Periapical Pathology

Question 1

Symptomatic Apical Periodontitis

Answer 1

First extension of plural inflammation into PA tissues

Question 2

Symptomatic Apical Periodontitis Irritants

Answer 2

Irreversible pulpitis –> inflammatory mediators
Bacterial toxins (from necrotic tooth)
Chemicals - NaOCl
Hyperocclusion - toot may still be vital, may be reversed
Overinstrumentation
Overextension of obturation material

Question 3

SAP symptoms and signs

Answer 3

Spontaneous Pain
Acute pain to percussion
Hot, Cold, Electric sensitivity (pulpitis)
May or may not respond to vitality tests
May or may not have PA radiolucency
Widened PDL
HISTO -- macrophages, PMNs
May have liquefaction necrosis

Question 4

SAP treatment

Answer 4

Vital – Remove irritant and monitor

Necrotic – RCT

Question 5

Asymptomatic Apical Periodontitis

Answer 5

Pulpal necrosis
Sequel to SAP
Chronic

Question 6

AAP signs and symptoms

Answer 6

Litte or no pain
No respose to vitality tests
Slightly senstive to palpation and perfusions
Wideneded PDL to extensive lesions

GRANULOMA
CYST

Question 7

AAP treatment

Answer 7

RCT

Extraction

Question 8

Condensing Osteitis

Answer 8

Variant of AAP

Most commonly the mandibular molar tooth

Question 9

Condensing osteitis Irritants

Answer 9

Persistant irritation to the pulp - AAP

Question 10

Condensing osteitis signs and symptoms

Answer 10

Increase in trabecular bone - Radiolucency

May or may not be painful

Question 11

Treatment for condensing osteitis

Answer 11

RCT

If not addressed it may become infected

Question 12

Idiopathic Osteosclerosis

Answer 12

Associated with fairly healthy teeth

Radiopaque lesions near the tooth apex

Question 13

Acute Apical Abscess

Answer 13

Abscess within a granuloma

Localized or diffuse liquidation of plural origin

Question 14

AAA signs and symptoms

Answer 14

RAPID ONSET - acute spontaneous pain
Moderate to sever discomfort
SWELLING
Purulence
Lymphadenopathy
** FEVER **
PA radiolucent
Varying degree of mobility

Question 15

AAA treatment

Answer 15

Antibiotics
Possible I&D
Eventually RCT

Question 16

Chronic Apical Abscess

Answer 16

Inflammatory lesion of plural origin - long standing

Question 17

CAA irritant

Answer 17

Necrotic Pulp

Question 18

CAA signs and symptoms

Answer 18

Assymptomatic
Not sensitive to biting
Feels different due to percussion
NO RESPONSE to pulp vitality testing
Apical radiolucency (LARGE)

MUCOSAL or FACIAL SINUS TRACT
(normal probing depths)

Question 19

CAA treatment

Answer 19

RCT