SEQUELAE OF PULPAL DISEASE Flashcards
PULPITIS (4)
Inflammation of the pulpal tissue
Reversible vs irreversible
Acute vs chronic
Symptomatic vs asymptomatic
MECHANISM OF ACTION:
INFLAMMATION OF THE PULP (4)
Limited blood supply
No collateral support
D e s t ruct ive
E x p ansi le p roces s
E x p ansi le p roces s
(3)
▪ Blood vessel dilation
▪ Leakage of fluid into surrounding tissue
▪ Migration of cells
PERIAPICAL LESIONS
Presence of (2) pulpitis
opened or closed
PERIAPICAL LESIONS
— of involved microorganism
Virulence
PERIAPICAL LESIONS
Extent of — of dentinal tubules
sclerosis
PERIAPICAL LESIONS
— of host immune response
Competency
PERIAPICAL GRANULOMA
mass of chronically inflamed granulation tissue
PERIAPICAL GRANULOMA
location
apex of non vital tooth
PERIAPICAL GRANULOMA
most are
asymptomatic
PERIAPICAL GRANULOMA
misnomer
not true granulomatous inflammation
PERIAPICAL GRANULOMA
may develop as the
initial periapical pathosis or arise after an initial periapical abscess
PERIAPICAL GRANULOMA
may transform into (2)
periapical cyst
abscess
DEFINITION OF A CYST
pathologic cavity located in soft tissue or bone lined by epithelium
APICAL PERIODONTAL CYST
(PERIAPICAL CYST)
an — cyst
inflammatory
APICAL PERIODONTAL CYST
(PERIAPICAL CYST)
asymptomatic, slow growing lesion associated with the root apex of a non-vital tooth
APICAL PERIODONTAL CYST
(PERIAPICAL CYST)
— possible
external root resorption
PERIAPICAL ABSCESS
accumulation of
acute inflammatory cells at the apex of a nonvital tooth
PERIAPICAL ABSCESS
may arise as the initial
periapical pathosis or as an acute exacerbation of chronic periapical lesion (phoenix abscess)
PERIAPICAL ABSCESS
generally,
symptomatic, but may be asymptomatic if there is a lack of accumulation of purulent material due to a chronic path of drainage
DRAINAGE PATHWAYS OF ACUTE
PERIAPICAL INFECTIONS (5)
1 . S ur f ace o f t h e g i ngi va ( p arulis )
2 . P al ate ( p al atal a b s ces s)
3 . M ax i llar y s i nus
4 . S o f t t i s s ue s p aces ( c e ll ulit is)
5 . F l oor o f m ou t h ( Lu dw ig A n g ina)
PARULIS (GUM BOIL) (2)
acute periapical inflammation
purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus
a parulis is the
intraoral opening of a sinus tract
parulis consists of
a mass of inflamed granulation tissue with an epithelialized sinus tract
ABSCESS
a localized collection of pus that has accumulated (consolidated) in a tissue cavity, producing fluctulance
CUTANEOUS SINUS TRACT
a dental abscess that drains extraorally, through the overlying skin
SINUS TRACT (2)
from within to the exterior
parulis is the end of a sinus tract
FISTULOUS TRACT (1)
connects two anatomic cavities
connects two anatomic cavities (2)
oroantral, oronasal fistula
tracheo-esophageal fistula
CELLULITIS
D i f f us e s p read o f a n a c u te
i n flamm ator y p roces s
t h rough t h e f a s c ial p l anes
o f s o f t t i s s ue p roduc ing
e r y t hema, e d ema, wa r m t h,
a n d p a i n
A b s c ess u n abl e to e s t ablis h
d r ainage i n to t h e o r al c av it y
o r o n to t h e s u r f ace o f s k i n
( s i nus t r ac t )
LUDWIG’S ANGINA
A n a g g ress ive, r a p idly
s p read ing c e l lulit is
i nvolvi ng m u lt iple a n a tomic
s p aces – t h e s u bmental ,
s ub lingual a n d
s u b mandib ular s p ac es
LUDWIG’S ANGINA
produces
m a s sive s we ll ing
o f n e c k t h at m ay ex tend
c l ose to c l av icl es a n d c a u se
a i r way o b s truc t ion
CAVERNOUS SINUS THROMBOSIS
Va l veless ve nous s y s tem m ay a l l ow r et rograde s p read o f
i nfec t ion f rom m i d dle t h i rd o f t h e f a c e
Formatio n o f a — w i t hi n t h e c avernous s i nus , a m a j or
d ural ve nous s i nus , a l i fe - th reatening i n fect ion
blood clot
M ay b e a s s oc iated w i t h s p read o f i n fec tion f rom
m ax i llar y
te et h
OSTEOMYELITIS
B a c terial i nfec t ion o f b o ne
OSTEOMYELITIS
B a c terial i nfec t ion o f b o ne
(4)
▪ Odontogenic infection
▪ Traumatic fracture of bone
▪ NUG, NOMA
- Developing countries
OSTEOMYELITIS
P re dis pos iti on
(3)
▪ Chronic systemic diseases
▪ Immunodeficiency
▪ Decreased vascularity of bone
Ac u te o s te o mye l i t i s
(2)
▪ Spread through medullar y spaces
▪ Minimal tissue reaction
C h ro n i c o s te o mye l i t i s
(3)
▪ Prominent tissue reaction
▪ Granulation tissue
▪ Fibrosis
SEQUESTRUM
f r agment o f n e c rot ic b o ne s e p arated f rom
a d j ac ent v i t al b o ne t h at u s u ally u nd ergoes s p ont aneous
ex fol iati on
INVOLUCRUM
nonvital b o ne, e n c as ed by v i t al b o ne
PROLIFERATIVE PERIOSTITIS
form of
chronic osteomyelitis
osteomyelitis with proliferative periostitis,
garre osteomyelitis
PROLIFERATIVE PERIOSTITIS
a periosteal rxn in which layers of
reactive vital bone are formed, producing cortical expansion
PROLIFERATIVE PERIOSTITIS
seen most frequently in
children and young adults in the mandibular molar and premolar area involving the lower bored or buccal cortex
CONDENSING OSTEITIS
(FOCAL CHRONIC
SCLEROSING OSTEOMYELITIS)
localized area of bone sclerosis associated with the apices of teeth with pulpal disease
CONDENSING OSTEITIS
(FOCAL CHRONIC
SCLEROSING OSTEOMYELITIS)
seen most frequently in
children and young adults involving the mandibular molars and premolars
A c t inomyces s p e cies
(2)
▪ Actinomyces israelii
▪ Actinomyces viscosus
F i lam entous b a c teria
(3)
▪ Branching
▪ Gram positive
▪ Anaerobic
ACTINOMYCOSIS – “RAY FUNGUS” (3)
actinomyces species
filamentous bacteria
normal oral flora
CLASSIFICATION OF ACTINOMYCOSIS
C e r vico - Faci al –
A b d omino - p elvic –
P u l monar y –
55 %
25 %
15 %
CERVICO-FACIAL ACTINOMYCOSIS
A r e a o f p r i o r t r a u m a – e n t r y f o r o r g a n i s m
(5)
▪ Sof t tissue injur y
▪ Periodontal poc ket
▪ Non -vital tooth
▪ Extraction soc ket
▪ Infected tonsil
CERVICO-FACIAL ACTINOMYCOSIS
direct extension through
soft tissue
CERVICO-FACIAL ACTINOMYCOSIS
disregards (2)
fascial planes, lymphatics
CERVICO-FACIAL ACTINOMYCOSIS
induration and fibrosis
woody
CERVICO-FACIAL ACTINOMYCOSIS
draining
sinus tracts
CERVICO-FACIAL ACTINOMYCOSIS
suppuration with
sulfur granules
