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Pathology > Sequalae of Pulpal Disease > Flashcards

Sequalae of Pulpal Disease Flashcards

1
Q

inflammation of the pulpal tissue

A

pulptitis

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2
Q

What are the three classifications of pulpits?

A
  1. reversible vs. irreversible
  2. acute vs. chronic
  3. symptomatic vs. asymptomatic
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3
Q

During inflammation of the pulp describe the blood supply and collateral support:

A

limited blood supply; no collateral support

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4
Q

The expansile process of pulpal inflammation includes:

A
  1. blood vessel dilation
  2. leakage and fluid into surrounding tissue
  3. migration of cells
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5
Q

pulp is alive, tooth can heal:

A

reversible pulpitis

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6
Q

pulp is dead, tooth cannot heal, even once irritant is removed:

A

irreversible pulpitis

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7
Q

can occur as a result of irreversible pulpits:

A

pulpal necrosis

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8
Q

-blood supply of tooth is severed
-tooth is discolored (grey)

A

pulpal necrosis

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9
Q

pulpitis characterized by sudden onset, and symptomatic:

A

acute pulpitis

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10
Q

In acute pulpits, there is a collection of _____ (_____)

A

neutrophils (abscess)

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11
Q

exudate enclosed within chambers, builds pressure:

A

abscess

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12
Q

acute pulpitis can progress to:

A
  1. osteomyelitis
  2. PA abscess
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13
Q

pulpitis characterized by longer process and asymptomatic:

A

chronic pulpitis

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14
Q

less irritant within the pulpal chamber occurs with:

A

chronic pulpitis

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15
Q

Chronic pulpitis can progress to:

A
  1. periodontitis
  2. PA granuloma
  3. PA cyst
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16
Q

Chronic hyperplastic pulpitis is seen mostly in:

A

Primary teeth (children)

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17
Q

what might cause the pulpal tissue to become hyperplastic in chronic hyperplastic pulpitis?

A

constant long-standing irritant

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18
Q

Discuss the symptoms of chronic hyperplastic pulpitis:

A

Asymptomatic

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19
Q

What causes the pulp polyp in chronic hyperplastic pulpitis?

A

Proliferation of granulation tissue

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20
Q

Due to pulp being contained in a rigid, non-expansive tooth cavity _____ occurs in pulpal inflammation

A

destruction

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21
Q

Presence of open or closed pulpitis occurs in:

A

periapical lesions

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22
Q

Virulence of involved ____ occurs in periapical lesions

A

microorganism

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23
Q

In a periapical lesions we may see extend to _____ of _____

A

sclerosis; dentinal tubulesThe

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24
Q

What is important in resolving periapical lesions?

A

Competency of host immune response

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25
Q

Cysts, granulomas and abscesses on a radiograph all appear:

A

Radiolucent

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26
Q

Mass of chronically-inflamed granulation tissue:

A

PA granuloma

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27
Q

Where is a PA granuloma located?

A

apex of non-vital tooth

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28
Q

Most PA granulomas are:

A

asymptomatic

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29
Q

What is an absolute must, in order to have a periapical granuloma?

A

NON-VITAL TOOTH

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30
Q

Is a PA granuloma considered a true granuloma?

A

NO- granulation tissue

(not true granulomatous tissue)

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31
Q

What is seen in this image?

A

Periapical radiolucency (PA granuloma)

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32
Q

A periapical granuloma may develop as the initial _____ or arise after an initial ______

A

periapical pathosis; periapical abscess

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33
Q

A periapical granuloma may transform into:

A
  1. periapical cyst
  2. periapical abscess
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34
Q

What type of inflammation is involved with periapical granulomas? What cells are present?

A

Chronic inflammation; plasma cells, macrophages & lymphocytes

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35
Q

What are frequently seen with PA granulomas?

A

Cholesterol clefts (giant multinucleated cells)

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36
Q

This image shows:

A

Periapical granuloma

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37
Q

This image shows:

A

Periapical granuloma

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38
Q

This image shows:

A

Periapical granuloma

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39
Q

This image shows a periapical granuloma. What helps to diagnose this?

A

Presence of neutrophils, plasma cells and macrophages

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40
Q

Pathologic cavity located in soft tissue or bone lined by epithelium:

A

Cyst

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41
Q

In order to have a cyst, what is an absolute must?

A

Epithelial lining

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42
Q

Components of a cyst include:

A
  1. wall (connective tissue wall)
  2. lumen (can be filled or empty)
  3. lining (epithelial lining)
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43
Q

Creates epithelial lining surrounding cavity of a cyst:

A

Rests of malassez

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44
Q

The epithelial lining of a cyst is derived from:

A

Rests of malassez

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45
Q

This image shows:

A

Rests of malassez

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46
Q

A periapical cyst may also be called: (2)

A
  1. radicular cyst
  2. apical periodontal cyst
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47
Q

Pathologically, how can differentiate a periapical cyst from a periapical granuloma:

A

the presence of an epithelial lining

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48
Q

an inflammatory cyst, that is an asymptomatic, slow-growing lesion associated with the root apex of a non-vital tooth:

A

periapical cyst

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49
Q

external root resorption may be possible with:

A

a periapical cyst

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50
Q

Accumulation of acute inflammatory cells at the apex of a non-vital tooth:

A

Periapical abscess

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51
Q

What is an absolute must for a periapical abscess?

A

NON-VITAL TOOTH!

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52
Q

A periapical abscess may arise as the initial ____ or as an _______ (____)

A

initial periapical pathosis; acute exacerbation of chronic periapical lesion (phoenix abscess)

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53
Q

Acute exacerbation of chronic periapical lesion:

A

Phoenix abscess

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54
Q

A localized collection of pus that has accumulated in a tissue cavity, producing swelling:

A

Abscess

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55
Q

Describe the symptoms of a periapical abscess:

A

Generally symptomatic but may be asymptomatic if there is lack of accumulation of purulent material due to a chronic path of drainage

56
Q

When might a periapical abscess be asymptomatic?

A

If there is a lack of accumulation of purulent material due to a chronic path of drainage

57
Q

Pathologically how can you differentiate between a periapical abscess vs a periapical granuloma?

A

By the presence of acute or chronic inflammatory cells

Periapical abscess= acute inflammation= neutrophils

Periapical granuloma= chronic inflammation= lymphocytes, plasma cells macrophages

58
Q

This image shows a ______, how can we be sure?

A

PA abscess; lots of neutrophils

59
Q

List the drainage pathways of acute periapical infections: (5)

A
  1. surface of gingiva (parulis)
  2. palate (palatal abscess)
  3. maxillary sinus
  4. soft tissue spaces (cellulitis)
  5. floor of mouth (Ludwig angina)
60
Q

Label the following drainage pathways of acute inflammation:

A
  1. surface of gingiva (parulis)
  2. palate (palatal abscess)
  3. maxillary sinus
  4. soft tissue spaces (cellulitis)
  5. floor of mouth (Ludwig angina)
61
Q

The following image shows:

A

Dental abscess

62
Q

gum boil

A

parulis

63
Q

acute periapical inflammation in which purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus

A

Parulis

64
Q

What does a parulis consist of?

A

A mass of inflamed granulation tissue with an epithelialized sinus tract

65
Q

The intraoral opening/terminal end of a sinus tract:

A

Parulis

66
Q

What can be seen in the following image?

A

Parulis

67
Q

What does the following image represent?

A

Parulis

68
Q

A localized collection of pus that has accumulated (consolidated) in a tissue cavity, producing fluctuance:

A

abscess

69
Q

Microscopically what do see in an abscess?

A

Neutrophils

70
Q

A dental abscess that drains extra orally, through the overlying skin (from within):

A

Cutaneous sinus tract

71
Q

What can be seen in this image?

A

cutaneous sinus tract

72
Q

Connects two anatomic cavities:

A

Fistula

73
Q

Connects sinus to oral cavity:

A

Oroantral fistula

74
Q

Fistulas are usually the result of:

A

Some sort of trauma or surgery

75
Q

Give two examples of fistulas:

A
  1. oroantral fistula
  2. tracheo-esophageal fistula
76
Q

Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth and pain:

A

Cellulitis

77
Q

If an abscess is unable to establish drainage into the oral cavity or onto the surface of skin (sinus tract) this will result in:

A

Cellulitis

78
Q

If a patient has trouble opening mouth secondary to cellulitis:

A

Trismus

79
Q

an aggressive, rapidly spreading cellulitis involving multiple anatomic spaces:

A

Ludwigs angina

80
Q

What are some anatomic spaces that Ludwigs angina may involve?

A
  1. submental space
  2. sublingual space
  3. submandibular space
81
Q

What makes Ludwigs angina a medical emergency?

A

Produces massive swelling of neck that may extend to close clavicles and cause airway obstruction

82
Q

Valveless venous system may allow retrograde spread of infection from middle third of the face:

A

Cavernous sinus thrombosis

83
Q

Cavernous sinus thrombosis is considered:

A

a medical emergency

84
Q

Cavernous sinus thrombosis is characterized by a _____ within the _____, a major dural venous sinus, resulting in a life-threatening infection

A

blood clot; cavernous sinus

85
Q

The cavernous sinus is a major:

A

Dural venous sinus

86
Q

Cavernous sinus thrombosis may be associated with spread of infection from:

A

maxillary teeth

87
Q

This image shows:

A

Trismus (secondary to cellulitis)

88
Q

This image shows:

A

Ludwigs angina

89
Q

This image shows:

A

Cavernous sinus thrombosis

90
Q

What are the significant anatomical strucutres passing through the cavernous sinus?

(5)

A

A. internal carotid artery
B. CN 3 (oculomotor)
C. CN 4 (trochlear)
D. CN 5 (trigeminal) (V1- opthalmic, V2- maxillary)
E. CN 6 (abducens)

91
Q

bacterial infection of bone:

A

osteomyelitits

92
Q

odontogenic infection or traumatic fracture of bone are both causes for:

A

Osteomyelitis

93
Q

NUG:

A

Necrotizing ulcerative gingivitis

94
Q

NOMA:

A

Necrosis that extends to cutaneous tissue

95
Q

Both NOMA and NUG are associated with:

A

Osteomyelitis

96
Q

Presdispositions to osteomyelitis include (3):

A
  1. chronic systemic diseases
  2. immunodeficiency
  3. decreased vascularity of bone
97
Q

Type of osteomyelitis characterized by spread through medullary space with minimal tissue reaction:

A

acute osteomyelitis

98
Q

Type of osteomyelitis characterized by a prominent tissue reaction involving granulation tissue and fibrosis:

A

Chronic osteomyelitis

99
Q

How does osteomyelitis appear radiographically?

A

Radiopaque

100
Q

a fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation:

A

sequestrum

101
Q

Non-vital bone encased by vital bone:

(dead bone surrounded by viable bone)

A

Involucrum

102
Q

Proliferative periostitis may also be called:

A

Garre Osteomyelitis

103
Q

a form of chronic osteomyelitis:

A

Proliferative periostitis

104
Q

Periostitis occurs on the ____ of bone

A

outside

105
Q

In proliferative periostitis, a ______ reaction occurs, in which layers of _____ are formed, producing cortical expansion

A

periosteal reaction; reactive vital bone

106
Q

Discuss where proliferative periostitis is most frequently seen:

A

Seen most frequently in children and young adults in mandibular molar & premolar area, involving the lower border or buccal cortex

107
Q

Cortical expansion is characteristic of what disease:

A

Proliferative periostitis

108
Q

If onion staining is seen on a radiograph, this is characteristic of:

A

Proliferative periostitis

109
Q

chronic focal sclerosing osteomyelitis may also be called:

A

Condensing osteitis

110
Q

Similarly to periapical cysts, periapical granulomas, and periapical abscesses, condensing osteitis is ALWAYS associated with _______

However this condition is different, in that radiographically it appears:

A

Nonvital tooth; radiopaque

111
Q

localized area of bone sclerosis associated with the apices of teeth with pulpal disease:

A

Condensing osteitis (focal chronic sclerosing osteomyelitis)

112
Q

Where do we see condensing osteitis most frequently?

A

seen most frequently in children and young adults involving the mandibular molars and premolars

113
Q

This image is characteristic of:

A

condensing osteitis

114
Q

actinomycosis may also be called:

A

Ray fungus

115
Q

actinomycosis is a _____ infection

A

bacterial (NOT FUNGAL)

116
Q

Actinomycosis is caused by: (species)

A
  1. actinomyces Israelii
  2. actinomyces Viscous
117
Q

Describe the actinomyces species that caused actinomycosis: (5)

A
  1. filamentous
  2. branching
  3. gram positive
  4. anaerobic
  5. normal oral flora
118
Q

What can be seen in the following image?

A

actinomycosis (ray fungus)

119
Q

Actinomycosis can be classified as: (3)

(include percentages)

A
  1. cervico-facial (55%)
  2. abdomino-pelvic (25%)
  3. pulmonary (15%)
120
Q

This image shows:

A

cervico-facial actinomycosis

121
Q

Where is the entry for the organism in cervico-facial actinomycosis?

A

Area of prior trauma

122
Q

The entry for cervico-facial actinomycosis is often an area of prior trauma, this includes: (5)

A
  1. soft tissue injury
  2. periodontal pocket
  3. non-vital tooth
  4. extraction socket
  5. infected tonsil
123
Q

Describe the extension of cervico-facial actinomycosis:

A

Direct extension through soft tissue

124
Q

What does cervico-facial actinomycosis disregard?

A

Fascial planes & lymphatics

125
Q

Woody induration and mycosis are terms associated with:

A

cervico-facial actinomycosis

126
Q

In cervico-facial actinomycosis describe the drainage:

A

draining sinus tracts & suppuration with sulfur granules

127
Q

Sulfur granules (purulent exudate- yellowish crusty areas) are associated with:

A

Cervico-facial actinomycosis

128
Q

Cervico-facial actinomycosis may also be called:

A

Lumpy jaw disease

129
Q

What disease is shown in this image?

A

Cervico-facial actinomycosis (lumpy jaw disease)

130
Q

What does this image show? What disease is this associated with?

A

Sulfur granules; cervicofacial actinomycosis

131
Q

What can be noted in this image? What disease is this associated with?

A

Sulfur granules; cervico-facial actinomycosis

132
Q

-Nonvital tooth
-periapical radiolucency
-lots of neutrophils (under microscope)

A

Periapical abscess

133
Q

-Nonvital tooth
-periapical radiolucency
-macrophages, plasma cells, neutrophils (under microscope) (also known as mixed inflammatory infiltrate)
-no epithelium seen

A

periapical granuloma

134
Q

-Nonvital tooth
-periapical radiolucency
-connective tissue wall (microscope)
-lumen (microscope)
-epithelial lining (stratified squamous epithelium) (microscope)
-macrophages (microscope)
-plasma cells (microscopes)
-lymphocytes (microscope)
-neutrophils (sometimes)

A

Periapcial cyst

135
Q

its common to see mixed inflammatory infiltration (chronic cells and acute cells) with:

A

Periapical lesions

136
Q

Differentiating between periapical cysts and periapical granulomas you look for:

A

Epithelium (because only cysts have this)

137
Q
A

Pathology (28 decks)

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