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BDS3 Oral Pathology > Periapical lesions - chronic > Flashcards

Periapical lesions - chronic Flashcards

1
Q

Another name for chronic periapical periodontitis?

A

Periapical granuloma

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2
Q

Why is chronic pp also called periapical granuloma?

A

Inflammation becomes confined in the shape of a granuloma

Replacement with granulation tissue (incl. bone and periodontal tissue)

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3
Q

When is periapical periodontitis defined as chronic?

A

Persistent irritation

Resorption of bone

Replacement with granulation tissue (incl. bone and periodontal tissue)

Collagen fibres surrounding granuloma

Granuloma attached to the tooth via capsule

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4
Q

Is the granuloma well localised?

A

Yes - contained a capsule

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5
Q

What is the contents of a periapical granuloma?

A

Granulation tissu e

Lymphocytes (T dominant), plasma cells and macrophages

Chlesterol crystals and haemosiderin deposits

Giant cells

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6
Q

What lymphocyte is most common in the periapical granuloma?

A

T cells

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7
Q

Why are there cholesterol clefts?

A

Due to breakdown of lists of cells

Cells have a cell membrane and thee are lots of cholesterol in the cell membrane - when cells breakdown, cholesterol is left

Cholesterol is made of fat, when you prepare the tissues you are left with cholesterol clefts

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8
Q

What are cholesterol clefts associated with?

A

Giant cells try to eat the cholesterol

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9
Q

What appears as brown deposits?

A

Haemosiderin deposits

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10
Q

What are haemosiderin deposits?

A

From the breakdown of RBCs

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11
Q

What are cells rests of malassez remenants of?

A

Hertwigs epithelial rot sheath (rot formation)

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12
Q

How does the granuloma attach to teh root?

A

Fibrous tissues anchors it

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13
Q

What structure can form into cysts?

A

Cell rests of malassez

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14
Q

What is shown here?

A

Anastomosing cords arranged inn oops and arcades

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15
Q

Clinical presentation of chronic periapical periodontitis?

A

Asymptomatic

Occasional pain upon tooth palpitation and percussion

Percussion produces a dull note due to the lack of resonance - cushioned by granuloma

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16
Q

What is shown in this PA?

A

Periapical radiolucency showing late stages of PP

17
Q

How does the early stages of periapical periodontistis appear on a radiograph?

A

Winding of the periodontal ligament

18
Q

Why is there variation in the periapical radiolucency?

A

Different appearance of the borders due to the difference in cellular activity

Sometimes well defined and sometime poorly defined - depends on stage of disease and activity of cells (resorption still going?)

19
Q

What has occurred i this PA?

A

Resorption of root as well as PP

Chronic periapical period it’s scan cause bone and root resorption

20
Q

What happens if you do not treat chronic periapical periodontitis?

A

The granuloma remains as it is

Enlargement of granuloma

Infection of granuloma

Acute abscess formation

Chronic abscess formation (can be either)

Radicular cysts formation

Osteosclerosis

Hypercementosis

Bone and/or root resorption

21
Q

What has formed here?

A

Abscess formation - pt in pain

22
Q

What is shown here?

A

Radicular cysts formation - consequence of chronic periapical periodontitis - where the granuloma use to be

23
Q

What is shown here?

A

Osteosclerosis

24
Q

What is shown here?

A

Hypercementosis - activation of odontoblasts

25
Q

What can Hypercementosis lead to?

A

Fusion to bone

Ankylosed / ankylosis

26
Q

Clinical presentation of an acute periapical abscess?

A

Rapid onset pain

Redness and swelling of adjacent soft tissues

Tenderness to percussion

Tooth mobility

27
Q

Cause of acute periapical abscess?

A

May develop from acute periapical periodontitis

More commonly develops from a periapical granuloma - longstanding periodontistsis

28
Q

Once pus has formed in the abscess, what are the routes the pus can spread?

A

May drain though the root canal

May drain into the gingival sulcus

Track formation trough cancellous bone leading to cortex perforation (buccal most common)

Lateral maxillary incisors and palatal roots drain palatally

Pus might form a subperiosteal abscess

Perforation of the periosteum and more track formation

Location of the perforation depends on anatomy

29
Q

Describe the route of pus through bone?

A

Move into cancellous bone (spongy)

Perforates cortical bone and cause sinus

Can drain into oral cavity

Intraorally or intraorally

30
Q

What side if the cortex perforation usually?

A

Buccally

Palatal roots or anterior teeth will drain lingual or palatally

31
Q

What happens when pus drains into the buccal cortical plate above or elbow the buccinator muscle?

A

Spread of the infection into the facial soft tissues

  • cellulitis
  • soft tissue abscesses that may further track into the skin surface
  • associated with scarring and fibrosis
32
Q

Why is this pt face swollen?

A

Maxillary abscess

33
Q

Where can maxillary molars pus drain into?

A

Maxillary sinus

Sinusitis

34
Q

What happens if you do not treat the abscess?

A

Lead to cellulitis - spread of infection and inflammation through facial tissues - not well localised - spreads all over

Pain

Fever

35
Q

Where can cellulitis lead to when maxillary teeth affected?

A

Extends towards the eye poses the risk cavernous sinus thrombosis

Upper half of face swollen

36
Q

Where can cellulitis lead to when mandibular teeth are affected?

A

Lower half of face swollen

Extension into the submandibular and cervical tissue may lad t respiratory stress

Involvement of deep spaces presents with Pain and trismus rather than facial swelling

37
Q

What is the worst consqunece of not treating an abscess?

A

Ludwig’s angina

Severe cellulitis

38
Q

What does ludwig’s angina involve?

A

Submandibular, sublingual and submental spaces

39
Q

What are the clinical manifestations of ludwig’s angina?

A

Swelling of flor of the mouth

Elevation and posterior displacement of the tongue

Difficulty in eating, swallowing and breathing

Breathing is further distressed if the infection involves the pharynx and larynx

Oedema of the epiglottis poses the risk of suffocation

BDS3 Oral Pathology (31 decks)

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