histopathology of periapical disease

Question 1

what is the lamina dura

Answer 1

white space that outlines the PDL

Question 2

PDL

Answer 2

sits between the lamina dura and cementum

Question 3

what does th ePDL contain

Answer 3

epithelial remnants from henrtwigs root head

- responsible for formation of root of the tooth

Question 4

classifications of periapical disease

Answer 4

inflammatory
reactive
neoplastic

Question 5

aetiology for periapical periodontitis

Answer 5

infection 
trauma (physical,chemicla, mechanical)

Question 6

symptomatic periapcial periodontitis

Answer 6

confined to periapicla space
localised pain
tooth elevated
may be transient or persistent

Question 7

acute periapical access

Answer 7

lead on from symtomatic periodical PDS

abscess localised to the PDL

Question 8

spread of infection

Answer 8

path of least resistance
PDL
root canal
through bone

Question 9

spread to sinus leads to

Answer 9

sinusitis

Question 10

spread to soft tissues of face

Answer 10

cellulitis

Question 11

periapical granuloma

Answer 11

Once periapical periodontitis is establish, Bone resorption occurs and is infilled by inflamed connective tissue (periapical granuloma)

Question 12

histology of periapical granuloma

Answer 12

• fibrous capsule (separated from an area of uninflamed tissue)
• granulation tissue (fibroblasts and ECM, blood vessles)
• Chronic inflammation (macrophages, lymphocytes, plasma cells, occasional neutrophils) Neutrophils are there as can tip the balance into acute by forming an abcess, this is an ongoing dynamic process)
• epithelium (rests of malassez may proliferate due to the inflammatory mediators)
• bone resorption: osteoclasts

Question 13

cysts of the jaws types and examples

Answer 13

1) Inflammatory
- radicular cysts (associated with the root of the tooth)
- paradental cysts
most common
2) Developmental
- follicular cysts (dentigerous, eruption)
- odontogenic keratocyst
- lateral periodontal cysts
- gingival cysts
- glandular odontogenic cyst

Question 14

radicular cysts and associated with

Answer 14

Arsise in the PDL from the epithelial rests of malassez as a result of the inflammation following death of the pulp
- always associated with a non vitla tooth

Question 15

what does location of radicular cyst depend on

Answer 15

• depends on where apical foramen opens
  1) Apical
• at the apex of a tooth associated with the opening of the root canal
  2) lateral
• at the side of a tooth associated with lateral branch of the root canal
  3) residual
• a radicular cyst which has persisted after extraction of the associated tooth

Question 16

histology of radicular cyst

Answer 16

1) Lumen
- where the contents of the cyst is
- where the fluid is
2) lining
- epithelium cell rests of mallesez
3) Walll
- inflamed fibrous connective tissue
- remains of the periapical granuloma

Question 17

cholesterol clefts

Answer 17

when cysts form there is lots of cell breakdown of cell membranes which contain lots of cholesterol
- the cholesterol crystallises out, left by dissolving of the cholesterol

Question 18

types of hyperementosis

Answer 18

aceullular

cellular

Question 19

reactive change leading to hypercemntosis examples

Answer 19

1) loss of function
- tooth overgrows as the opposing tooth is not there (due to extraction of unerupted teeth)
2) inflammation
- a tooth with periapical granuloma
- mobile teeth (periodontitis)
3) Pagets disease
- bone disease
4) Idiopathic