inflammatory jaw lesions Flashcards
1 defense mechanism of body
inflammation - but in the 2nd line of defense
periapical abscess
accumulation of acute inflammatory cells (neutrophils, not time) and purulence a the apex of the tooth
cause of PA abscess
infection of trauma
t/f PA abscess can be symptomatic or asymptomatic
true
microscopically, the key cell to an acute abscess is
neutrophil
tx of pa abscess
elimination of infection focus
endo
pa granuloma
chronic apical periodontitis (lymphocytes)
mass of chronically inflamed tissue
defensive reaction
cytokines releases
75% of apical inflammatory lesions are
pa granulomas
cells of chronic pa granulomas
lymphocytes (no macrophages)
tx of pa granuloma
endo or extraction with curettage
radicular cyst arises from
stimulation of epithelium at apex of non vital tooth
variants of radicular cyst
lateral radicular and residual cyst
3 parts of cysts
EPITHELIUM, CT, lumen
t/f radiographically, you can’t tell the difference bt cyst, granuloma, or abscess
true
rarefying osteitis
cannot be differentiates clinically
generally well defined and radiolucent
most common lesions (cysts, granuloma, abscess)
grow slow, focal
condensing osteitis
localized proliferative reaction of bone to low grade inflammatory stimulus
what is most commonly associated with apex of a nonvital tooth
condensing osteitis
what is critically associated with an area of inflammation
condensing osteitis
radiographic features of condensing osteitis
tooth root outline is visible
pdl is widened or shows rarefying oseitis
localized sclerotic radiopaque area in pa region outside the radiolucent area
sequence of events for condensing osteitis
- disease, pulpal inflammation, pa inflammation, rarefying osteitis
- bone deposited around rarefying osteitis
tx of condensing osteitis
endo, but left with a bone scar (sclerotic bone that doesn’t go away)s
osteomyelitis
acute/chronic inflammation of bone away from initial site
diffuse area
osteomyelitis leads to
necrosis and sequestra
sequestrum
piece of necrotic bone that separated from surrounding viable bone
cause of osteomyelitis
tooth infection, bacterial infections (pyogenic staph and strep)
predisposing conditions of osteomyelitis
decreased host resistance, decreased vascular supply to bone
pathogenesis of osteomyleitis
acute suppurative inflammation, interruption of vascular supply, necrosis and resorption of bone
involucrum
dead bone that has new vital bone surrounding it
features of osteomyelitis
pain, paresthesia, swelling, drainage, fever, leukocytosis, tender lymphadenopathy
osteomyelitis is more common in
the mandible
radiographic features of osteomyelitis
nno changes in 1st week, later, diffuse radiolucent areas
radiopaque areas representing sequestra
tx of osteomyelitis
acute: abs, surgery maybe
chronic: difficult, surgery, IV abs
t/f you can get a pathologic fracture with osteomyelitis
true
onion skin pattern is seen in
osteomyelitis with proliferative periostitis
osteomyelitis with proliferative periostitis is
pa inflammation spreading to the periosteum
bony swelling, not painful
periosteum responds to osteomyl. with proliferative periostitis by
depositing bone
osteomyl. with proliferative periostitis occurs in
immmunocompromised/young people and mandible
radiographic appearance of osteomyelitits with proliferative periostitis
parallel layers of new bone depositied bt the cortex and periosteum
remodeling of bone occurs is how long with osteomyl. with proliferative periostitis
6-12 months
causes of periosteal new bone formation
osteomyelitis, neoplasms (ewings sarcoma, osteosarcoma), cysts, trauma
osteoradionecrosis
chronic infection of bone
follows high dose radiation therapy to bone
very painful
osteoradionecrosis is more common in
mandible
cause of osteoradionecrosis
greater than 75 grays
less than 60 grays there is a minimal risk
pathogenesis of osteoradionecrosis
thickening of bvs, destruction of osteoblastc/cytes, abscence of bone formation, trauma or infection
t/f. tx is easier than prevention in osteoradionecrosis
false
tx of osteoradionecrosis
abs, surgery, hyperbaric o2, radical surgical resection
complications of osteoradionecrosis
bony deformity and pathologic fracture
orocutaneous fistulas
BMU
basic multicellular unit: group of osteoclasts, blasts, and local vascular supply
final remodelong of bone
osteoclasts are used for
signaling, resorption, and lemellar bone deposition and angiogenesis
bisphosphonates are used for
cancer or oseteoporosis (oral, smaller dosage)
inhibiting apoptosis of osteoclasts
t/f decreased osteoclast function inhibits bone remodeling
true
zometa, boniva, aredia are IV drugs commonly seen with
jaw osteonecrosis
other meds that can lead to MRONJ
denossumab - antireorptive agent that prevents osteoclastic maturation; anti-neoplastic med or for osteoporosis
antiangiogenic agents - attempt to decrease blood supply to malignancy, vascular endothelial inhibitor
ARONJ
antiresorptive related osteonecrosis of the jaw
BRONJ clinical findings
IV bisphosphonates more likely to cause
intraorally show single or multifocal areas of exposed necrotic bone
radiographs may show increased radiopacity prior to necrosis
painful
mandible
post extraction
tx and prognosis for BRONJ
prevention
improve dental health before future procedures
symptomatic pts: systemic antibiotics and chorhexidine, asymptomatic pts: chorhexidine only
smooth exposed bone
what do you include on the differential with osteomyelitis
radiation induced osteonecrosis
MRONJ
metastatic disease
