Lecture 4- Pulpal & Periapical Disease & Periapical Radiolucencies

Question 1

Four aspects of pulpal interpretation:

Answer 1

1. size
2. secondary dentin
3. pulp stones/ pulpal sclerosis
4. internal/external resoprtion

Question 2

Describe the pulp chamber of a younger patient:

Answer 2

larger pulp chamber & RC space is larger

Question 3

How old is this patient?

Answer 3

pulp chamber of kid

Question 4

Why might a younger patient be more prone to carious exposures of the pulp?

Answer 4

Larger pulp horns- pulp is closer to the occlusal surface

Question 5

How old is this patient?

Answer 5

pulp chamber of kid

Question 6

As we age, our pulp chambers:

Answer 6

shrink

Question 7

How old is this patient?

Answer 7

older- small pulp chamber & secondary dentin formation

Question 8

As the pulp chamber gets smaller, it usually:

Answer 8

maintains shape

Question 9

Why does the pulp chamber get smaller with age?

Answer 9

part of aging process + stress of occlusal forces

(secondary dentin formation)

Question 10

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

Answer 10

The pulp chamber of tooth #7 is larger than the pulp chambers of the adjacent teeth. We can see a periapical radiolucency on #7. This tooth probably became non-vital at a young age.

When the tooth became non-vital, so the secondary dentin did not form

Question 11

Why does the pulp chamber appear non-existent?

Answer 11

due to secondary dentin formation- probably still a pulp chamber in there just very small

Question 12

Comparing the first & second molars, we can note:

Answer 12

localized secondary dentin formation- distal pulp horn of 1st molar- This can also be referred to as tertiary dentin formation that is formed due to the carious lesion on the 1st molar.

Question 13

Additional dentin formation caused by irritation from deep carious lesion:

Answer 13

secondary/tertiary dentin formation

Question 14

How can we tell if tertiary dentin is formed (what distinguished this from primary dentin?)

Answer 14

shape of pulp chamber is changed

Question 15

We generally refer to the calcifications in the pulp as:

Answer 15

pulp stones

Question 16

Describe pulp stones:

Answer 16

• occur in the RC space or pulp chamber
• can be single or multiple
• can vary in size
• teeth are still vital (no clinical significance unless trying to do endo)

Question 17

What can be seen in this radiograph?

Answer 17

pulp stones in the molars

Question 18

What can be seen in the radiograph?

Answer 18

pulp stones

Question 19

A more widespread diffuse form of pulp stones, where the calcification can almost completely fill the pulp chamber and often times fills the root canal spaces:

Answer 19

pulpal sclerosis

Question 20

What can be seen in the following image?

Answer 20

pulpal sclerosis

Question 21

Inflammation of the pulp that causes resorption of the dentin in the root and it starts from within the pulp and goes outward

Answer 21

Internal root resoprtion

Question 22

Describe the margins in internal root resoprtion:

Answer 22

smooth and well defined

Question 23

Internal root resorption is inflammation of the pulp that causes resorption of the ___ in the root. It starts from within the pulp and goes outward.

Answer 23

dentin

Question 24

The area of internal resoprtion of a root is typically described as:

Answer 24

ovoid or round

Question 25

What is the treatment for internal root resoprtion?

Answer 25

RCT (to try to stop the resorptive process)

Question 26

What can be seen in the following radiograph?

Answer 26

internal root resorption

Question 27

What can be seen in the following radiograph?

Answer 27

internal root resoprtion (this image also has some external root resorption)

Question 28

Root resorption caused by EXTERNAL forces

Answer 28

External root resorption

Question 29

With external root resorption, the remaining surfaces are usually:

Answer 29

smooth

Question 30

As the tooth resorbs in external root resorption, the PDL and lamina dura:

Answer 30

move with the resorbing root

Question 31

What can be seen in the following radiograph?

Answer 31

external root resoprtion

Question 32

You see this benign tumor in a patient, and you know that its slow growing due to the displacement of teeth. What else can be seen (that has occurred due to this tumor)

Answer 32

external root resoprtion

Question 33

What can be see in the following radiograph?

Answer 33

external root resorption (associated with an inflammatory PA lesion)

Question 34

T/F- Internal root resorption always requires therapy. External root resorption may or may not require treatment

Answer 34

True

Question 35

List some causes of periapical radiolucencies:

Answer 35

1. periapical abscess 2. periodical granuloma 3. periapical cyst 4. residual/recurrent cyst 5. periapical memento-osseous dysplasia 6. fibrous healing defect

Question 36

Periapical INFLAMMATORY lesions include: (3)

Answer 36

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

Question 37

- Reversible/irreversible pulpitis - Acute apical abscess These are both examples of:

Answer 37

Acute pulpal/periapical disease

Question 38

This patient comes in on E-chair and is complaining of periapical pain of the second molar. You take a radiograph, and note the periodontal ligament space and lamina dura are intact. Radiographically you may not see any evidence of disease here.

Answer 38

reversible puulpitis

Question 39

- PDL space thickening - discontinuity of lamina dura - periapical radiolucency these findings are characteristic for:

Answer 39

apical abscess

Question 40

What can yo see in this radiograph?

Answer 40

apical abscess

Question 41

What is the first sign you may see on a radiograph for an apical abscess?

Answer 41

PDL space widening

Question 42

What is the second radiographic signs for an apical abscess?

Answer 42

discontinuity of the lamina dura

Question 43

What is the the third radiographic signs for an apical abscess?

Answer 43

periapical radiolucency

Question 44

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

Answer 44

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

Question 45

What can we see in the following radiograph?

Answer 45

apical abscess (the start of one)

Question 46

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

Answer 46

acute

Question 47

What can be seen in the following radiograph? Describe it

Answer 47

- Ill defined radiolucency at apex of tooth - Apical abscess

Question 48

List the chronic periapcial inflammatory lesions: (4)

Answer 48

1. chronic apical abscess 2. periapical granuloma 3. periapical cyst 4. periapical rarefying osteitis

Question 49

1. chronic apical abscess 2. periapical granuloma 3. periapical cyst 4. periapical rarefying osteitis The following are:

Answer 49

chronic periapical inflmattory lesions

Question 50

Three radiographic lesions that are often indistinguishable:

Answer 50

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

Question 51

Instead of saying this is either a 1. chronic apical abscess 2. periapical granuloma 3. periapical cyst we might just say:

Answer 51

this is a periapical rarefying osteitis

Question 52

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

Answer 52

RCT

Question 53

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

Answer 53

sclerotic bone

Question 54

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

Answer 54

sclerotic bone - chronic apical abscess

Question 55

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

Answer 55

sclerotic bone - chronic apical abscess

Question 56

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

Answer 56

periapcial granuloma

Question 57

Periapical granulomas often develop from:

Answer 57

periapical abscesses

Question 58

Radiographically, the appearance of a periapical granuloma is quite:

Answer 58

variable

Question 59

What can be seen in the following image?

Answer 59

periapical granuloma

Question 60

Periapical ____ often form from periapical granulomas

Answer 60

Periapical cysts

Question 61

What can bet seen in the following image?

Answer 61

periapical cyst

Question 62

Cystic degeneration of a periapical granuloma which results in a fluid filled cavity:

Answer 62

periapical cyst

Question 63

Periapical cyst tend to be ____ in shape:

Answer 63

rounded (hydraulic)

Question 64

What can be seen in the pano?

Answer 64

periapical cyst