Sequalae of Pulpal Disease Flashcards
1
Q
inflammation of the pulpal tissue
A
pulptitis
2
Q
What are the three classifications of pulpits?
A
- reversible vs. irreversible
- acute vs. chronic
- symptomatic vs. asymptomatic
3
Q
During inflammation of the pulp describe the blood supply and collateral support:
A
limited blood supply; no collateral support
4
Q
The expansile process of pulpal inflammation includes:
A
- blood vessel dilation
- leakage and fluid into surrounding tissue
- migration of cells
5
Q
pulp is alive, tooth can heal:
A
reversible pulpitis
6
Q
pulp is dead, tooth cannot heal, even once irritant is removed:
A
irreversible pulpitis
7
Q
can occur as a result of irreversible pulpits:
A
pulpal necrosis
8
Q
-blood supply of tooth is severed
-tooth is discolored (grey)
A
pulpal necrosis
9
Q
pulpitis characterized by sudden onset, and symptomatic:
A
acute pulpitis
10
Q
In acute pulpits, there is a collection of _____ (_____)
A
neutrophils (abscess)
11
Q
exudate enclosed within chambers, builds pressure:
A
abscess
12
Q
acute pulpitis can progress to:
A
- osteomyelitis
- PA abscess
13
Q
pulpitis characterized by longer process and asymptomatic:
A
chronic pulpitis
14
Q
less irritant within the pulpal chamber occurs with:
A
chronic pulpitis
15
Q
Chronic pulpitis can progress to:
A
- periodontitis
- PA granuloma
- PA cyst
16
Q
Chronic hyperplastic pulpitis is seen mostly in:
A
Primary teeth (children)
17
Q
what might cause the pulpal tissue to become hyperplastic in chronic hyperplastic pulpitis?
A
constant long-standing irritant
18
Q
Discuss the symptoms of chronic hyperplastic pulpitis:
A
Asymptomatic
19
Q
What causes the pulp polyp in chronic hyperplastic pulpitis?
A
Proliferation of granulation tissue
20
Q
Due to pulp being contained in a rigid, non-expansive tooth cavity _____ occurs in pulpal inflammation
A
destruction
21
Q
Presence of open or closed pulpitis occurs in:
A
periapical lesions
22
Q
Virulence of involved ____ occurs in periapical lesions
A
microorganism
23
Q
In a periapical lesions we may see extend to _____ of _____
A
sclerosis; dentinal tubulesThe
24
Q
What is important in resolving periapical lesions?
A
Competency of host immune response
25
Cysts, granulomas and abscesses on a radiograph all appear:
Radiolucent
26
Mass of chronically-inflamed granulation tissue:
PA granuloma
27
Where is a PA granuloma located?
apex of non-vital tooth
28
Most PA granulomas are:
asymptomatic
29
What is an absolute must, in order to have a periapical granuloma?
NON-VITAL TOOTH
30
Is a PA granuloma considered a true granuloma?
NO- granulation tissue
(not true granulomatous tissue)
31
What is seen in this image?
Periapical radiolucency (PA granuloma)
32
A periapical granuloma may develop as the initial _____ or arise after an initial ______
periapical pathosis; periapical abscess
33
A periapical granuloma may transform into:
1. periapical cyst
2. periapical abscess
34
What type of inflammation is involved with periapical granulomas? What cells are present?
Chronic inflammation; plasma cells, macrophages & lymphocytes
35
What are frequently seen with PA granulomas?
Cholesterol clefts (giant multinucleated cells)
36
This image shows:
Periapical granuloma
37
This image shows:
Periapical granuloma
38
This image shows:
Periapical granuloma
39
This image shows a periapical granuloma. What helps to diagnose this?
Presence of neutrophils, plasma cells and macrophages
40
Pathologic cavity located in soft tissue or bone lined by epithelium:
Cyst
41
In order to have a cyst, what is an absolute must?
Epithelial lining
42
Components of a cyst include:
1. wall (connective tissue wall)
2. lumen (can be filled or empty)
3. lining (epithelial lining)
43
Creates epithelial lining surrounding cavity of a cyst:
Rests of malassez
44
The epithelial lining of a cyst is derived from:
Rests of malassez
45
This image shows:
Rests of malassez
46
A periapical cyst may also be called: (2)
1. radicular cyst
2. apical periodontal cyst
47
Pathologically, how can differentiate a periapical cyst from a periapical granuloma:
the presence of an epithelial lining
48
an inflammatory cyst, that is an asymptomatic, slow-growing lesion associated with the root apex of a non-vital tooth:
periapical cyst
49
external root resorption may be possible with:
a periapical cyst
50
Accumulation of acute inflammatory cells at the apex of a non-vital tooth:
Periapical abscess
51
What is an absolute must for a periapical abscess?
NON-VITAL TOOTH!
52
A periapical abscess may arise as the initial ____ or as an _______ (____)
initial periapical pathosis; acute exacerbation of chronic periapical lesion (phoenix abscess)
53
Acute exacerbation of chronic periapical lesion:
Phoenix abscess
54
A localized collection of pus that has accumulated in a tissue cavity, producing swelling:
Abscess
55
Describe the symptoms of a periapical abscess:
Generally symptomatic but may be asymptomatic if there is lack of accumulation of purulent material due to a chronic path of drainage
56
When might a periapical abscess be asymptomatic?
If there is a lack of accumulation of purulent material due to a chronic path of drainage
57
Pathologically how can you differentiate between a periapical abscess vs a periapical granuloma?
By the presence of acute or chronic inflammatory cells
Periapical abscess= acute inflammation= neutrophils
Periapical granuloma= chronic inflammation= lymphocytes, plasma cells macrophages
58
This image shows a ______, how can we be sure?
PA abscess; lots of neutrophils
59
List the drainage pathways of acute periapical infections: (5)
1. surface of gingiva (parulis)
2. palate (palatal abscess)
3. maxillary sinus
4. soft tissue spaces (cellulitis)
5. floor of mouth (Ludwig angina)
60
Label the following drainage pathways of acute inflammation:
1. surface of gingiva (parulis)
2. palate (palatal abscess)
3. maxillary sinus
4. soft tissue spaces (cellulitis)
5. floor of mouth (Ludwig angina)
61
The following image shows:
Dental abscess
62
gum boil
parulis
63
acute periapical inflammation in which purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus
Parulis
64
What does a parulis consist of?
A mass of inflamed granulation tissue with an epithelialized sinus tract
65
The intraoral opening/terminal end of a sinus tract:
Parulis
66
What can be seen in the following image?
Parulis
67
What does the following image represent?
Parulis
68
A localized collection of pus that has accumulated (consolidated) in a tissue cavity, producing fluctuance:
abscess
69
Microscopically what do see in an abscess?
Neutrophils
70
A dental abscess that drains extra orally, through the overlying skin (from within):
Cutaneous sinus tract
71
What can be seen in this image?
cutaneous sinus tract
72
Connects two anatomic cavities:
Fistula
73
Connects sinus to oral cavity:
Oroantral fistula
74
Fistulas are usually the result of:
Some sort of trauma or surgery
75
Give two examples of fistulas:
1. oroantral fistula
2. tracheo-esophageal fistula
76
Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth and pain:
Cellulitis
77
If an abscess is unable to establish drainage into the oral cavity or onto the surface of skin (sinus tract) this will result in:
Cellulitis
78
If a patient has trouble opening mouth secondary to cellulitis:
Trismus
79
an aggressive, rapidly spreading cellulitis involving multiple anatomic spaces:
Ludwigs angina
80
What are some anatomic spaces that Ludwigs angina may involve?
1. submental space
2. sublingual space
3. submandibular space
81
What makes Ludwigs angina a medical emergency?
Produces massive swelling of neck that may extend to close clavicles and cause airway obstruction
82
Valveless venous system may allow retrograde spread of infection from middle third of the face:
Cavernous sinus thrombosis
83
Cavernous sinus thrombosis is considered:
a medical emergency
84
Cavernous sinus thrombosis is characterized by a _____ within the _____, a major dural venous sinus, resulting in a life-threatening infection
blood clot; cavernous sinus
85
The cavernous sinus is a major:
Dural venous sinus
86
Cavernous sinus thrombosis may be associated with spread of infection from:
maxillary teeth
87
This image shows:
Trismus (secondary to cellulitis)
88
This image shows:
Ludwigs angina
89
This image shows:
Cavernous sinus thrombosis
90
What are the significant anatomical strucutres passing through the cavernous sinus?
(5)
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
bacterial infection of bone:
osteomyelitits
92
odontogenic infection or traumatic fracture of bone are both causes for:
Osteomyelitis
93
NUG:
Necrotizing ulcerative gingivitis
94
NOMA:
Necrosis that extends to cutaneous tissue
95
Both NOMA and NUG are associated with:
Osteomyelitis
96
Presdispositions to osteomyelitis include (3):
1. chronic systemic diseases
2. immunodeficiency
3. decreased vascularity of bone
97
Type of osteomyelitis characterized by spread through medullary space with minimal tissue reaction:
acute osteomyelitis
98
Type of osteomyelitis characterized by a prominent tissue reaction involving granulation tissue and fibrosis:
Chronic osteomyelitis
99
How does osteomyelitis appear radiographically?
Radiopaque
100
a fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation:
sequestrum
101
Non-vital bone encased by vital bone:
(dead bone surrounded by viable bone)
Involucrum
102
Proliferative periostitis may also be called:
Garre Osteomyelitis
103
a form of chronic osteomyelitis:
Proliferative periostitis
104
Periostitis occurs on the ____ of bone
outside
105
In proliferative periostitis, a ______ reaction occurs, in which layers of _____ are formed, producing cortical expansion
periosteal reaction; reactive vital bone
106
Discuss where proliferative periostitis is most frequently seen:
Seen most frequently in children and young adults in mandibular molar & premolar area, involving the lower border or buccal cortex
107
Cortical expansion is characteristic of what disease:
Proliferative periostitis
108
If onion staining is seen on a radiograph, this is characteristic of:
Proliferative periostitis
109
chronic focal sclerosing osteomyelitis may also be called:
Condensing osteitis
110
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:
Nonvital tooth; radiopaque
111
localized area of bone sclerosis associated with the apices of teeth with pulpal disease:
Condensing osteitis (focal chronic sclerosing osteomyelitis)
112
Where do we see condensing osteitis most frequently?
seen most frequently in children and young adults involving the mandibular molars and premolars
113
This image is characteristic of:
condensing osteitis
114
actinomycosis may also be called:
Ray fungus
115
actinomycosis is a _____ infection
bacterial (NOT FUNGAL)
116
Actinomycosis is caused by: (species)
1. actinomyces Israelii
2. actinomyces Viscous
117
Describe the actinomyces species that caused actinomycosis: (5)
1. filamentous
2. branching
3. gram positive
4. anaerobic
5. normal oral flora
118
What can be seen in the following image?
actinomycosis (ray fungus)
119
Actinomycosis can be classified as: (3)
(include percentages)
1. cervico-facial (55%)
2. abdomino-pelvic (25%)
3. pulmonary (15%)
120
This image shows:
cervico-facial actinomycosis
121
Where is the entry for the organism in cervico-facial actinomycosis?
Area of prior trauma
122
The entry for cervico-facial actinomycosis is often an area of prior trauma, this includes: (5)
1. soft tissue injury
2. periodontal pocket
3. non-vital tooth
4. extraction socket
5. infected tonsil
123
Describe the extension of cervico-facial actinomycosis:
Direct extension through soft tissue
124
What does cervico-facial actinomycosis disregard?
Fascial planes & lymphatics
125
Woody induration and mycosis are terms associated with:
cervico-facial actinomycosis
126
In cervico-facial actinomycosis describe the drainage:
draining sinus tracts & suppuration with sulfur granules
127
Sulfur granules (purulent exudate- yellowish crusty areas) are associated with:
Cervico-facial actinomycosis
128
Cervico-facial actinomycosis may also be called:
Lumpy jaw disease
129
What disease is shown in this image?
Cervico-facial actinomycosis (lumpy jaw disease)
130
What does this image show? What disease is this associated with?
Sulfur granules; cervicofacial actinomycosis
131
What can be noted in this image? What disease is this associated with?
Sulfur granules; cervico-facial actinomycosis
132
-Nonvital tooth
-periapical radiolucency
-lots of neutrophils (under microscope)
Periapical abscess
133
-Nonvital tooth
-periapical radiolucency
-macrophages, plasma cells, neutrophils (under microscope) (also known as mixed inflammatory infiltrate)
-no epithelium seen
periapical granuloma
134
-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)
Periapcial cyst
135
its common to see mixed inflammatory infiltration (chronic cells and acute cells) with:
Periapical lesions
136
Differentiating between periapical cysts and periapical granulomas you look for:
Epithelium (because only cysts have this)
137
