Pulpal, Periapical, and Periodontal Disease

Question 1

pulpitis

Answer 1

inflammation of the pulp

Question 2

etiologies of pulpitis (4)

Answer 2

1. mechanical damage
2. thermal injury
3. chemical irritation
4. bacterial effects

Question 3

MAIN difference between reversible and irreverisble pulpitis

Answer 3

reversible pulpitis - pain stops after a few minutes, only pain when stimulated

irreversible pulpitis - sharp, severe pain that lingers

Question 4

What difficulty is presented with irreversible pulpitis?

Answer 4

difficult to localize pain to specific tooth

Question 5

another name for pulp polyp

Answer 5

chronic hyperplastic pulpitis

Question 6

demographics of pulp polyp

Answer 6

children and adolescents

Question 7

clinical features of pulp polyp (3)

Answer 7

1. asymptomatic
2. granulomatous proliferation of pulpal tissue (pulp does not die, but becomes hyperplastic)
3. large cavity and pulp exposed

Question 8

acute apical periodontitis + chronic inflammation

Answer 8

periapical granuloma

Question 9

acute apical periodontitis + pyogenic bacteria and suppuration (pus formation)

Answer 9

periapical abscess

Question 10

acute apical periodontitis + activation of cell rests of Mallassez and cystic degeneration

Answer 10

periapical cyst

Question 11

another name for parulis

Answer 11

gum boil

Question 12

parulis (definition)

Answer 12

type of periapical abscess that occurs at the opening of the sinus tract near the apex of the tooth in the gums

Question 13

if parulis is perforated, the pus is drained into the _______

Answer 13

oral cavity

Question 14

periapical abscess usually drains to which side?

Answer 14

buccal

Question 15

periapical abscess on maxillary lateral incisors usually drain

Answer 15

palatally (inclination)

Question 16

periapical abscess near mandibular second and third molars usually drain

Answer 16

onto the skin surfus

Question 17

clinical features of ludwig’s angina (4)

Answer 17

1. massive neck swelling
2. woody tongue
3. bull neck
4. dysphagia, dysphonia, respiratory embarassment, constiuttional symptoms

Question 18

spaces involved in ludwig’s angina

Answer 18

affects sublingual, submandibular, and submental spaces

Question 19

management of ludwig’s angina

Answer 19

1. maintain airway
2. resolve infection

Question 20

clinical features of cavernous sinus thrombosis (6)

Answer 20

1. perioral and periorbital edema
2. ocular protrusion and fixation
3. pupillary dilation, photophobia, loss of vision
4. proptosis (buldging or protrusion of eye)
5. chemosis (swelling of conjunctiva)
6. ptosis (upper eyelid drooping over the eye)

Question 21

cranial nerves involved in cavernous sinus thrombosis

Answer 21

III, IV, V1, V2, VI

Question 22

management of cavernous sinus thrombosis

Answer 22

1. incision and drainage
2. IV antibiotics
3. tooth extraction
4. systemic corticosteroids

recognize what is going on and send PT to hospital!

Question 23

prognosis of cavernous sinus thrombosis

Answer 23

high mortality (30%)

Question 24

infection space that contributes to cavernous sinus thrombosis

Answer 24

1. lateral to sella turcica and medial to temporal bone
2. dental infections count for 10% of cases

Question 25

highest risk area of face leading to cavernous sinus thrombosis

Answer 25

canine space infection

Question 26

what is osteomyelitis?

Answer 26

"bone marrow inflammation" acute or chronic inflammatory process in the medullary space or cortical surfaces of bone that extend away from the intitial site of involvement

Question 27

Is osteomyelitis more common in the maxilla or mandible? why?

Answer 27

mandible (less vascular supply)

Question 28

signs and symptoms of acute suppurative osteomyelitis?

Answer 28

fever pain swelling lyphadenopathy lower lip paresthesia drainage

Question 29

x-ray features of acute suppurative osteomyelitis (4)

Answer 29

1. ill defined radiolucency (moth eaten appearance) 2. widened PDL 3. loss of lamina dura 4. cortical duplication

Question 30

signs and symptoms of chronic suppurative osteomyelitis

Answer 30

swelling pain purulent discharge sinus tracts tooth loss pathologic fracture sequestration of non-vital one

Question 31

cortical duplication in proliferative periostitis

Answer 31

onion peel appearance periosteal reaction to infection

Question 32

another name for alveolar osteitis

Answer 32

dry socket

Question 33

alveolar osteitis

Answer 33

premature fibrinolysis of post-extraction clot

Question 34

Risk factors for alveolar osteitis

Answer 34

smoking oral contraceptives poor surgical technique excess use of vasoconstrictor

Question 35

management of alveolar osteitis

Answer 35

irrigation analgesics obtundent dressing

Question 36

most important thing to remember with the management of dry sockets

Answer 36

difficult to treat, try to prevent

Question 37

systemic factors of gingival inflammation

Answer 37

hormonal changes stress substance abuse malnutrition medication diabetes immune dysfunction heavy-metal poisoning

Question 38

local factors of gingival inflammation

Answer 38

local trauma tooth crowding dental anomalies tooth fracture caries gingival recession high frenum attachment

Question 39

clinical features of gingivitis

Answer 39

1. loss of stippling 2. bleeding on probing 3. increasing erythema and edema 4. gingival hyperplasia 5. pyogenic granuloma

Question 40

demographics of localized juvenile spongiotic gingival hyperplasia

Answer 40

adolescents

Question 41

clinical features of localized juvenile spongiotic gingival hyperplasia

Answer 41

small, bright red, hemorrhagic, velvety / papillary, sessile lesion usually on maxillary gingiva

Question 42

management of localized juvenile spongiotic gingival hyperplasia

Answer 42

surgical incision

Question 43

causes of plasma cell gingivitis

Answer 43

allergic etiology (cinnamon gum, herbal toothpastes, breath mints) use of "kath" in Yemen

Question 44

clinical features of plasma cell gingivitis

Answer 44

rapid onset of stomatodynia (intensified by toothpaste, hot or spicy foods)

Question 45

histopathological features of plasma cell gingivitis

Answer 45

intense plasmacytic infiltrate

Question 46

granulomatous gingivitis due to embedded foreign materials

Answer 46

foreign material embedded in CT (pumice, cement, luting agents, etc)

Question 47

prevention of granulomatous gingivitis due to embedded foreign material

Answer 47

cautious dental care (teeth polishing after 2 weeks of SRP)

Question 48

management of granulomatous gingivitis

Answer 48

identify foreign material excise symptomatic tissue graft healthy tissue

Question 49

medications frequently associated with gingival hyperplasia

Answer 49

Phenytoin calcium channel blockers cyclosporin

Question 50

clinical features of gingival hyperplasia

Answer 50

related to degree of inflammation minimal = firm / pink / stippled moderate = red / edematous severe = friable, ulcerated

Question 51

management of gingival hyperplasia

Answer 51

1. discontinue medication 2. substitute medication 3. aggressive preventative dental measures 4. gingivioplasty to gingivectomy

Question 52

etiology of gingival fibromatosis

Answer 52

familial or idiopatic

Question 53

clinical features of gingival fibromatosis

Answer 53

1. firm texture 2. normal color 3. multiple problems (cosmesis, retained decisuous teeth, abnormal occlusion, inadequate lip closure, dysphagia and dysphonia)

Question 54

management of gingival fibromatosis

Answer 54

mild cases respond to SRP gingivectomy for advanced cases

Question 55

cause of Papillon-Lefevre syndrome

Answer 55

mutation and loss of function of the Cathepsin C gene (autosomal recessive trait)

Question 56

clinical features of Papillon-Lefevre syndrome

Answer 56

-Palmar and planter hyperkeratosis -advanced periodontitis

Question 57

management of Papillon-Lefevre syndrome

Answer 57

cutaneous hyperkeratosis treated with vitamin A analogs and keratolytics periodontal manifestations difficult to control