Pulpal, Periapical, and Periodontal Disease

Question 1

Abscess

Answer 1

• Confined pocket of puss
• collects in tissues, organs or spaces inside the body

Question 2

Cyst

Answer 2

• Closed sac
• distinct membrane
• develops abnormally in cavity or structure of body

Question 3

Granuloma

Answer 3

• Mass or nodule of chronically inflamed tissue
• associated w/infective process

Question 4

Primary Dentin

Answer 4

• Dentin formed before crown completion

Question 5

Secondary Dentin

Answer 5

• After primary dentin
• leads to smaller pulp chambers and canals
• Deposition not uniform
• associated w/calcification related disease
  
  • arthritis
  • gout
  • kidney. stones
  • gall stones

Question 6

Causes of Secondary Dentin

Answer 6

• Early formation associated with progeria (accelerated aging)
• Significant traumatic injury
  
  • early obliteration of pulp chamber and canal =calcific metamorphosis
  • leads to yellow discoloration of crown
• Physiologic secondary dentin
  
  • result of aging
  • functional forces of occlusion promote deposition
  • begin in apical areas and spread coronally

Question 6

What is the timeline for pulpal and periodical disease?

Answer 6

1. Caries, Trauma, Periodontitis
2. Death of Dental Pulp
3. Apical Bone inflammation
4. Dental Granulation formation
5. Stimulation of epithelial rest of Malassez
6. Epithelial Proliferation
7. Periapical Cyst formation

Question 7

How does Dentin show up radiographically?

Secondary & Tertiary Dentin

Answer 7

• accelerated closure of pulp chamber and canal
• obliterated pulpal space

Question 8

how long do Alterations in dentin take after trauma?

Answer 8

As early as 3 months

Question 9

What separates primary and secondary dentin?

Answer 9

• line of demarcation
  
  • bending of tubules

Question 10

Tertiary Dentin

Answer 10

• localized to pulpal end of odontoblastic processes

Question 11

Calcific Metamorphosis

Answer 11

• hard tissue deposited in root canal space
• yellow discoloration of clinical crown

Question 12

Calcific Metamorphosis

Answer 12

• hard tissue deposited in root canal space
• yellow discoloration of clinical crown

Question 13

Pulpal Calcifications

Answer 13

• prevalence increases with age
• associated w/chronic pulpitis

Question 14

Types of Pulpal Calcifications?

Answer 14

• Denticles
• Pulp Stones
• Diffuse Linear Calcifications

Question 15

Pulpitis

Answer 15

• Inflammation of the Pulp

Question 16

What does pulpits cause?

Answer 16

• increased fluid pressure
  
  • adjacent to affected dentin
  • increases interstitial pressure
    
    • →causes increased flow of fluid back into capillaries of adjacent uninflamed tissue and increased drainage

Question 17

What are the causes of Pulpitis:

Answer 17

• Mechanical Damage
• Thermal Injury
• Chemical Irritation
• Bacterial effects

Question 18

Chronic Hyperplastic Pulpitis

Answer 18

• aka Pulp polyp
• Teeth w/large chamber
  
  • molars
• Mostly children
• Pink to red nodule
  
  • in pulp chamber
• inflammatory hyperplasia

Question 19

Periapical Granuloma

Answer 19

• Aka Apical Periodontitis
• inflamed granulation tissue at apex of non-vital tooth
• Formation of apical inflammatory lesion:
  
  • Early stages:
    
    • neutrophils predominate
      
      • release prostaglandins→activate osteoclasts
    • radiographic alterations absent
      
      • acute apical periodontitis
  • Chronic Inflammatory cells dominate host response
    
    • stimulate fibroblasts and microvasculature
• Phoenix Abscess

Question 20

Acute Apical Periodontitis

Answer 20

• constant dull, throbbing pain
• pain on biting and percussion
  
  • periodical granuloma-asymptomatic
• represent 75% of apical inflammatory lesions
• 50% fail to respond to conservative endo

Question 21

Periapical Cyst

Answer 21

• aka Radicular Cyst
• True epithelium-lined cyst in response to inflammation
• Source of epithelium
  
  • Rest of malassez
• No Symptoms
• Radiograph:
  
  • loss of lamina dura
• Root Resorption-Common
• Cyst Development-Common

Question 22

What are the variants of Periapical Cysts

Answer 22

• Periapical Pocket cyst
• Periapical True cysts
• Lateral Radicular Cyst
• Residual Periapical Cyst

Question 23

Periapical Pocket Cysts

Answer 23

• Incomplete epithelial lining
• apical portion of tooth extends into cyst lumen

Question 24

Periapical True Cysts

Answer 24

* Complete Epithelium-lined * bag like structure * adjacent to tooth apex

Question 25

Lateral Radicular Cyst

Answer 25

* appear along lateral aspect of root * mimic radiograph of lateral periodontal cyst

Question 26

Residual Periapical Cyst

Answer 26

* Inflammatory cyst * post extraction

Question 27

Periapical Abscess

Answer 27

* Acute Apical Periodontitis * earliest stage of all forms of periodical inflammatory disease * symptomatic and asymptomatic presentations * Radiograph: * Thickened PDL * ill defined radiolucency * or both * Parulis (gum boil) * Dental abscesses drain via cutaneous sinus * perforate buccally-thinner bone * Drain through lingual cortical plate * Maxillary Lateral incisors * palatal roots of maxillary molars * mandibular 2nd and 3rd molars\ * Can spread through bloodstream=systemic symptoms * fever * lymphadenopathy * malaise

Question 28

Cellulitis

Answer 28

* Abscess that doesn't drain through surface of skin or into oral cavity * spread diffusely through fascial planes of soft tissue * Types: * Ludwigs Angina * Cavernous Sinus Thrombosis

Question 29

Ludwig's Angina

Answer 29

* aggressive and rapid spreading cellulitis * involves: * sublingual * submandibular * submental spaces * Acute infection from lower molar teeth-70% * extend to lateral pharyngeal space→retropharyngeal space * spread to mediastinum * serious consequences * massive swelling of neck-→clavicle * Woody Tongue * sublingual space * compromised airway * Bull neck * submandibular space * Restricted neck movement

Question 30

Cavernous Sinus Thrombosis

Answer 30

* edematous periorbital enlargement * involve: * eyelids * conjunctiva * Involve Canine space * Protrusion and fixation eyeball * proptosis, chemises, ptosis