Periapical periodontitis

Question 1

Describe periapical periodontitis

Answer 1

Inflammation of periodontal ligament + other tissues around apex of the tooth

Question 2

Causes of periapical periodontitis

Answer 2

• spread of infection following death of the pulp
• extrusion of antiseptics through apex during RCT
• high filling or biting on something hard cause cause acute periapical periodontitis

Question 3

Clinical findings of acute periapical periodontitis
where is infection?
what can 2 things can develop?
is tooth vital?
what can develop if inflammation worsens

Answer 3

• infection usually localised (tender to touch)
• abscess can develop
• face swelling
• tooth not vital (not responding to vitality test)
• as inflammation more severe - intense throbbing pain

Question 4

Radiology of acute periapical periodontitis

Answer 4

bone resorption not had time so may only show widening of periodontal ligament space

Question 5

Pathology of acute periapical periodontitis

Answer 5

acute inflammation

Question 6

Management of acute periapical periodontitis

Answer 6

• RCT
• Extraction
• open drainage through skin/mouth if abscess causing swelling

Question 7

Acute > …….. ……. = ………… or ……….. ……

Answer 7

alveolar abscess
cellulitis
draining sinus

Question 8

Chronic > ………… ………… = …….. ……… or ……… …….. …………

Answer 8

periapical granuloma
radicular cyst
focal sclerosing osteitis (rarley)

Question 9

Clinical findings of chronic periapical periodontitis

List 4

Answer 9

• Low grade infection
• may follow acute periapical periodontitis
• tooth not vital
• minimal symptoms

Question 10

Radiology of chronic peripical periodontitis

Answer 10

often radiolucency found

Question 11

Pathology of chronic periapical periodontitis

Answer 11

chronic inflammation and granulation tissue at apex of tooth

Question 12

Sequelae of chronic periapical periodontitis

aftermath of periodontitis

Answer 12

• periapical granuloma and in some cases radicular cyst
• acute exacerbation with abscess, cellulitis + sinus formation
• rarely focal sclerosis osteitis (abnormal bone growth/lesions)

Question 13

Treatment of chronic periapical periodontitis

Answer 13

• RCT
• Extraction
• radicular cyst may need to be enucleated

Question 14

4 factors of periapical granuloma

• symptoms?
• history of?
• tooth vital?

Answer 14

• most asymptomatic
• may have history of pulpitis - therefore may be symptomatic
• tooth NOT vital - will not respond to vitality tests

Question 15

Radiographic features of periapical granulomas

Answer 15

• 75% of apical inflammatory lesions
• can be discovered on radiographs
• tooth shows loss of apical lamina dura
• radiolucency - bone resorption

Question 16

Pathology of periapical granuloma

Answer 16

• chronically inflamed granulation tissue at apex of non-vital tooth
• defensive reaction secondary to the presence of bacteria in the root canal with spread of related toxins into the apical zone

Question 17

Pathology of periapical granuloma
what type of tissue?
What type of cells?
Bone?

Answer 17

• granulation tissue
• neutrophils, lymphocytes, plasma cells, histiocytes, multi-nucleated giant cells
• bone resorption

Question 18

What may a periapical granuloma arise after?

Answer 18

periapical abscess