Histopathology of periapical disease Flashcards

1
Q

look at slides for histology pics

A

look at slides for histology pics

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2
Q

Which periodontal fibres insert into alveolar bone?

A

Sharpey’s fibres

run obliquely across PDL space and insert into bone to anchor tooth within socket

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3
Q

PDL contains epithelial remnants of Hertwig’s root sheath called

A

Rest cells of Malassez

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4
Q

What are rest cells of Malassez

A

epithelial remnants of Hertwig’s root sheath in PDL

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5
Q

Lamina dura

A

Thin layer of cortical bone outlining PDL space, seen as white gap on radiograph
Can change path if there is a periapical disease

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6
Q

Classification of periapical disease: inflammatory

A

Periapical periodontitis

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7
Q

Classification of periapical periodontitis: reactive

A

‘Osteosclerosis’
Hypercementosis
Ankylosis
Cemento-osseus dysplasia

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8
Q

Classification of perapical periodontitis: neoplastic

A

Benign cementoblastoma

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9
Q

Perapical periodontitis

A

Almost always arises as consequence of pulp death due to caries
May be traumatic (e.g. blow to tooth)

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10
Q

Periapical periodontitis: aetiology

A
Infection (bacterial)
-via root canal (caries)
-via periodontium (e.g. pocket)
Trauma
-physical: direct blow, high filling, malocclusion, bruxism
-chemical: via root canal
-mechanical: root filling
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11
Q

Symptomatic periodontitis

A

Non-vital tooth –> symptomatic (acute) PP –> acute periapical abscess –> acute alveolar abscess –> cellulitis or chronic abscess
Can become chronic, chronic can become acute

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12
Q

Acute periapical abscess

A
Bacteria
-mixed anaerobes 
-root canals or peri-apex
Primary abscess
Radiographic changes
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13
Q

Symptomatic periapical periodontitis

A
Confined to periapical space
Localisable pain
Tooth elevated 
Little radiographic change
May be transient or persistent
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14
Q

Spread of infection

A
Tracking of pus
-PDL
-root canal (if open)
-through bone (sinus formation)
Influence of anatomy 
-antrum
-muscle attachments
-soft tissue (cellulitis)
Bone - osteomyelitis
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15
Q

Osteomyelitis

A

Rare
Pxs on bisphosphonates
Pxs who have had radiotherapy

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16
Q

Where may an abscess on an upper tooth drain to

A
Maxillary sinus
From central incisor --> infraorbital region
Soft tissues of cheek
Nasal passage
Intraoral
Palate
17
Q

Sinus tract

A

Alveolar abscess - chronic
Discharge intraorally
Cyclical symptoms as it fills up, then discharges

18
Q

Where may an abscess on a lower tooth drain to

A

Intraoral
Lower incisor –> the chin
Mandible
Floor of mouth

19
Q

Periapical granulomas

A

Mass of inflamed fibrous CT at base of apex of tooth
Granulation tissue
Loss of bone and replacement
Fibroblasts, macrophages, blood supply

20
Q

Periapical granuloma: histology

A

Fibrous capsule
Granulation tissue
Inflammation
-lymphocytes, plasma cells, macrophages, occasional neutrophils
Epithelium - rest of Mallasez may proliferate
Bone resorption: osteocalsts

21
Q

What can periapical granuloma lead to

A

Radicular cyst

22
Q

Cysts of the jaws - odontogenic

A

Inflammatory
-radicular (most common)
-paradental
Developmental (a lot of types)

23
Q

Radicular cyst

A

Arise in PDL from epithelial rests of Malassez as result of inflammation following death of pulp
Always associated with non-votal tooth

24
Q

Types of radicular cysts

A

Apical: at apex of tooth associated with opening of root canal
Lateral: at side of tooth associated with lateral branch of root canal
Residual: radicular cyst which has persisited after extraction of associated tooth

25
Stimulus for proliferation of cyst
Inflammation | Apical granuloma --> radicular cyst --> periodontitis --> pericoronitis
26
Pathogenesis - radicular cyst
Caries --> non-vital pulp --> apical granuloma --> proliferating odontogenic epithelium --> cyst
27
Radicular cysts: histology
Wall (usually fibrous CT) Lining (mostly epithelial lining) -proliferative Lumen filled with fluid and some cellular debris -plasma cells -antibodies -cholesterol accumulation (from cell walls), seen as cholesterol clefts
28
Osteosclerosis
``` Rarefying osteitis (loss of bone): clinically more acute - radiolucent Focal sclerosing osteitis (sclerotic bone, more dense): ill-defined periapical radiopacity ```
29
Hypercementosis
Common - may be age related Reactive change caused by: -loss of function - tooth 'overgrows' (unerupted teeth) -inflammation (in a granuloma or mobile teeth with periodontitis) -Paget's disease -idiopathic
30
Hypercementosis histology
Thick layer of cementum around root which is indistinguishable from bone
31
Ankylosis
Hypercementosis obliterates PDL and fuses with alveolar bone
32
Cemento-osseus dysplasia
``` Reactive lesions Age 30-50 Often females Multiple radiopacities -around tooth roots -in edentulous areas Composed of irregular trabeculae of woven bone and cementum in fibrous stroma (fibro-osseus) ```
33
Florid cemento-osseus dysplasia (Gigantiform cementoma)
``` Often in edentulous areas Irregular radiopacities Masses of fused bone and cementum-like tissue Reactive, 'scarred bone' Calcified bodies which fuse into a mass ```
34
Cementoblastoma
``` Benign neoplasm Age 10-40 Radiopaque lesion attached to tooth root Usually mandibular molar teeth Composed of -sheets of cementum and osteoid -many plump 'osteoblasts' Resembles osteoblastoma ```