PMI03-2019 Flashcards
What is periapical periodontitis?
Inflammation of PDL and other tissues around the tooth apex
What may cause periapical periodontitis?
Usually due to spread of infection from apical foramen following pulp necrosis
Extrusion of antiseptics through apex during RCT
High fillings or biting suddenly on a hard object causes acute and transient PA periodontitis
What clinical findings would lead to a diagnosis of acute periapical periodontitis?
History of pulpitis
Small amount of tooth extrusion - escape of exudate into PDL
Pain well localised and TTP - no longer confined to pulp
Tooth not vital/sensible unless pulpal necrosis limited to one canal in a multirooted tooth
Progression of inflammation may cause intense throbbing pain
Abscess may develop
Can spread in tissue planes causing facial swelling
Rarely local lymphadenopathy and very rarely osteomyelitis of cellulitis
What radiological finding would lead to a diagnosis of acute periapical periodontitis?
Widening of PDL space apically (not enough time for bone resorption yet)
How would you manage acute periapical periodontitis?
Endodontic treatment
Extraction
Open drainage if abscess is causing swelling
What clinical findings would lead to a diagnosis of chronic periapical periodontitis?
Low-grade infection
May follow acute periapical periodontitis
Tooth is not vital/sensible unless pulpal necrosis limited to one canal in a multirooted tooth (rarely)
Minimal symptoms
Can be tender to percussion
What radiological findings would lead to a diagnosis of chronic periapical periodontitis?
Periapical radiolucency
What are the possible sequelae that may arise following chronic periapical periodontitis?
Periapical granuloma –> radicular cyst
Acute exacerbation may result in an abscess, cellulitis and draining sinus tract formation
Very rarely focal sclerosing osteitis
How would you treat chronic periapical periodontitis?
Endodontic treatment
Extraction
Radicular cyst may need to be enucleated
What can be the confusion with periapical granulomas?
Misnamed = actually chronically inflamed granulation tissue at apex, not true granulomatous inflammation
What clinical findings may indicate periapical granuloma?
Most are asymptomatic
May have a history of pulpitis and can have co-existing pulpitis
Tooth is not vital unless pulpal necrosis limited to a single canal in a multirooted tooth
What is the pathology of periapical granulomas
Defensive reaction, secondary to presence of bacteria in root canal (toxins spread to apical tissues)
Chronically inflamed granulation tissue
Neutrophils, lymphocytes, plasma cells, histiocytes, multinucleated giant cells
Cholesterol clefts and haemosiderin (RBC breakdown, brown)
Small foci of acute inflammation with focal abscess formation may be seen
Surrounding fibrous wall
Bone resorption (tooth can also be resorbed but is more resistant than bone)
What radiographic findings may indicate a periapical granuloma?
75% of apical inflammatory lesions
Loss of lamina dura
Apical bone resorption = circumscribed or ill-defined radiolucency
Rarely root resorption
Variable size - can be as small as 2cm, large lesions may be cysts but cannot distinguish based on size alone
What is an apical scar?
Rare defect created by periapical inflammatory lesions which heal by fibrosis rather than bone deposition
Occur most frequently when both facial and lingual cortical plates have been lost
What may arise after a periapical abscess?
Periapical granuloma
Cellulitis
Draining sinus
