Pulpal and Periapical Disease Flashcards
What are three kinds of pulpitis?
1-Reversible Pulpitis
2-Irreversible Pulpitis
3-Chronic hyperplastic pulpitis
What are 3 periapical pathologies?
1-Periapical Granuloma
2-Apical Periodontal Cyst
3-Periapical Abscess
What are 3 possible sequelae of not treating periapical pathology?
1-Sinus Tract
2-Osteomyelitis (bone marrow inflammation)
3-Cellulitis (soft tissue plane infection)
What is the most common periapical pathology?
Periapical granuloma
*less common are apical periodontal cyst (rest of serres), Periapical abscess, periapical scar
What is the earliest change at the apex of the root with a periapical granuloma?
Widening of the PDL space at the apex
What are secondary acute inflammatory changes within a periapical granuloma called historically?
Phoenix abscess
What are 4 clinical presentations of a periapical granuloma?
1-Mostly asymptomatic
2-Tooth not typically mobile
3-Not sensitive to percussion
4-Does not respond to thermal or electric pulp test
What are 3 possible treatments for a periapical granuloma?
1-Conventional endodontic treatment
2-Surgical endodontic treatment
3-Extraction
What cells do you typically see histologically in an abscess?
Neutrophils
What are the three orientations of Apical Periodontal Cysts?
1-Classic pattern (centered on root tip)
2-Lateral Apical (apical 1/3 to the side of root)
3-Residual (edentulous space with radiolucency)
What are two other names for Apical Periodontal Cysts?
- Perioapical cyst
- Radicular cyst
A lumen with a spider web like appearance in the surrounding epithelium is typically of what?
Apical Periodontal Cyst
The accumulation of acute inflammatory cells at the apex of a nonmetal tooth that gets worse with time is called what?
Periapical Abscess
*Lots of Neutrophils
A defect created by periapical inflammatory lesions that fills with collagenous CT is called what?
Periapical Scar
What is granulation tissue made up of?
Inflammatory cells, blood vessels and collagen
What is it called when an inflamed pulp grows out of the tooth?
Chronic Hyperplastic pulpitis
Granulation tissue growing out of an extraction site is called what?
Epulis Granulomatosa
*may be metastatic cancer if it is not granulation tissue
What are the 4 main sequelae of Periapical Pathology?
1-Sinus tract
2-Ostemyelitis
3-Cellulitis (Ludwig’s Angina and Cavernous sinus thrombosis)
4-Condensing Osteitis
A periapical abscess with pus that dissects through bone into soft tissue following the path of least resistance is called what?
Sinus Tract
*Has a point of exit to drain purulent material
Also called a parulis or gum boil, what marks the exit point of a sinus tract on the oral mucosa?
Intraoral Sinus Tract
Typically an enlarged external nodular mass, what lesion is more commonly found with mandibular teeth?
Cutaneous Sinus tract
*Red, yellow, white or purple
Acute or chronic inflammation of the bone, usually due to bacterial infection is called what?
Osteomyelitis
*Actue infection does not produce Xray changes
What is a sequestra?
Infected bone
What is an involucrum?
Fragments of necrotic bone that become surrounded by new, vital bone
When purulence perforates the cortex and spreads through overlying soft tissue it is called?
Cellulitis
What are the two dangerous types of cellulitis associated with dentistry?
1-Ludwigs Angina
2-Cavernous Sinus thrombosis
Deadly cellulitis of the submandibular region resulting in “woody tongue”(sublingual space) and “bull neck”(submandibular space) is called?
Ludwig’s Angina
*Obvious pus collections are not present
What are 4 treatments for Ludwig’s Angina?
1-Maintenance of the airway
2-Incision and drainage
3-Antibiotic therapy
4-Elimation of infection source
What typically results from an abscess of Maxillary anterior (most often Canine) and is an edematous periorbital enlargement?
Cavernous Sinus Thrombosis
*Also may have swelling along the lateral border of the nose
What is the typical treatment for Cavernous Sinus Thrombosis?
Surgical drainage and High dose antibiotics
What are 6 possible sequelae for Cavernous Sinus Thrombosis?
1-Protrusion and fixation of eyeball 2-Pupil dilation with photophobia 3-Excessive lacrimation 4-Loss of sight in involved eye 5-Meningitis 6-Brain Abscess
Also known as focal sclerosing osteomyelitis, what is a localized area of bone sclerosis associated with the apices of teeth with pulpitis called?
Condensing Osteitis
*Associated inflammation is critical. Residual areas are called bone scars
Though Condensing Osteitis appears similar to idiopathic osteosclerosis, what distinguishes it?
The radiopaque region is not separated form the apex
