Exam 4-Pulpitis/Periapical-Lecture1 Flashcards
Pulpitis is simply inflammation involving the dental pulp, BUT it can also only be ________ of the blood vessels!
dilation
What are the two causes of pulpitis?
caries and trauma
What are the 3 classifications of pulpitis?
1.Reversible 2.Irreversible 3.Chronic Hyperplastic
What is the MAIN (not only) indicator of REVERSIBLE pulpitis? (The CLASSIC indicator)
PAIN on COLD stimulation (hot also works, but not as often)
What is the duration of pain in reversible pulpitis?
pain fades away RAPIDLY after the stimulus is removed
The pain in reversible pulpitis can be intermittent, and sometimes not ________
reproducible
How does the radiograph present in pulpitis?
Radiograph is NORMAL
What are the two treatments for reversible pulpitis?
1.remove the cause (traumatic occlusion) 2. TIME
What is the classic stimulus and pain duration for IRREVERSIBLE pulpitis?
Hot and LINGERING pain (minutes) after removal of stimulus
Is the degree of pain a differentiating factor for irreversible pulpitis?
Nope, it can vary from mild to excruciating
What are three indicators for irreversible pulpitis?
1.temperature 2.chewing pressure 3.percussion
What can sometimes trigger “spontaneous” pain in irreversible pulpitis?
lying down
What is the most common indicator of irreversible pulpitis on a radiograph?
slight widening of the PDL
What are the 2 treatments for irreversible pulpitis?
extraction or endo
What is another name for chronic hyperplastic pulpitis?
a pulp polyp
What is the term for when the pulp grows out from inside the tooth to produce a red soft tissue mass in the crown area?
Chronic Hyperplastic Pulipitis
What are the two treatments for chronic hyperplastic pulpitis?
extraction and endo
What is the term for death of the pulp tissue due to overwhelming inflammation in a confined environment?
Pulp Necrosis
Why is a tooth discolored in pulp necrosis? Breakdown of the red blood cells in the dentinal tubules into a brown pigment (_________) produces tooth discoloration
hemosiderin
Are there symptoms of pain in pulp necrosis?
Yes, there can be! No pain through intense pain
Does percussion testing have an affect on a pulp necrosis tooth?
Yes, it can be sensitive to percussion
Pulp necrosis: Radiographs typically show _______ of the periodontal ligament area or destruction of bone in the _______ region
thickening…..periapical
GREATER THAN ____% of all lesions found at the periapical region of a tooth are the result of pulpal inflammation (pulpitis) that PROGRESSES to pulp necrosis
95%
With periapical pathology, The tooth, when tested, will prove to be _______
non-vital
With periapical pathology, what kind of response is there to hot and cold stimuli?
NONE
With periapical pathology, what kind of response to electric pulp testing procedures?
NONE
With periapical pathology, tenderness to what actions may still be present??
Tenderness to percussion and mastication
With periapical pathology, earliest radiographic change is a widening of the ____________ at the root apex area
periodontal ligament space
With periapical pathology, Longer duration lesions produce _________, usually _______, radiolucent defect in the
alveolar bone at the root apex
circumscribed, symmetric
With periapical pathology, what are the 3 standard lesions for your differential diagnosis? What is a 4th, outlier that has distinct characteristics?
1.Periapical Granuloma 2.Apical periodontal cyst 3.Periapical Abscess….4.Periapical Scar (outlier, very unique characteristics)
What are three possible sequelae to a localized periapical lesion?
1.Sinus tract 2.OsteoMyelitis 3.Cellulitis
What is another name for a periapical granuloma?
Chronic Apical Periodontitis
What is the MOST COMMON periapical pathosis?
Periapical Granuloma (aka chronic apical periodontitis)
periapical granuloma: Accumulation of inflammatory tissue at the periapex in response to noxious products of WHAT condition?
pulp necrosis
In a pericaplical granuloma, its important to remember that it is _______ inflammation, not ______!!
CHRONIC….acute
Are periapical granuloma’s typically symptomatic?
Nope, typically asymptomatic (not sensitive to percussion)
Are teeth with a periapical granuloma typically mobile?
Nope, typically immobile
A periaplical granuloma will present on a radiograph as symmetrical and well defined…what is characteristic about the borders of the lesion? What anatomic structure has been lost here?
“punched out” there is no cortical bone around the lesion…LAMINA DURA has been lost at the root tip
Root ________ can be seen with a periapical granuloma.
resorption
What was the rule of thumb used for differentiating a periapical granuloma from a apical periodontal cyst?
If it is bigger than a nickel on the radiograph, its probably a cyst
What are the three types of treatment for a periapical granuloma?
1.Conventional endo tx 2.surgical endo tx 3.extraction
What are the alternative names for an apical periodontal cyst?
Periapical Cyst or Radicular Cyst
An apical periodontal cyst is inflammatory stimulation of epithelial remnants of _____________ results in epithelial proliferation and cyst formation
Hertwig’s epithelial root sheath
Does an apical periodontal cyst typically have symptoms or mobility?
typically asymptomatic and usually not mobile
In an apical periodontal cyst _________ of the affected or adjacent teeth can occur
displacement
An apical periodontal cyst usually do not produce clinically noticeable enlargement of the _________
alveolar bone
apical periodontal cyst: The border of the cyst usually tells if there is active inflammation or it is done…which feature is most common?
punched out border is most common (so active inflammation)
An apical periodontal cyst is basically radiographically identical to a ________
Periapical Granuloma (Variable size
May show static behavior or very slow growth
Symmetrical Well defined
Punched out border most often
Loss of lamina dura in the area of the lesion is usually present Root resorption can be seen)
What are the three radiographic variations of an apical periodontal cyst?
1.Classic (at root tip) 2.LATERAL Apical Periodontal Cyst 3.RESIDUAL apical periodontal cyst
What are the treatment options for an apical periodontal cyst?
1.conventional endo 2.surgical endo 3.extraction
