Pulp and Periapical Disease Exam 2 Flashcards
What is pulpitis ?
Starts w/ an injury to the tooth
What are the most common bacteria in pulpititis?
- Mutans group streptococci
- Streptococcus mutans and streptococcus sobrinus
What is the pulp ?
- Connective tiisue that reacts to injury with inflammatory response
Accessory canals may lead to inflammation on the lateral portion of the root
What causes a pulpitis ?
- Caries (PRIMAY CAUSE)
- Cracks in corwn or root
- Periodontal pockets
- Trauma from blows
- Bruxism, abrasion, erosion
- Latrogenic
What is Reversible Pulpitis and what is its treatment ?
- Tooth is asymptomatic unless stimulated
- Pain sharp and intense 5-10 min
- Temp changes
- Treatment: protect pulp from further thermal stimulation
What is irreversible pulpitis?
- Spontaneous Pain lasting 20 min
- Pulpal tissue exhibits acute and chronic inflammatory changes
- Less intense pain as granulation tissue replaces pulp during healing
- Pain may become initiated or worsen when PT lays down
- Difficult to know which tooth
Treatment: Root canal or extraction
What is acute pulpitis?
Result of rapid bacterial invasion (mostly in kids)
No drainage
What is chronic pulpitis?
- Usually the result of chronic, loawgrade irritant.
- Reparative dentin acts as a barrier
What is Pulpal Necrosis?
- Pulp tissue no longer living
- result from sudden trauma in blood supplyy is severed
- Result of untreated pulpitis
- Tissue being replaced by granulation tissue
- First sign tooth discoloration
- asymptomatic
What are the common diagnostic techniques?
- History and nature of pain
- Reaction to thermal
- Reactionn to electrical stimulation
- REaction to percussion
- Radiographic examination
- Visual exam
What is chronic hyperplastic pulpitis?
Rare condition seen in childrens molars
Result of rampant acute caries
Crown disintegrates before the pulp
Also known as Pulp polyp
What is a periapical lesions?
Lesions that forms depends on:
virulence of microorganis,
Extent of sclerosis of dentinal tubules,
Host immune response
What are the factors for a chronic pulpitis ?
Low virulence bacteria
Older tooth with sclerotic dentin
Healthy patient= mild, chronic symps, healing= granulation tissue, scare tissue and dense bone
What are the factors for acute pulpitis?
- Virulent bacteria, young tooth with open dentinual tubles = rapid intense destruction
What are common lesions follwoing pulpitis?
- Periapical granuloma
- Periapical cyst
- Periapical abscess
- Osteomyelitis
- Cellulitis
What is the map for chronic?
Chronic apical periodontitis –> Periapricall granuloma —> Periapical cyst
What is the map for actue?
Periapical abscess –> Osteomyelitis –> Chronic osteromyelitis, cellulitis, Garre osteomyelitis
What lesions can turn into each other?
Abscess (Pus), Cyst (epithellial lining) and Granuloma (Granulation tissue)
What is a periapical abscess?
initial lesion that develops when acute pulpitis extends into adjacent tissue
- Can have elevated temperature and malaise
- Tooth extruded in the socket, great pain, elevated temo, malaise, swelling and redness at apex
- Pus seeks drainage along the path of least resistance
- Treatment: incise and drain, antibiotics then extraction/root canal
What is a periapical Granuloma?
- Most common lesion that occurs after necrosis
- Occurs as chronic pulpitis progresses into the periapical region
- can show slight vitality with pul test
- widened PDL
- Pulp now consists with granulation and dense fibrous
Treatment: Root canal, apioectomy or extraction
What is periapical cyst ?
Common development in a long-standing untreated periapcal granuloma
* Stimulated by low grade inflammation
* Develops continously intil it destroys large portion of alveolar bone
*Treatment: Surgical removal
What is osteomyelitis?
An inflammatory process within trabecular bone
** Most commonly caused by direct extension of an untreated periapical abscess
Treatmet: radiation therapy to the head
What is acute osteomyelitis?
- Severe pain
- Elevated temp
- Lympnadenopathy
- Island of dead bone surronded by purluent exudate
What is Chronic Osteomyleitis?
- Occurs in response to low grade inflammatory process
- osteocytes stimulate dense trabecular bone
- Little to no pain
What are the two types of chronic osteomyelitis?
Sclerosing osteomyelitis
Garre Osteomyelitis
Who does Garre osteomyelitis occur in ?
Children as a hyperplastic reaction to chronic osteomyelitis
What are the treatments for Sclerosing and Garre OSteomyelitis?
Sclerosing- none, dense bone remians
Garre- Reverts to normal after source eliminated
What is Cellulitis?
- Painful swelling of head and face
- Enzymes exudate bacteria break decrease fascia surrounding muscle bundles allows exudate to spread and cavise swelling
What is the cause of cellulitis?
- spread of purelent exudate along fascial planes
- Extension of periapical abscess into soft tissue
What is the symptoms of cellulitis?
- Pain
- Increase temp
- Malase
- Lymphadenopathy
What are the resulting conditions for cellulitis
- Pulp Stones- often in chronic pulpitis
- No pain/clinical signifance
- No tx necessary
- maxillary involvement: spread to eye and brain
- Luduig angina- spread to FOM and Neck= suffocation
What are the different types of resorption ?
Types: external and internal
What is external resorption ?
Loss of structure that begin on outside
caused by : pressure form tumors, cysts, occlusal/mechaniacal forces, impaction
What is the internal resorption ?
- Begins within pulp
What are root fractures?
- Tooth=brittle (after root canal)
- More prone to fracture
What is pericontitis?
Inflammation of mucosa around partially erupted tooth- mand 3rd=most common
-operculum: Tissue flap
Tx: Irrigate
Antibitoics
Extraction
Trim operculum
What is Alveolar osteoitis ?
“Dry socket”
post op complication of tooth extraction
clot lost by healed
raw denuded bone=exposed
What are the symptoms of alveolar osteoitis?
Very painful
Bad odor/taste
not an infection
What are facial disturances ?
- Failure of palatine process to fuse w/ premaxilla= cleft
What are the different Soft tissue abnormalities?
- Lip pits
- Double lip
What are the different abnormalities of the tongue ?
- Ankyloglossia
- Macroglossia
- Bifid tongue
- Median rhomboid glossitis
- Fissured tongue
- Erythema migrans
- Hairl tongue
What are the abnormalities of the teeth?
Anodonta
Hypodontia/oligontia
Supernumerary–> mesiodens
What are the abnormalities of the size of teeth?
Microdontia
