Focal Inflammatory Lesions Flashcards
Periapical Abscess
- Accumulation of acute inflammatory cells & purulence at the apex of the tooth
- Neutrophils
- Rads: Looks like PDL widening and poorly defined RL
- Often has draining sinus tract to ST
- Can arise as initial pathosis or from acute exacerbation of prior lesion
- Symptomatic or asymptomatic
Periapical Abscess Tx
- Drainage & removing infection focus
- S/S go away after 48hr
- NSAIDs pre-op, post-op, pain control
- Abx for medically compromised
- Endo tx or extraction
Focal vs. Generalized/diffuse
Focal: Width of one tooth
Generalized: Across multiple teeth
Other name(s) for Periapical Granuloma
Chronic Apical Periodontitis
Periapical Granuloma
- Mass of chronically inflamed tissue at the apex of non-vital tooth
- Lymphocytes
- Rad: RL at apex of tooth; punched out border
- Sometimes lesion is barely seen and affected teeth have loss of lamina dura @ root tip
- Usually asymptomatic
- Defensive rxn to microbes in canal & apex
- Inflammatory cells release cytokines that destroy bone
-
75% of apical inflammatory lesions
*
Periapical Granuloma Tx
- Successful tx depends on complete reduction/control of bacteria
- If tooth can be maintained, RCT can be performed
- Non-restorable, extraction & curettage
- All ST should be evaluated histopathologically
What lesion represents 75% of apical inflammatory lesions?
Periapical granuloma
AKA chronic apical periodontitis
What lesion represents 15% of all periapical RLs?
Periapical Cyst
AKA Radicular Cyst
AKA Apical Periodontal Cyst
What are other names for Periapical Cyst?
Radicular Cyst
Apical Periodontal Cyst
Periapical (Radicular) Cyst
- Represents 15% of all periapical RLs
- Stimulation of epithelium @ apex of non-vital tooth
- Variants:
- Lateral radicular cyst
- Residual cyst
- Cyst lined by stratified squamous epithelium
- CT wall contains chronic inflammatory infiltrate
- Rad: Well-circumscribed RL intimately associated w/ apex; RL may or may not have RO rim
What are variants of Periapcial (Radicular) Cyst?
- Lateral radicular cyst
- Residual cyst
Lateral Radicular Cyst
Variant of Periapical (Radicular) Cyst
- Inflammatory cyst on lateral aspect of root
Residual Cyst
Variant of Periapical (Radicular) Cyst
- Cyst remaining post-extraction
Periapical Cyst Tx
- Tooth restorable: RCT
- Tooth non-restorable: Extraction & curettage
- >2cm, periapical surgery
- Recurrence not expected
Rarefying Osteitis
- Radicular granuloma, cyst, abscess cannot be differentiated radiographically
- All are generally well-defined and RL
- Collectively known as rarefying osteitis
- Rarefy: To make thin or less dense
- Most common lesion in the jaw
- Most grow slowly and don’t reach large sizes
- ALL included in differential dx
- Abscess
- Granuloma
- Cyst
What is the most common lesion in the jaw?
Rarefying Osteitis
- Inflammatory thinning of bone
- Must include abscess, cyst, granuloma in differential dx
Condensing Osteitis
- AKA sclerosing osteitis
- Localized proliferative rxn of bone to low-grade inflammatory stimulus
- Inflammation is causing bone deposition rather than resorption
- Bone is walling off infection as inflammatory rxn
- Bone does not return to normal after endo tx. Instead you get bone scar
- Association w/ area of inflammation is critical
- Inflammation is causing bone deposition rather than resorption
- Most commonly associated w/ apex of non-vital tooth
- Rad: Root outline visible; PDL widened or shows rarefying osteitis; localized sclerotic RO area in periapical region outside RL area; denser around molar
- Condensing osteitis implies rarefying osteitis is present
Sequence of events for condensing osteitis
- Tooth disease
- Pulpal inflammation & necrosis
- PA inflammation
- Rarefying osteitis
- Bone deposition (sclerosing/condensing osteitis) around rarefying osteitis
What is another name for condensing osteitis?
Sclerosing osteitis
Condensing Osteitis Tx
- Resolution of infection focus
- W/ surgery or endo, 85% regress fully or partially
- RO area remains after inflammation resolution and is known as “bone scar”
Buccal Bifurcation Cyst
- Develops on the buccal of MN permanent M1s
- Occurs in children ~10yo
- Associated w/ buccal enamel extensions
- Predisposes teeth to pocket formation
- Size ranges from 1.2-2.5cm
- Rad: Well circumscribed, unilocular RL involving buccal bifurcation & root
- Root apices tipped toward lingual MN cortex
- Same histology as inflamed dentigerous cyst & radicular cyst; need location/history
Buccal Bifurcation Cyst Tx
- Enucleation
- Involved tooth can often be maintained
- W/in 1yr, complete clinical & radiographic healing
Other names for Alveolar Osteitis
Dry socket
Fibrinolytic Alveolitis
Alveolar Osteitis
- Destruction of initial clot or inappropriate healing
- Risk factors: Impacted M3s, poor OH, inexperienced surgeons, traumatic extractions, contraceptive use, pre-surgical infections
- 20% of smokers (40% if you smoke w/in 24hr of op)
- Vasoconstriction = interferes w/ clot formatin
Alveolar Osteitis Tx
- Rad exam to r/o root tip or foreign body
- Irrigate w/ warm saline
- Avoid curettage
- Analgesics + home irrigation
- Antiseptic dressing? Controversial
Inflammation
Rxn of vascularized tissues against an offending agent, characterized by the exit of fluids and blood cells to the interstitium
What are the Focal Inflammatory Lesions?
- Periapical Abscess
- Periapical Granuloma
- AKA Chronic Apical Periodontitis
- Periapical Cyst
- AKA Radicular Cyst, Apical Periodontal Cyst
- Rarefying Osteitis
- Condensing Osteitis
- Buccal Bifurcation Cyst
- Alveolar Osteitis
- AKA Dry Socket, Fibrinolytic Alveolitis
