ORAL PATH non-cystic inflammatory lesions

Question 1

symptoms of acute periapical abscess?

Answer 1

severe pain which disturbs sleep
tooth very TTP

Question 2

signs of acute periapical abscess?

Answer 2

tooth mobility
associated swelling (facial and IO)
pus from apical tissues

Question 3

radiographic features of acute periapical abscess?

Answer 3

wider apical PDL
radiolucency

Question 4

symptoms of chronic periodontal abscess?

Answer 4

often none

Question 5

signs of chronic periodontal abscess?

Answer 5

sinus

Question 6

radiographic features of chronic perio abscess?

Answer 6

PAP (granuloma or cyst)

Question 7

what is the common cause for periradicular/ periapical inflammation?

Answer 7

bacterial infection following pulpal death

Question 8

when a non-vital tooth has periradicular periodontitis, what pathways can it follow?

Answer 8

acute or chronic lesions

(acute lesions can become chronic, chronic lesions can have acute flareups)

Question 9

what is the acute symptom from periradicular periodontitis?

Answer 9

acute abscess
can be cellulitis or chronic abscess

Question 10

what is the chronic symptom from periradicular periodontitis?

Answer 10

periapical granuloma

Question 11

clinical features of acute periradicular periodontitis?

Answer 11

history of pain
grossly carious/ heavily restored tooth
previous trauma
little to see radiographically (unless acute exacerbation of chronic lesion)

Question 12

what is the histopathology of acute periradicular periodontitis?

Answer 12

acute inflammatory changes:
- vascular dilation
- neutrophil infiltration
- tissue oedema

Question 13

what is the key acute inflammatory cell?

Answer 13

neutrophil

Question 14

treatment options for acute periradicular periodontitis?

Answer 14

XLA
endo

Question 15

what can acute and chronic periradicular periodontitis lead to?

Answer 15

periapical abscess

Question 16

clinical features of acute periapical abscess?

Answer 16

pain
swelling/ sinus

Question 17

histopathology of acute periapical abscess?

Answer 17

central collection of pus with an adjacent zone of preserved neutrophils
surrounded by granulation tissue

Question 18

treated options for acute periapical abscess?

Answer 18

drainage and XLA/ endo

Question 19

clinical features of chronic periradicular periodontitis?

Answer 19

non-vital tooth, may be previous RCT
often minimal symptoms
apical radiolucent lesion may be evident on radiograph

Question 20

histopathology of chronic periradicular periodontitis?

Answer 20

chronic inflammatory changes

lymphocytes and plasma cells
granulation tissue progresses to fibrosis

resorption of bone

Question 21

treated options for chronic periradicular periodontitis?

Answer 21

XLA
endo
endo retreatment
periradicular surgery

Question 22

what is a periapical granuloma?

Answer 22

mass of inflamed granulation tissue at the apex of a non-vital tooth

not a true granuloma

Question 23

what can a periapical granuloma progress to?

Answer 23

an abscess
may undergo cystic change (radicular cyst)

Question 24

clinical features of periapical granuloma?

Answer 24

as for chronic periradicular periodontitis - minimal
however
apical radiolucent lesion typically evident on radiograph

Question 25

histopathology of periapical granuloma?

Answer 25

inflamed granulation tissue proliferation of cell rests of Malassez haemosiderin and cholesterol deposits from RBC/inflam cell breakdown resorption of adjacent bone and or tooth

Question 26

treatment options for periapical granuloma?

Answer 26

XLA endo endo retreatment periradicular surgery

Question 27

histopathology of pericoronitis?

Answer 27

acute and chronic inflammatory changes including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue

Question 28

what type of cyst may arise in chronic pericoronitis?

Answer 28

paradental cyst

Question 29

clinical features of pericoronitis?

Answer 29

pain swelling/ tenderness of operculum bad taste trismus

Question 30

treatment for pericoronitis?

Answer 30

irrigation consider XLA of opposing tooth antibiotics (if systemically unwell)