L4- Pulpal & Periapical Disease & Periapical radiolucencies

Question 1

Four aspects of pulpal interpretation:

Answer 1

1. size
2. secondary dentin
3. pulp stones/pulpal scerlosis
4. internal/external resorption

Question 1

Describe the pulp chamber of younger patients:

Answer 1

Pulp chamber & RC space is larger

Question 2

Why are younger patients more prone to carious exposures of the pulp?

Answer 2

Larger pulp horns = pulp is closer to the occlusal surface

Question 3

Looking at this image, what is the age of the patient?

Answer 3

kid

Question 4

Looking at this image, what is the age of the patient?

Answer 4

older patient

(small pulp chamber, secondary dentin formation)

Question 5

As the pulp chamber gets smaller, it usually:

Answer 5

maintains the same shape

Question 6

Why does the pulp chamber get smaller with age?

Answer 6

Part of aging process + stress of occlusal forces & secondary dentin formation

Question 7

What do you notice in this image? What might be the reason?

Answer 7

The pulp chamber of tooth #7 is larger than the pulp chamber of the adjacent teeth. We can see a periapcical radiolucency on #7. The tooth probably became non-vital at a younger age- so secondary dentin formation stopped

Question 8

Why does the pulp chamber appear non-existent?

Answer 8

Secondary dentin formation

Question 9

Comparing the first & second molars we can note:

Answer 9

localized secondary dentin formation (distal pulp horn of first molar)

Question 10

Additional dentin formation caused by irritation from deep carious lesion:

Answer 10

secondary/tertiary dentin

Question 11

How can you tell if tertiary dentin is formed (what distinguishes this from primary dentin?)

Answer 11

Shape of pulp chamber has changed

Question 12

We generally refer to calcifications in the pulp as:

Answer 12

pulp stones

Question 13

Describe pulp stones:

Answer 13

• can occur in RCT space or pulp chamber
• can be single or multiple
• can very in size although normally small
• teeth are still vital (no clinical significance unless you need to do endo on these teeth)

Question 14

What can be seen in the radiograph?

Answer 14

pulp stones

Question 15

What can be seen in the radiograph?

Answer 15

pulp stones (molars)

Question 16

A more widespread, diffuse form of pulp stones where the calcifcation can almost fill the pulp chambers & often times also fills the RC spaces:

Answer 16

pulpal sclerosis (teeth are still vital)

Question 17

What can be seen in the following radiograph?

Answer 17

pulpal sclerosis

Question 18

Inflammation of the pulp causes resorption of the dentin in the root, starting from within the pulp & goes outwards:

Answer 18

Internal root resorption

Question 19

Describe the margin in internal root resorption:

Answer 19

smooth & well defined

Question 20

Internal root resorption is inflammation of the pulp that causes resorption of the _____ in the root. It states from within the pulp & goes outward:

Answer 20

dentin

Question 21

The area of internal root resoprtion is usually describe as:

Answer 21

ovoid or round

Question 22

What is the treatment for internal root resorption?

Answer 22

RCT (to try to stop the resorption process)

Question 23

What can be seen in the following image?

Answer 23

internal root resorption

Question 24

What can be seen in the following image?

Answer 24

internal root resorption (also some external resorption as well)

Question 25

Root resorption caused by external forces that begins outside the tooth and works its way inward:

Answer 25

External root resorption

Question 26

With external root resorption, the remaining surfaces are usually:

Answer 26

smooth

Question 27

As the tooth resorbs in external root resorption, what happens to the PDL & lamina dura

Answer 27

They follow the tooth- moving with the resorbing tooth

Question 28

What can be seen in the following image?

Answer 28

external root resorption

Question 29

We seen this benign tumor in a younger patient. We note that its slow growing due to the displacement of teeth. What has occurred due to this tumor?

Answer 29

external root resorption

Question 30

What can we see in the following image?

Answer 30

External root resorption (associated with an inflammatory PA lesion)

Question 31

T/F: Internal root resorption always requires therapy, whereas external root resorption may or may not

Answer 31

True

Question 32

List some causes of periapical radiolucencies:

Answer 32

1. periapical abscess 2. periapical granuloma 3. periapical cyst 4. residual/recurrent cyst 5. periapical cemento-osseou dysplasia 6. fibrous healing defect

Question 33

Periapical INFLAMMATORY lesions include:

Answer 33

1.periapical abscess 2. periapical granuloma 3. periapical cyst

Question 34

-reversible/irreversinle pulpitis -acute apical abscess These are both examples of:

Answer 34

ACUTE pulpal/periapical disease

Question 35

The patient comes in on E-chair & is complaining of periapcial pain of the second molar. Radiographically you note that the PDL & lamina dura are intact. Radiographically you may not see any evidence of disease here

Answer 35

Irreversible pulpitis

Question 36

-PDL space thickening -Discontinuity of lamina dura -Periapical radiolucency These are all:

Answer 36

Radiographic findings at apex

Question 37

What is the first radiographic sign you may see of an apical abscess?

Answer 37

PDL space widening

Question 38

What is the second radiographic signs you may see of an apical abscess?

Answer 38

Periapical radiolucency

Question 39

What is the third radiographic sign you may see of the apical abscess?

Answer 39

periapical radiolucency

Question 40

What do you see when looking at the mesial apex of the first molar?

Answer 40

slight PDL widening (mesial root of 1st molar), but lamina dura is intact

Question 41

What can be seen in the following radiograph?

Answer 41

Apical abscess

Question 42

Once you have an apical abscess, it is no longer considered:

Answer 42

acute

Question 43

What can be seen in the following radiograph?

Answer 43

-ill-defined radiolucency at apex of tooth -apical abscess

Question 44

-chronic apical abscess -periapical granuloma -periapical cyst -periapical rarefying osteitis These are all:

Answer 44

chronic periapical inflammatory lesions

Question 45

Three radiographic lesions that are often indistinguishable:

Answer 45

1. chronic apical abscess 2. periapical granuloma 3. periapical cyst

Question 46

List the four types of chronic periapical inflammatory lesions:

Answer 46

-chronic apical abscess -periapical granuloma -periapical cyst -periapical rarefying osteitis

Question 47

Instead of saying there is a: 1. chronic apical abscess 2. periapical granuloma 3. periapical cyst We might just say:

Answer 47

this is a periodic rarefying osteitis

Question 48

What is the treatment for the following? 1. chronic apical abscess 2. periapical granuloma 3. periapical cyst

Answer 48

RCT

Question 49

When you have a chronic apical abscess, you may or may not see:

Answer 49

sclerotic bone

Question 50

What can seen be seen in the following radiograph? What is this a characteristic of?

Answer 50

Sclerotic bone; chronic apical abscess

Question 51

What can seen be seen in the following radiograph? What is this a characteristic of?

Answer 51

Sclerotic bone; chronic apical abscess

Question 52

A periapical radiolucency that instead of being filled with inflammatory fluid or pus, it is filled with granulation type tissue:

Answer 52

Periapical granuloma

Question 53

Periapical granulomas often develop from:

Answer 53

periapical abscesses

Question 54

What can be seen in the following image?

Answer 54

Periapical granuloma

Question 55

Radiographically, the appearance of a periapical granuloma is quite:

Answer 55

variable

Question 56

Periapical ____ often form from periapical granulomas

Answer 56

cysts

Question 57

Cystic degeneration of a periaoical granuloma that results in a fluid filled cavity:

Answer 57

periapical cyst

Question 58

What can bet seen in the following image?

Answer 58

periapical cyst

Question 59

Periapical cyst tend to be ____ in shape:

Answer 59

rounded (hydraulic)

Question 60

What can be seen in the following image?

Answer 60

periapical cyst

Question 61

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