OS- Pulp and periapical disease Flashcards
What is a granuloma?
Giant cells formed by the fusion of epithelial macrophages together during chronic inflammation.
These can destroy soft tissue throught the production of MMPs, Reactive Oxygen species and reactive Nitrogen species.
Compare an apical cyst to an infected apical cyst in terms of pain .
An apical cyst is painless but can result in pain (e.g. due to it’s location)
An infected apical cyst causes pain.
What is the other name for pulp hyperaemia?
Reversible pulpitis.
List the clinical symptoms of pulp hyperaemia?
- Pain lasting for a few seconds
- Pain on hot and cold
- Pain killers work
- Pain resolves after the stimulus
- There is caries approaching the pulp but the tooth can still be restored without treating the pulp
- There is still a blood supply to the tooth.
List the clinical symptoms for acute pulpitis?
- Constant pain
- Pain killers not working
- Keeping patient up at night
- Rection to thermal stimuli
- Poorly localised pain
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Why is an exposed acute pulpitis less painful than a closed off one?
If the pulp is exposed there is relief of the pressure in the root canal. This reduces the pain compared to a closed off lesion.
How can we diagnose acute pulpitis using special tests ?
- negative TTP
- Numb the patient up beside the tooth and see if the pain goes away
- Radiographs
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How do we diagnose acute periodontitis?
- Radiographs:
- Widening of periodontal space
- Loss of lamina dura
- Radiolucency
- Non vital tooth
- Tenderness to percussion
- Increase in mobility.
How do we diagnose traumatic periodontitis?
- Clinical examination of the occlusion
- Functional positioning (may have funny habits)
- Posturing
- Tender to perucssion
- Normal vitality
- Radiographs- can show generalised widening of the PDL space.
What can cause traumatic periodontitis?
Parafunction
How do we treat traumatic periodontitis?
- Gumshield
- Occlusal adjustment- restoration may be too high.
List the symptoms of an abscess.
Severe unremitting pain
Acute tenderness in function
Acute tenderness on percussion.
What is sialadentitis?
Infection of the salivary gland causng pus pouring out of the ducts.
List the 5 cardinal signs of inflammation.
Redness
Swelling
Pain
Heat.
Loss of function.
Explain the pain caused by an abscess.
- Abscess perforates through bone
- Pain reduces (initial relief of pressure)
- The redness/ swelling builds up.
- Increased swelling causes more pain.
- Initial reduction in the tenderness to percussion of the tooth as pus escapes into the soft tissues.
What variables affect the site of swelling of an acute apical abscess:
- Position of tooth in the arch
- Root length
- Muscle attachment.
How do we treat an abscess?
- Drain it
- Soft tissue incision intraorally
- Soft tissue incision extraorally
- Treat the cause
- Pulp extirpation
- Extraction
- Peri-radicular surgery.
What do we consider for the assessment of the need of antibiotics?
- Severity- is patient becoming systemically unwell
- Has adequate drainage been achieved?
- Local factors
- Compromising the airway
- Dysphagia- difficulty swallowing
- Trismus- impacted mouth opening
- Lymphadenitis
- Location- has it spread to the floor of the mouth?
- Patient’s medical conditions (immunocompromised/diabetes/elderly)
Describe how a granuloma can undergo cystic change?
If the source of infection isn’t cleaned up,
the toxins stimulate the rests of mallassez to undergo and proliferate causing the granuloma to grow outwards.
Overtime- it will outgrow the nutrient supply forming a central area of necrosis (cavity) and fluid is drawn in- causing the cyst.
