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
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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

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3
Q

Cardinal Signs of Inflammation4

A
  • Calor
  • Dolor
  • Rubor
  • Tumor
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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
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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
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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
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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
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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
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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
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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
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11
Q

Alveolar Osteiis

A
  • Dry socket
  • Plasminogen–> Plasmin–> Lysis of fibrin–> Kinins
  • Xray to rule out root tip or foreign body
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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
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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
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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
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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
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16
Q

Osteomyelitis

What is it

App/location

Leads to

2 types

A
  • Acute or chronic inflammation of bone away from initial site
  • Diffuse area involved, not localized and not well-defined
  • Leads to bone necrosis and sequestra
    • Sequestrum: piece of necrotic bone that seperated from surrounding viable bone
  • Acute (<1 month) Chronic (>1month)
17
Q

Osteomyelitis

Cause

Predisposing factors

A
  • Tooth-related infection most common
  • Vast majority caused by bacterial infections
    • Pyogenic organisms: Staph and strep
  • Predisposing conditions
    • Decreased host resistance
    • Decreased vascular supply to bone
18
Q

Osteomyelitis

Pathogenesis

A
  • Acute suppurative inflammation
  • Interruption of vascular supply
  • Necrosis and resorption of bone
    • Formation of sequestrum and involucrum
    • Sequestrum: fragment of necrotic bone
    • Involucrum: Dead bone (sequestrum) that has new vital bone surrounding it
19
Q

Osteomyelitis

Clinical features

A
  • Pain is a major feature, sometimes paresthesia
  • Swelling, purulent drainage
  • Fever, leukocytosis, and tender lymphadenopathy
  • More common in mandible
  • Xray
    • No raiographic changes during first weed
    • Later diffuse, radiolucent areas
    • Radiopaque areas representing sequestra
20
Q

Osteomyelitis

Tx

A
  • Acute
    • Treatment includes antibiotics
    • Surgery may or may not be required
  • Chronic
    • Difficult to manage (fibrous wall blocks AB)
    • Surgical intervention is mandatory
    • AB must be administered via IV
21
Q

Osteomyelitis with Proliferative Periostitis

A
  • Represents a periosteal reaction to the presence of inflammation
  • Most frequent cause is dental caries with perapical inflammation spreading to periosteum
  • Periosteum responds by depositing bone
  • Most cases seen in PM and molar area of the mandible
  • Bone deposited in layers parallel to the bony cortex=onionskin pattern
  • Young patients
  • Bony swelling but not painful
  • Xray- Parallel layers of new bone deposited btw the cortex and periosteum
22
Q

Abcess Granuloma Cyst relationship

A
  • Nonvital pulp can become
    • PA abcess or
    • PA Granuloma
  • Abcess and granuloma can become
    • PA cyst
  • Radiographically cant identify and should include abcess, granuloma and cyst in diff dx