
What is the tx for pulp hyperaemia
Restore and monitor
What are the clinical features of acute pulpitis
Constant severe pain
Reacts to thermal stimuli
Poorly localised pain
No response to analgesia
Open pulpitis symptoms are less severe
How will acute pulpitis respond to percussion
Unlikely to be TTP because the periodontal ligament is not inflamed yet
How will acute pulpitis respond to pulp testing
Pulp testing will not show much
What diagnostic tool can be useful for acute pulpitis
diagnostic LA to help localise pain
What are the clinical features of acute periodontitis
Pain is easier to localise
Tooth is non-vital (unless traumatic)
How will acute periodontitis respond to percussion
will be very TTP
What sort of mobility may we see with acute periodontitis
Slight increase in mobility
What will a radiograph of a tooth with acute periodontitis show
- 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
What is traumatic periodontitis caused by
Caused by parafunction e.g tooth clenching/grinding
What are the clinical findings of a tooth with traumatic periodontitis
Clinical examination of occlusion
TTP
Normal vitality
What may we see on a radiograph of a tooth with traumatic periodontitis
May see generalised widening of PDL space (because of increased pressure)
What is the tx for a tooth with traumatic periodontitis
Occlusal adjustment
Therapy for parafunction
What are the clinical features of a tooth with acute apical abscess prior to perforating bone
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
What is the treatment for acute apical abscess (prior to perforation of bone)
Drainage (should only require intra-oral incision at this stage)
Remove cause:
- XLA
- RCT
- Periradicular surgery
Possible AB
What are the need of antibiotics for an acute apical abscess based on
- Severity
- Absence of adequate drainage
- Patient’s medical condition
What are the clinical features of acute apical abscess (post perforation of bone)
- 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
What are the clinical findings of a tooth with an acute apical abscess (post perforation)
Initial reduction in TTP of tooth as pus escapes into the soft tissue
What is the site of swelling dependent on
- Position of tooth in arch
- Root length
- Muscle attachments
- Potential spaces in proximity to lesion
What is tx for acute apical abscess (post perforation)
Drainage (intra or extra oral incision)
Remove cause:
- XLA
- RCT
- Periradicular surgery
What is open pulpitis
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
What are causes of dental abscesses
- acute apical abscess
- periodontal abscess
- pericoronitis
- sialadentitis
What is an acute apical abscess
- caused by infection of the root canal
What is a periodontal abscess
- develops directly in the periodontium, not related to the pulp, related to periodontal disease but has the same symptoms as a periapical abscess
What is pericoronitis
inflammation around the crown, usually partially erupted teeth
What is sialadenitis
- infection of glands (usually it is the major salivary glands that get infected which results in a facial swelling, redness, and pus pouring out)
What local factors should we look at when assessing for AB prescription
- toxicity
- airway compromisation
- dysphagia
- trismus
- lymphadenitis
- location (floor of mouth)
What are systemic factors that require consideration for AB prescription
- immunocompromised
- diabetes
- extremes of age
What is lymphadenitis
enlargement of one or more lymph nodes, usually due to infection
