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DENT 317 - Oral Pathology > Pulpal and Periapical Diseases > Flashcards

Pulpal and Periapical Diseases Flashcards

1
Q

8 tests available to determine origin of pain

A
  • Clinical examination - visual, explorer, trans illumination
  • Electric Pulp Tester
  • Cold Test - Ice / Ethyl Chloride / Endo Ice
  • Hot test - Gutta percha
  • Percussion/ bite “tooth sleuth”
  • Palpation of the alveolus
  • Cavity Test
  • Imaging (radiographs, CBCT)
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2
Q

4 potential causes of pulpitis

A
  • Bacterial infection (caries)
  • Mechanical damage - removal of dentin too close to pulp
  • Thermal injury - inadequate water-air spray
  • Chemical irritation - disinfectants or toxic fluids
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3
Q

Define reversible pulpitis

A

A clinical diagnosis involving reversible inflammation of the pulp

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4
Q

Define symptomatic irreverible pulpitis

A

A clinical diagnosis indicating that the vital inflamed pulp is incapable of healing

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5
Q

Define aymptomatic irreversible pulpitis

A

A clniical diagnosis indicating that the vital inflamed pulp is incapable of healing

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6
Q

7 signs and symptoms of reversible pulpitis

A
  • Sudden mild to moderate pain of short duration (subsides within seconds after removal of the stimulus)
  • Different from dentinal sensitivity (ICE CREAM)
  • Usually in response to cold or sweet but sometimes heat
  • Does not occur spontaneously
  • Not worse when lying down
  • Mild increase in sensitivty to electric pulp tester
  • NO increased mobiltiy or sensitivity to percussion
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7
Q

Treatment for reversible pulpitis

A

Remove the source of irritation

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8
Q

8 signs and symptoms of irreversible pulpitis

A
  • Sharp severe pain to heat that continues after removal of stimulus
  • Cold, heat, sweet or acidic foods cause pain
  • Spontaneous pain
  • Usually lasts longer than 20 min
  • Worse when lying down
  • May be difficult to localize, pain may be referred to other teeth
  • Throbbing pressure late, heat worsens but cold may produce relief
  • No pain to percussion
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9
Q

2 treatment options for irreversible pulpitis

A
  • Removal of pulp (RCT)
  • Extraction
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10
Q

Define periapical granuloma

A

Mass of chronically inflamed granulation tissue at apex of a non-vital tooth (usually asymptomatic). Not a true granuloma. Chronic inflammation surrounded by fibrous connective tissue

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11
Q

Cause of periapical granuloma

A

Bacteria in the root canal system liberate toxins in the apical region from a dead (non-vital) tooth. May be associated with an endodontically treated tooth if there is no apical seal

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12
Q

Radiographic appearance of periapical granuloma

A

Rarefying osteitis - focal loss of bone –> well-defined periapical radiolucency

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13
Q

5 treatment options for pericapical granuloma

A
  • Eliminate offending microorganisms
  • Antibiotics not usually indicated unless systemic symptoms
  • RCT or retreatment of root canal
  • Extraction if tooth cannot be restored
  • Periapical surgery with biopsy and retrograde fill if retreatment fails or a post + core that cannot be removed are in place
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14
Q

4 characteristics of periapical (radicular) cyst

A
  • Usually asymptomatic unless acutely inflamed
  • Non vital tooth
  • Well-defined periapical radiolucency
  • Loss of lamina dura
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15
Q

Define periapical abscess

A

Accumulation of acute inflammatory cells at apex of a non-vital tooth. May be symptomatic or asymptomatic. Tooth usually sensitive to percussion

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16
Q

Cause of periapical abscess

A

May arise de-nova from non-vital tooth or from a pre-existing periapical granuloma or periapical cyst

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17
Q

Results of tests on tooth with periapical abscess

A
  • Usually sensitive to percussion
  • No response to cold
  • No response to electric pulp tester
  • No response to a test cavity (use high speed bur without LA)
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18
Q

Symptoms of periapical abscess

A
  • Asymptomatic if pus can drain from site
  • Headache
  • Malaise
  • Fever
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19
Q

Radiographic appearance of periapical abscess

A

Widening of periodontal ligament space or ill-defined radiolucency. If very early, no radiographic changes detectable

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20
Q

Define parulis

A

A sessile papule on the gingiva at the site where a draining sinus tract reaches the surface (gum boil)

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21
Q

Define sinus tract

A

A drainage pathway from a deep focus of infection to an opening on the surface

22
Q

Define fistula

A

A drainage pathway between two epithelium lined surfaces (oro-antral fistula)

23
Q

Biopsy results of parulis

A

Acutely inflamed granulation tissue

24
Q

Management of parulis

A
  • Treat source of infection or else would reoccur
  • Gutta percha point may be used to tract the origin of a fistula
25
Q

Define cellulitis

A
  • Spread of infection into soft tissues. Usually requires hospitalization
  • Acute and diffuse infection of soft tissu, usually resulting from the extension of a periapical abscess
  • Diffuse spreading of purulent exudate along fascial planes that separate the muscle bundles
26
Q

Evaluation of patient with cellulitis

A
  • Always ask if patient can swallow (fluids or pills)
  • Always ask if there is any difficulty breathing
  • Always evaluate for any change in level of consciousness
  • Evaluate fever - is patient toxic
27
Q

Treatment of patient with cellulitis

A
  • Not localized, therefore incision and drainage will not liberate pus – a small amount of bloody fluid may drain from the site
  • Incision and drainage in soft tissues or through tooth (source of infection must be removed - pulpectomy or extraction)
  • Antibiotics - first line = penicillin or clindamycin
  • Fluid replacement / maintain patent airway
  • Patient should improve in the next 12 - 24 hours - if worse, IV abx may be necessary (microbiology - culture and sensitivity)

NOTE: no treatment = potential death

28
Q

Define Ludwig’s angina

A

Cellulitis involving fascial spaces between muscles and other structures of the posterior floor of mouth which may compromise the airway. Patient should be admitted to hospital

29
Q

Potential consequence of thrombophlebitis of the cavernous sinus

A

Brain abscess and death

30
Q

Define osteomyelitis

A

Inflammation involving marrow spaces and medullary bone. Most commonly caused by an extension of an untreated periapical abscess. More common in mandible vs. maxilla (more vascular)

31
Q

Biopsy results of acute osteomyelitis

A

Necrotic (non-vital bone) associated with neutrophils.

NOTE: bacterial colonies may be present on the surface of bone. Sequestrum formation. Diagnosis requires clinical correlation. Radiogrpahic correlation and Gallium scan may be helpful

32
Q

4 predisposing factors for osteomyelitis

A
  • Bone disease (i.e. osteoporosis)
  • Bone lesions (i.e. Florrid osseous dysplasia)
  • Radiotherapy of bone secondary to treatment of a malignancy (osteoradionecrosis)
  • Immunocompromised patient
33
Q

5 types of osteomyelitis

A
  • Acute suppurative osteomyelitis
  • Chronic suppurative osteomyelitis
  • Diffuse sclerosing osteomyelitis
  • Condensing osteitis (focal sclerosing osteomyelitis)
  • Osteomyelitis with proliferative periosititis
34
Q

Clinical features of accute suppurative osteomyelitis (4)

A
  • Pain
  • Fever
  • Malaise
  • Paresthesia
35
Q

Radiographic appearance of acute suppurative osteomyelitis

A
  • Early lesions = few signs with conventional rx
  • Advanced cases = moth-eaten bone destruction
36
Q

8 symptoms and consequences of chronic suppurative osteomyelitis

A
  • Swelling
  • Pain
  • SInus formation
  • Purulent discharge
  • Sequestrum formation
  • Tooth loss
  • Pathologic fracture

NOTE: May arise from acute suppurative or denovo

37
Q

Define focal sclerosing osteomyelitis

A

Localized area of bone sclerosis associated with the apices of teeth with pulpitis or pulpal necrosis

NOTE: No radiolucent border and not separated from the apices of teeth

38
Q

Describe diffuse sclerosing osteomyelitis

A

Pain, inflammation and increased diffuse opacity of bone

39
Q

Define osteomyelitis with proliferative periostitis (Garre osteomyelitis)

A

Bone formation with periosteal reaction in response to inflammation

40
Q

Most frequent cause of osteomyelitis with proliferative periostitis (Garre osteomyelitis)

A

Dental caries

41
Q

Appearance of Garre osteomyelitis on occlusal films

A

Onion skin appearance

42
Q

Treatment of osteomyelitis (4)

A
  • Remove source of infection
  • Debridement and surgical drainage
  • High dose antibiotic therapy (months)
  • Hyperbaric oxygen therapy (used less frequently)
43
Q

Cause of alveolar osteitis (dry socket)

A

Premature fibrinolysis of the initial clot

44
Q

6 characteristics of alveolar osteitis (dry socket)

A
  • More frequent in mandible
  • 25 - 30% of impacted 3rd molar
  • 20 - 40 years of age
  • Bare bone socket
  • Severe pain, foul odor
  • 10 - 40 days duration
45
Q

Management of alveolar osteitis (dry socket)

A
  • Obtain PA (rule out retained root fragment/foreign body)
  • Remove sutures, irrigate warm saline
  • Inspect socket clinically but DO NOT CURRETAGE
  • Home irrigation saline or chlorhexidine
  • Antiseptic dressing to pack socket? reduces symptoms but may delay healing
46
Q

Define pulpal necrosis

A

A clinical diagnostic category indicating the death of the dental pulp. The pulp is non responsive to pulp testing

47
Q

Define condensing osteitis

A

Diffuse radiopaque lesion representing a localized bone reaction to a low-grade inflammatory stimulus, usually seen at the apex of a tooth

48
Q

Define symptomatic apical periodontitis

A

Inflammation, usually of the apical periodontium, producing clniical symptoms including a painful response to biting and or percussion or palpation. May be assocaited with an apical radiolucency

49
Q

Define acute apical abscess

A

An inflammatory reaction to pulpal infection and necrosis - rapid onset, spontaneous pain, tenderness of tooth to pressure, pus formation and swelling of associated tissues

50
Q

Define asymptomatic apical periodontitis

A

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms

51
Q

Define chronic apical abscess

A

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little discomfort or no discomfort, and the intermittent discharge of pus through an associated sinus tract

DENT 317 - Oral Pathology (6 decks)

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