periapical tissues

Question 1

what causes symptomatic periapical periodontitis

Answer 1

Inflammation of periradicular/periapical tissues caused by bacteria and their toxins in the root canal space exiting the root canal system.
Pulp-necrotic/irreversibly inflamed

Question 2

what are signs and symptoms of symptomatic periapical periodontitis

Answer 2

Discomfort to biting/chewing
Sensitivity to percussion
Palpation may cause sensitive result
Sensibility testing depends if pulp necrotic/inflamed.

Question 3

how is symptomatic periapical periodontitis seen radiographically?

Answer 3

PDL may appear normal and lamina dura intact or widened/radiolucent
Inflammatory cells,PMN seen clustered around the apex of non vital tooth spreading to bone.

Question 4

describe acute periapical abscess and their cause

Answer 4

Abscess due to infection of root canal

Cause: bacteria have progressed into periradicular tissues and immune response can’t defend against invasion.

Question 5

what are the signs and symptoms of acute periapical abscess

Answer 5

Rapid onset
Pain 
Pus
Mobility (hyper occlusion)
Systemic involvement 
Swelling 
Localised/diffuse 
Fluctuant/ non fluctuant

Question 6

how would an acute periapical abscess appear radiographically

Answer 6

PDL space: normal/widened/radiolucent (periapical)

2 weeks for bony destruction to be evident

Question 7

how would you treat an acute periapical abscess

Answer 7

drainage through canal/incision in soft tissue
RCT
Extraction

Question 8

describe a chronic periapical abscess

Answer 8

Inflammatory reaction to pulpal infection and necrosis characterised by gradual onset, little to no discomfort and intermittent discharge through an associated sinus tract.

Clinically 
Asymptomatic 
Percussion and palpation- non sensitive 
Sensibility test non responsive 
Radiograph- radiolucent area on bone.

Question 9

describe condensing osteitis

Answer 9

Periapical inflammatory disease that results from a reaction to a dental related infection.

Cause
Low grade chronic inflammation i.e necrotic pulp, restoration or crack
Inflammation causes bone production- sclerotic reaction
Results from good patient immunity and low grade irritation.

Radiograph- periapical radiopacity

Tx: treat cause/RCT

Question 10

describe clinical testing

Answer 10

Pulp testing- hot, cold, electric
Periapical tests- percussion, palpation, tooths slooths
Radiographs- periapicals
Additional- selective anesthesia, cavity test