Pulpal, Periapical, Odontogenic, and Bone Infecitons Flashcards
What makes the pulp a unique organ?
It is enclosed in hard tissue and inflammation can be particularly damaging
Why can pulpal inflammation be so damaging?
Increased interpulpal pressure can occur because it is surrounded by hard tissue and can’t go anywhere
This compromises blood flow, resulting in tissue damage
Irreversible damage leads to pulpal necrosis
What makes the tooth so unique (for the purpose of this lecture)?
Roots are enclosed in bone, and the ingress for circulation is tiny and also surrounded by bone
What is the most common cause of pulpal inflammation and necrosis?
Bacterial infection
How can bacteria infect the pulp?
Direct pulp exposure
Bacterial penetration through dentinal tubules from caries
Direct access due to traumatic fracture of the tooth
Travel from bloodstream (unlikely)
Traumatic fracture can lead to what?
Bacteria can easily enter the pulp
Infection happens quickly if pulps are not mechanically sealed
trauma may damage the blood supply or sever the apex resulting in tissue death
What occurs is the pulp is non-vital?
There is a disruption of positive fluid flow, making the tooth more vulnerable to invasion by microbes
Infection may take a long time depending on bacterial access
There’s no immune response so bacteria can easily grow once they arrive
T/F - Bacteria are necessary for pulpal and periapical disease to occure
True - that’s why a good seal is critical for the success of pulpal therapy
What characteristics do bacterial species involved with pulpal and periapical disease have?
Anaerobic
gram-
bacilli
Multiple species are found in infecitons
T/F - DNA-based studies show different bacterial profiles of infections than those seen in previous cultivaiton-based studies
True
What are the most common species of periapical infection based on DNA analysis?
Enterococcus faecalis
Burkolderia
Streptococcus
What species are the most common based on cultivation studies with periapical abscesses?
Prevotella and Porphyomonas
They’re responsible for the foul odor of necrotic pulps
T/F - endodontic infections usually only have one species
False - they’re mixed bacterial infections
How does oxygen concentration vary in the canal of a pulpal infection?
There’s a gradient depending on the area of necrosis
Necrotic canals have anaerobic conditions
How do nutrients differ in the canal of pulpal infections?
Coronally = salivary constituents and ingested food (saccrolytic bacteria found here)
More apically = serum and cellular proteins are more avaliable (proteolytic bacteria found here)
Pulpitis
Early stage of endodontic infeciton
Pulp is compromised by infection
Can be reversed if treated early
Early symptoms include lowered threshold and prolonged pain response to cold or other stimulus
What is the sign of the shift from reversible to irreversible pulpitis and eventually pulpal necrosis?
Spontaneous pain signals
-pain can be quite severe (sharp or throbbing)
As pulp becomes necrotic, what happens to immune cells?
They can’t enter the pulp due to a lack of blood supply, so the response shifts to the periapical region
What happens as immune response shifts to periapical tissues?
Bone resorption takes place and allows space for a barrier of inflammatory cells to accumulate and prevent spread of infection
Inflammatory response is usually effective and bacteria are confined to periapical tissues (otherwise, orofacial infections occur)
How does the bacterial load compare in the periapical tissues v the pulp in periapical lesions?
Low in the pulp (because its necrotic)
High in the periapical tissues
