ORAL PATH non-cystic inflammatory lesions Flashcards
symptoms of acute periapical abscess?
severe pain which disturbs sleep
tooth very TTP
signs of acute periapical abscess?
tooth mobility
associated swelling (facial and IO)
pus from apical tissues
radiographic features of acute periapical abscess?
wider apical PDL
radiolucency
symptoms of chronic periodontal abscess?
often none
signs of chronic periodontal abscess?
sinus
radiographic features of chronic perio abscess?
PAP (granuloma or cyst)
what is the common cause for periradicular/ periapical inflammation?
bacterial infection following pulpal death
when a non-vital tooth has periradicular periodontitis, what pathways can it follow?
acute or chronic lesions
(acute lesions can become chronic, chronic lesions can have acute flareups)
what is the acute symptom from periradicular periodontitis?
acute abscess
can be cellulitis or chronic abscess
what is the chronic symptom from periradicular periodontitis?
periapical granuloma
clinical features of acute periradicular periodontitis?
history of pain
grossly carious/ heavily restored tooth
previous trauma
little to see radiographically (unless acute exacerbation of chronic lesion)
what is the histopathology of acute periradicular periodontitis?
acute inflammatory changes:
- vascular dilation
- neutrophil infiltration
- tissue oedema
what is the key acute inflammatory cell?
neutrophil
treatment options for acute periradicular periodontitis?
XLA
endo
what can acute and chronic periradicular periodontitis lead to?
periapical abscess
clinical features of acute periapical abscess?
pain
swelling/ sinus
histopathology of acute periapical abscess?
central collection of pus with an adjacent zone of preserved neutrophils
surrounded by granulation tissue
treated options for acute periapical abscess?
drainage and XLA/ endo
clinical features of chronic periradicular periodontitis?
non-vital tooth, may be previous RCT
often minimal symptoms
apical radiolucent lesion may be evident on radiograph
histopathology of chronic periradicular periodontitis?
chronic inflammatory changes
lymphocytes and plasma cells
granulation tissue progresses to fibrosis
resorption of bone
treated options for chronic periradicular periodontitis?
XLA
endo
endo retreatment
periradicular surgery
what is a periapical granuloma?
mass of inflamed granulation tissue at the apex of a non-vital tooth
not a true granuloma
what can a periapical granuloma progress to?
an abscess
may undergo cystic change (radicular cyst)
clinical features of periapical granuloma?
as for chronic periradicular periodontitis - minimal
however
apical radiolucent lesion typically evident on radiograph
histopathology of periapical granuloma?
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
treatment options for periapical granuloma?
XLA
endo
endo retreatment
periradicular surgery
histopathology of pericoronitis?
acute and chronic inflammatory changes including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue
what type of cyst may arise in chronic pericoronitis?
paradental cyst
clinical features of pericoronitis?
pain
swelling/ tenderness of operculum
bad taste
trismus
treatment for pericoronitis?
irrigation
consider XLA of opposing tooth
antibiotics (if systemically unwell)
