Inflammatory lesions of the jaw Flashcards
Describe the pathogenesis of periapical lesions
7 symptoms of periapical lesions
- Asymptomatic
- Occasional toothache
- Severe pain with or without swelling
- Mobility, elevation of the involved tooth
- Sensitive to percussion
- Pain with periapical palpation
- Spontaneous drainage with fistula
Radiographic aspect of early periapical lesion
Any radiographic change
Radiographic aspect of chronic lesions
Lytic (radiolucent) or sclerotic (radiopaque) changes
Location of periapical lesions
- At the apex of the involved tooth
- Laterally to the apex
2 possible peripheral findings of periapical lesions
- Ill-defined periphery with a gradual transition from normal to abnormal bone pattern of the lesion
- Well-defined periphery with a sharp transition, appearance of cortical boundary
5 possible appearances of internal structure of periapical lesions
- Earliest change = widening of the PDL space
- Later stage = radiolucent appearance/ radiopacities (sclerosis)
- Periapical rarefying osteitis (bone resorption)
- Periapical sclerosing osteitis (bone formation)
- Osteosclerosis
3 characteristics of osteosclerosis
- Thicker trabeculae
- Increased number of trabeculae per unit area
- Sclerotic pattern located at the periphery
4 effects of periapical lesions on surrounding structures
- Lamina dura around apex is lost
- External resorption of the apical region of the root
- Sclerotic reaction
- Destruction of expansion of the cortical boundaries
3 effects of periapical lesions on the maxillary sinus
- Periosteal reaction in the floor of the maxillary sinus
- Thin layer of new bone produced by the infalmed periosteum
- Ragional mucositis of the adjacent segment of the maxillary sinus
2 differential diagnoses for periapical lesions
- Radicular cyst
- Periapical cemental dysplasia
How to differentiate a radicular cyst from a periapical lesion
Lesions are larger than 1 cm in diameter
3 characteristics of early radiolucent phase of periapical cemental dysplasia
- Diagnosis relies on clinical examination
- Test of tooth vitality
- Associated with the apical region of the mandibular anterior teeth
Describe mature periapical cemental dysplasia
Evidence of a dense, radiopaque structure within the radiolucency
Define pericoronitis
Inflammation of the soft tissues surrounding the crown of a partially erupted tooth
Usual location of pericoronitis
Often seen in association with the third mandibular molars
Bone changes centered on the follicular space
Describe the periphery of pericoronitis
Ill-defined with a gradual transition of the normal trabecular pattern into a sclerotic region
Describe the internal structure of pericoronitis
- Area of radiolucency imemdiately adjacent to the crown
- Sclerotic aspect of bone adjacent to the pericoronitis
Describe the effects of pericoronitis on surrounding structures
- Sclerosis and rarefaction of the surrounding bone
- Extensive case –> evidence of periosteal new bone formation
Define osteomyelitis
Inflammation of bone that spreads through the bone to inbolbe the marrow, cortex, and periosteum
Cause of osteomyelitis
Pyogenic organisms reaching the bone from abscessed teeth or postsurgical infection
2 principal categories of osteomyelitis
- Acute osteomyelitis
- Chronic osteomyelitis
Time frame of acute osteomyelitis
4 weeks after onset of disease
Which jaw most commonly experiences acute osteomyelitis?
Mandible
7 symptoms of acute osteomyelitis
- Rapid onset
- Pain
- Swelling of adjacent soft tissues
- Fever
- Lymphadenopathy
- Associated teeth may be mobile and sensitive to percussion
- Paresthesia of the lower lip
Describe the radiographic appearance of the early stages of acute osteomyelitis (within 2 weeks)
No radiographic changes
6 radiographic characteristics of acute osteomyelitis (later stages)
- Slight decrease in the density of the involved bone
- Replacement of marrow fat by inflammation (hypointense signal on CT/MRI)
- Sclerotic regions become apparent
- Cancellous bone osteolysis
- Cortical plate perforation
- Periosteal reaction
5 radiographic characteristics of chronic osteomyelitis
- Increased bone density (diffuse sclerosis)
- Areas of osteolysis
- Defects of cortical bone
- Cortical plate thickening
- Fistula, sequestra
4 differential diagnoses of chronic osteomyelitis
- Firbous dysplasia
- Osteosarcoma
- Oral epidermoid carcinoma
- Bisphosphonate-related osteonecrosis of the jaws
3 ways to differentiate fibrous dysplasia from chronic osteomyelitis
- No signs of acute infection
- Outer cortex may be thinned
- COrtical bone is not destroyed
