Inflammatory Jaw Lesions Flashcards
1
Q
Inflammatory Jaw Lesions 10
Focal 5
Diffuse/gen 5
A
- Focal
- Periapical abcess
- Periapical granuloma
- Radicular cyst
- Condensing Osteitis
- Buccal Bifurcation Cyst
- Diffuse Gen
- Osteomyelitis
- Osteomyelitis w/ proliferative periostitis
- Osteoradionecrosis
- Bisphosphanate osteonecrosis of the jaws
2
Q
Inflammation definition
A
Reaction of vascularized tissues against an offending agent, characterized by the exit of fluids and blood cells to the interstitium
3
Q
Cardinal Signs of Inflammation4
A
- Calor
- Dolor
- Rubor
- Tumor
4
Q
Periapical Abcess
What is it
Due to
Often has
Tx
A
- Accumulation of acute inflammatory cells and purulence at the apex of the tooth
- Due to infection or trauma
- Often has draining tract to ST
- Symptomatic or asymptoatic
- Xray
- Poorly defined
- May have widening or loss of PDL
- Loss of lamina dura
- Tx
- drainage an elimination of infection focus
- Endodontic therapy or extraction
5
Q
Periapical Granuloma
AKA
Occurrence
What
Whats released
Xray3
Tx3
A
- AKA Chronic apical periodontitis
- Represents 75% of apical inflammatory lesions
- Mass of chronically inflammed tissue at apex of nonvital tooth
- Defensive reaction
- Cytokines released by inflammatory cells destroy bone
- Xray
- Poorly defined
- Loss of lamina dura apically
- Widened/loss PDL
- TX
- If tooth can be mmaintained, root canal therapy can be performed
- If nonrestorable, extraction and curettage indicated
- All St removed should be evaluated histopathologically
6
Q
Periapical Radicular Cyst
Arises from
Variants
Xray 3
Tx 3
A
- Arises from stimulation of epithelium at apex of nonvital tooth
- Variants include lateral radicular cyst and the residual cyst
- Cyst lined by stratified squamous epipthelium. CT wall contains chronic inflammatory infiltrate
- Xray
- Well defined RL around apex
- Missing PDL and lamina dura
- May or may not have RO rim
- Tx
- same as periapical granuloma
- If lesion is >2cm perapical surgery is typically performed
- Residual: All need to be surgically excised
7
Q
Rarefying Osteitis
def
xray gen app
Collectively
Occurrence
Growth
Symptoms
Rarefy definition
A
- Radicular granuloma, cyst, abcess of a non vital pulp CANNOT be differentiated radiographically
- All generally well-defined and radiolucent
- Collectively known as rarefying osteitis (abcess, granuloma, cyst)
- The most common lesion of the jaws
- Most grow slowly and dont become large
- Asymptomatic unless acutely inflammed
- Rarefy: to make thin or less dense
- Include all of these in diff dx
- Cyst
- Granuloma
- Abcess
- If tooth is vital it cannot be rarefying psteitis
8
Q
Condensing Osteitis
What is it
Assoc with
Inflammation causes
Xray features
A
- Localized proliferative reaction of bone to low-grade inflammatory stimulus
- Associated with apex of nonvital tooth
- Inflammation causes bone deposition rather than bone resorption
- Association with area of inflammation is critical
- Xray features
- Tooth root outline is visible
- PDL is widened/loss or shows rarefying osteitis
- No lamina dura
- Localized sclerotic radiopaque area in periapical region outside the radiolucent area
9
Q
Condensing Osteitis
Sequence of events
Tx
A
- Tooth disease–> pulpal inflammation and necrosis–> periapical inflammation–> rarefying osteitis
- Bone deposited (sclerosing/condensing osteitits) around rarefying osteitits
- Tx
- resolution of infection focus
- With surgery or endo most regress fully or partially
- Radiopaque area persists as scar
10
Q
Buccal Bifurcation Cyst
What is it
Common location
Deographic
Assoc with
Predisposes
App
Charateristics
Tx
A
- Inflammatory cyst with uncertain pathogenesis
- Characteristically develops on the buccal aspect of the mand first permananet molar
- Occurs in children, average age 10
- Associated with buccal enamel extensions
- Predisposes tooth to pocket formation
- Well-circumscribed, unilocular radiolucency involvng the buccal bifurcation and root
- Characteristics
- Root apices tipped toward lingual mand cortex
- Same histologic findings as inflammed dentigerous cyst or radicular cyst need location and Hx
- Tx
- Enucleation, involved tooth can often be maintained
11
Q
Alveolar Osteiis
A
- Dry socket
- Plasminogen–> Plasmin–> Lysis of fibrin–> Kinins
- Xray to rule out root tip or foreign body
12
Q
Periapical Abcess Possible Sequela
Occurs with
4 kinds
A
- Occurs with spread of infection/inflammation through adjacent structures
- Infection/inflammation at a distant location from origin
- Localized
- Sinus tract, parulis
- Generalized
- Cellulitis, osteomyelitis
13
Q
Periapical Abcess Sequla: Sinus Tract
What is it
A
- Periapical abcess with purulence
- Pus dissects through the bone, destroying bone
- Perforates the cortical plate of bone, extending into ST
- Tends to follow the path of least resistance
- Finds a point of exit and drains purulent material
- May be intermittent drainage
- Location of sinus tract depends on the involved tooth and path of least resistance
14
Q
Periapical Abcess Sequela: Intraoral Parulis
Marks
2 types
A
- gum boil
- Marks the exit point of the sinus tract on the oral mucosa
- 2 types
- A hole with surrounding redness
- An enlarged nodular mass
- Yellow to white red to purple
- Sessile or polypoid
15
Q
Periapical Abcess sequela: Cutaneous Parulis
app
A
- Typically an enlarged nodular mass
- Red lesion with other shades of yellow, white, purple
- Mand teeth commonly involved
