Diseases of the pulp and periodontium Flashcards
What is pulp hyperaemia?
Increased blood supply due to trauma or caries (reversible pulpitis)
What are the clinical features of pulp hyperaemia?
Pain lasting for seconds
Pain stimulated by hot/cold or sweet foods
Pain resolves after stimulus
Caries approaching pulp but tooth can still be restored without treating pulp
What are the features of acute pulpitis?
Constant Severe Pain
Reacts to Thermal Stimuli
Poorly Localised Pain/Referred pain- brain struggles to realise which branch of CN5
No (or Minimal) Response to analgesics- cannot reach pulp
Open Symptoms Less Severe
How is diagnosis of acute pulpitis achieved?
History- best method
Visual examination
Negative Tenderness to Percussion (usually)
Pulp testing is equivocal
Radiographs- pulp chamber will look no different on radiographs
Diagnostic’ Local Anaesthetic
Removal of Restorations
What can acute pulpitis go on to become?
Chronic pulpitis
Acute Apical Periodontitis
What is chronic pulpitis?
When inflammation and infection is underlying and flares up (becomes acute) intermittently
What occurs in acute periodical peridontitis?
Inflammation progresses out of pulp chamber and into surrounding periodontal tissue
What are the features of AAP?
Very TTP- feels high in mouth
Tooth is non-vital (unless traumatic)
Slight increase in mobility
Radiographically:
Loss of clarity of Lamina Dura
Delay in changes at the apex of the tooth- widening of apical periodontal space
What may a radiolucent shadow suspected to be AAP actually be?
May indicate an ‘old’ lesion e.g. Flare up of apical granuloma
What causes Traumatic Periodontitis?
Parafunction (Tooth clenching or grinding)
What are the features of traumatic periodontitis?
Occlusally- posturing, functional positioning
TTP
Vital
Widening of PDL space radiographically
How do you treat traumatic periodontitis?
Occlusal adjustment
Therapy for parafunction
What can AAP progress onto?
Acute apical abscess
Chronic apical infection (granuloma)
What are the types of pus producing dental infections?
Acute apical abscess (most common)
Periodontal Abscess
Pericoronitis
Sialadenitis
What is pus made of?
Dead neutrophils and immune cells
What organisms are involved in a dental abscess?
Polymicrobial- anaerobes are most important
What are some examples of unusual infections that can be the causes of chronic infections which do not resolve?
Staphylococcal lymphadenitis of childhood
Cervico-facial actinomycosis- can occur following extraction (rare)
What are the 5 cardinal signs of inflammation?
Heat
Redness
Swelling
Pain
Loss of function
What occurs in an AAA?
Initially it is almost identical to AAP, then infection erodes through bone and soft tissues following the path of least resistance
Once the abscess perforates through bone:
Pain often remits (unless it’s in the palate)
Swelling, redness and heat (in the soft tissues) become increasingly apparent
As swelling increases pain returns
There is an initial reduction in tenderness to percussion of the tooth as pus escapes into the soft tissues
How is the site of swelling in an AAA determined?
The position of the tooth in the arch
Root length
Muscle attachments
Potential spaces in proximity to lesion
How is an AAA treated
Provide Drainage- soft tissue incision intraorally/extraorally
Remove source/cause- Extract tooth, Pulp extirpation, Periradicular surgery
AB
What is the patients need for antibiotics to treat an AAA based on?
Severity
Absence of adequate drainage
Patient’s medical condition
What is a chronic sinus?
Infection around apex perforates bone and drains into mouth
-> appears as blister with poor taste on discharge
What is a chronic apical infection?
Occurs when abscess subsides but low grade infection remains ongoing (susceptible to flare ups)
What can granulomas become?
Apical cyst (not painful but is inflammatory and can grow/become infected)
What is a periodontal abscess?
Development of abscess within PDL (similar symptoms to AAA
What is pericoronitis?
Inflammation around the crown of a tooth (usually partial erupted)
-> can become an abscess
What is sialadenitis and its features?
Infection off salivary gland (usually major)
-> Facial swelling, mouth dryness, redness, pus coming from duct
What are the systemic factors for assessing whether patient needs Antibiotics?
Immunocompromised pts
Acquired causes (e.g. HIV)
Drug Induced (e.g. Steroids, Cytostatics)
Blood disorders (e.g. Leukaemias)
Diabetes- affects neutrophils
Elderly
What are local factors to consider when assessing patient need for ABP?
Toxicity- systemic symptoms
Airway compromisation
Dysphagia
Trismus
Lymphadenitis
Location (e.g. floor of mouth)- can affect breathing
What is reversible pulpitis and its symptoms?
Denotes a level of inflammation in which returning to a normal state is possible if noxious stimuli removed
Mild-moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds (<5 secs), no mobility, no pain on percussion (hasn’t reached PA tissues)
What is irreversible pulpitis?
Denotes a higher level of inflammation in which dental pulp has been damaged beyond point of recovery (requires RCT/extraction)
Sharp, throbbing, severe pain upon stimulation, and pain may be spontaneous or occur without stimulation, pain persists after stimulation removed (>5 secs)
Describe periapical granuloma (chronic apical periodontitis):
Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries)
*NOT a true granuloma because not granulomatous inflammation! (Note that granulomatous inflammation has epithelioid histiocytes mixed with lymphocytes and giant cells)
What is the etiology of periapical (radicular) cyst?
Caries, trauma, periodontal disease
Death of dental pulp
Apical bone inflammation
Dental Granuloma
Stimulation of epithelial rests of Malassez- Proliferation pf epithelium
Periapical Cyst Formation
