Inflammatory Jaw Lesions Flashcards
Inflammatory Jaw Lesions 10
Focal 5
Diffuse/gen 5
- 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
Inflammation definition
Reaction of vascularized tissues against an offending agent, characterized by the exit of fluids and blood cells to the interstitium
Cardinal Signs of Inflammation4
- Calor
- Dolor
- Rubor
- Tumor
Periapical Abcess
What is it
Due to
Often has
Tx
- 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
Periapical Granuloma
AKA
Occurrence
What
Whats released
Xray3
Tx3
- 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
Periapical Radicular Cyst
Arises from
Variants
Xray 3
Tx 3
- 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
Rarefying Osteitis
def
xray gen app
Collectively
Occurrence
Growth
Symptoms
Rarefy definition
- 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
Condensing Osteitis
What is it
Assoc with
Inflammation causes
Xray features
- 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
Condensing Osteitis
Sequence of events
Tx
- 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
Buccal Bifurcation Cyst
What is it
Common location
Deographic
Assoc with
Predisposes
App
Charateristics
Tx
- 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
Alveolar Osteiis
- Dry socket
- Plasminogen–> Plasmin–> Lysis of fibrin–> Kinins
- Xray to rule out root tip or foreign body
Periapical Abcess Possible Sequela
Occurs with
4 kinds
- Occurs with spread of infection/inflammation through adjacent structures
- Infection/inflammation at a distant location from origin
- Localized
- Sinus tract, parulis
- Generalized
- Cellulitis, osteomyelitis
Periapical Abcess Sequla: Sinus Tract
What is it
- 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
Periapical Abcess Sequela: Intraoral Parulis
Marks
2 types
- 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
Periapical Abcess sequela: Cutaneous Parulis
app
- Typically an enlarged nodular mass
- Red lesion with other shades of yellow, white, purple
- Mand teeth commonly involved