Periapical pathology Test #2 Flashcards
What changes occur in the periapical tissues as a consequence of pulpal necrosis?
-Pathological
The interaction between the pulpal irritants and the host defense results in what?
-Activation of an extensive array of reactions to protect the host
What does resorption prevent in periapical pathology?
-Osteomyelitis
The reactions in periapical pathology are complex and usually mediated by what?
- Nonspecific mediators of inflammation
- Specific immune reactions
What are some inflammatory mediators?
- Vasodilation
- Increase vascular permeability
- Recruit inflammatory cells from blood ciruclation
What does SAP stand for?
-Symptomatic apical periodontitis
What does AAP stand for?
-Asymptomatic apical periodontitis
What does AAA stand for?
-Acute apical abcess
What does CAA stand for?
-Chronic apical abcess
In SAP the first extension of pulpal inflammation goes where?
-Periradicular tissues
What are the irritants that cause SAP?
- Inflammatory mediators from irreversible pulpitis
- Bacterial toxins from necrotic pulp
- Chemicals
- Hyperocclusion
- Overistrumentation
- Overextension of obturation material
What is liquefactive necrosis?
Pus
What are the signs and symptoms of SAP?
- Spontaneous pain
- Acute pain to biting or percussion
- Hot, cold or electric sensitivity
- May or may not respond to pulp vitality tests
- May or may not have PA radiolucency
- Widened (thickened) PDL
- PMNs/macrophages
- Liquefaction necrosis
What is the treatment for SAP that is vital?
- Remove irritant (reduce occlusion, time)
- RCT
What is the treatment for necrotic SAP?
-RCT
What causes AAP?
-Pulpal necrosis
What is AAP a sequel to?
-SAP
Is AAP chronic or acute?
-Chronic
T/F AAP is generally asymptomatic
True
What are the signs and symptoms of AAP?
- Little or no pain
- No response to pulp vitality tests
- Slightly sensitive to palpations
- Widened PDL to extensive lesion
- Granuloma
- Apical cyst
What is an apical cyst?
-Stratified squamous epithelium surrounded by CT containing all cellular components found in granuloma
What do you see in a granuloma?
- PMNs
- Mast cells
- Macrophages
- No epithelium
What percent of AAP signs are granulomas?
-59%
What percent of AAP signs are cysts?
-22%
What signs of AAP are scars?
12%
What is the treatment of AAP?
-Remove cause by RCT or extraction
What is a variant of AAP?
-Condensing osteitis
What type of bone do you get an increase of in condensing osteitis?
-Trabecular bone
T/F Condensing osteitis usually goes away following RCT
True
What causes AAA?
-Localized or diffuse liquefaction lesion of pulpal origin
What does AAA destroy?
-Periapical tissues
What type of pulp do you see with AAA?
-Necrotic
What is an abscess within a granuloma associated with?
AAA
What are the signs and symptoms of AAA?
- Rapid onset of acute spontaneous pain to percussion, biting, and palpation
- Moderate to sever discomfort and swelling
- Pus
- Surrounding the abscess is granulomatous tissue
- Lymphadenophy
- Periapical radiolucency
- No response to pulp vitality tests
- Varying degree of mobility
- Frequently febrile
What is the treatment of AAA?
- RCT eventually’
- Possible incision and drainage
What is the cause if CAA?
-Inflammatory lesion of pulpal origin
What do you see in the histology of CAA?
-Same as AAA
What are the signs and symptoms of CAA?
- Generally asymptomatic
- Not sensitive to biting
- May feel different to percussion
- No response to pulp vitality tests
- Apical radiolucency
- Mucosal or facial sinus tract (they will have some kind of intra or extra oral draining sinus tract)
What periapical pathology will have some kind of intra or extra oral draining sinus tract?
-CAA
What is the most common cuase of the intermittently suppurating cutaneous sinus tract in the face and neck?
-Chronic dental infection
What is the treatment for CAA?
-RCT
What pulpal pathologies do you do RCT on?
- Hyperplastic pulp
- Irreversible pulpitis
- Necrotic pulp
- SAP
- AAP
- AAA
- CAA
- Condensing osteitis
