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Oral Path 2 > Focal Inflammatory Lesions > Flashcards

Focal Inflammatory Lesions Flashcards

1
Q

Periapical Abscess

A
  • 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
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2
Q

Periapical Abscess Tx

A
  • 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
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3
Q

Focal vs. Generalized/diffuse

A

Focal: Width of one tooth

Generalized: Across multiple teeth

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4
Q

Other name(s) for Periapical Granuloma

A

Chronic Apical Periodontitis

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5
Q

Periapical Granuloma

A
  • 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
    *
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6
Q

Periapical Granuloma Tx

A
  • 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
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7
Q

What lesion represents 75% of apical inflammatory lesions?

A

Periapical granuloma

AKA chronic apical periodontitis

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8
Q

What lesion represents 15% of all periapical RLs?

A

Periapical Cyst

AKA Radicular Cyst

AKA Apical Periodontal Cyst

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9
Q

What are other names for Periapical Cyst?

A

Radicular Cyst

Apical Periodontal Cyst

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10
Q

Periapical (Radicular) Cyst

A
  • 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
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11
Q

What are variants of Periapcial (Radicular) Cyst?

A
  • Lateral radicular cyst
  • Residual cyst
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12
Q

Lateral Radicular Cyst

A

Variant of Periapical (Radicular) Cyst

  • Inflammatory cyst on lateral aspect of root
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13
Q

Residual Cyst

A

Variant of Periapical (Radicular) Cyst

  • Cyst remaining post-extraction
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14
Q

Periapical Cyst Tx

A
  • Tooth restorable: RCT
  • Tooth non-restorable: Extraction & curettage
  • >2cm, periapical surgery
  • Recurrence not expected
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15
Q

Rarefying Osteitis

A
  • 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
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16
Q

What is the most common lesion in the jaw?

A

Rarefying Osteitis

  • Inflammatory thinning of bone
  • Must include abscess, cyst, granuloma in differential dx
17
Q

Condensing Osteitis

A
  • 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
  • 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
18
Q

Sequence of events for condensing osteitis

A
  • Tooth disease
  • Pulpal inflammation & necrosis
  • PA inflammation
  • Rarefying osteitis
  • Bone deposition (sclerosing/condensing osteitis) around rarefying osteitis
19
Q

What is another name for condensing osteitis?

A

Sclerosing osteitis

20
Q

Condensing Osteitis Tx

A
  • 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”
21
Q

Buccal Bifurcation Cyst

A
  • 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
22
Q

Buccal Bifurcation Cyst Tx

A
  • Enucleation
  • Involved tooth can often be maintained
  • W/in 1yr, complete clinical & radiographic healing
23
Q

Other names for Alveolar Osteitis

A

Dry socket

Fibrinolytic Alveolitis

24
Q

Alveolar Osteitis

A
  • 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
25
Q

Alveolar Osteitis Tx

A
  • Rad exam to r/o root tip or foreign body
  • Irrigate w/ warm saline
  • Avoid curettage
  • Analgesics + home irrigation
  • Antiseptic dressing? Controversial
26
Q

Inflammation

A

Rxn of vascularized tissues against an offending agent, characterized by the exit of fluids and blood cells to the interstitium

27
Q

What are the Focal Inflammatory Lesions?

A
  • 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

Oral Path 2 (11 decks)

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