Sequelae of Pulpal Disease Flashcards
Inflammation of the pulpal tissue
Reversible vs irreversible
Acute vs chronic
Symptomatic vs asymptomatic
Pulpitis
Limited blood supply No collateral support Destructive Expansile process ▪Blood vessel dilation ▪Leakage of fluid into surrounding tissue ▪Migration of cells
Inflammation of pulp
Presence of opened or closed pulpitis
Virulence of involved microorganism
Extent of sclerosis of dentinal tubules
Competency of host immune response
Periapical lesions
Mass of chronically-inflamed granulation tissue
Apex of non-vital tooth
Most are asymptomatic
Misnomer -not true granulomatous inflammation
May develop as the initial periapical pathosis or arise after an initial periapical abscess
May transform into a periapical cyst or abscess
Periapical granuloma
Pathologic cavity located in soft tissue or bone line by epithelium
- Epithelial lining
- Wall
- Lumen
Cyst
- An inflammatory cyst
- Asymptomatic slow-growing lesion associated with the root apex of a non-vital tooth
- External root resorption
Apical periodontal cyst/periapical cyst/radicular cyst
In order to have a cyst, you must have _____
Epithelium
- Accumulation of acute inflammatory cells at the apex of a non-vital tooth
- May arise as the initial periapical pathosis or as an acute exacerbation of chronic periapical lesion (Phoenix abscess)
- Generally symptomatic but. may be asymptomatic if there is a lack of accumulation of purulent material due to a chronic path of drainage
Periapical abscess
If tooth presents with periapical radiolucency that is non-vital, what is present if there is granulation tissue only in the biopsy?
Periapical granuloma
If tooth presents with periapical radiolucency that is non-vital, what is present if there is granulation tissue and hyperplastic epithelium in the biopsy?
Periapical cyst
If tooth presents with periapical radiolucency that is non-vital, what is present if there is neutrophils in the biopsy?
Periapical abscess
- Acute periapical inflammation
- Purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus
- Intraoral opening of a sinus tract
- Consists of a mass of inflamed granulation tissue with an epithelialized sinus tract
Parulis (gum boil)
Localized collection of pus accumulated in a tissue cavity producing fluctuance
Abscess
Dental abscess that drains extraorally through the overlying skin
Cutaneous sinus tract
_____
- from within to the exterior
- parulis is the end of a this
Sinus tract
________
-connects 2 antomic cavities
Fistula
- Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth, and pain
- Abscess unable to establish drainage into the oral cavity or onto the surface of skin
Cellulitis
- An aggressive, rapidly spreading cellulitis involving multiple anatomic spaces; the submental, sublingual, and submandibular spaces
- Produces massive swelling of neck that may extend close to clavicles and cause airway obstruction
Ludwig’s angina
- Valveless venous system may allow retrograde spread of infection from middle third of the face
- Formation of a blood clot within cavernous sinus, a major dural venous sinus, a life-threatening infection
- May be associated with spread of infection from max teeth
Cavernous sinus thrombosis
What are located in cavernous sinus?
CN V1, V2, III, IV, and VI
Internal carotid artery
Bacterial infection of bone ▪Odontogenic infection ▪Traumatic fracture of bone ▪NUG, NOMA ▪Developing countries Predisposition ▪Chronic systemic diseases ▪Immunodeficiency ▪Decreased vascularity of bone Can be acute or chronic
Osteomyelitis
Fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation
Sequestrum
Non-vital bone encased by vital bone
Involucrum
- A chronic form of chronic osteomyelitis
- Osteomyelitis with proliferative periostitis
- Periosteal rxn in which layers of reactive vital bone are formed producing cortical expansion
- Seen most frequently in children and young adults in the mand molar and premolar area involving the lower border of buccal cortex
Garre osteomyelitis
- Localized area of bone sclerosis associated with the apices of teeth with pulpal disease
- Seen most frequently in children and young adults involving mand molars and premolars
Condensing osteitis
- Filamentous bacteria
- Gram pos
- Anaerobic
- Normal oral flora
Actinomyces
What percentage of actinomycosis are cervicofacial?
55%
\_\_\_\_\_ actinomycosis Area of prior trauma –entry for organism ▪Soft tissue injury ▪Periodontal pocket ▪Non-vital tooth ▪Extraction socket ▪Infe cted tonsil Direct extension through soft tissue Disregards fascial planes , lymphatics “Woody” induration and fibrosis Draining sinus tracts Suppuration with “sulfur granules”
Cervicofacial actinomycosis
