Sequelae of Pulpal Disease

Question 1

what is pulpitis

Answer 1

inflammation of pulpal tissue

Question 2

what are the types of pulpitis

Answer 2

reversible and irreversible
- acute vs chronic
- symptomatic vs asymptomatic

Question 3

what is the mechanism of action of the inflammation of pulp

Answer 3

• limited blood supply
• no collateral support
• destructive
  -expansile process: BV dilation, leakage of fluid into surrounding tissue, migration of cells

Question 4

what patients get chronic hyperplastic pulpitis

Answer 4

pediatric patients

Question 5

what is another name for chronic hyperplastic pulpitis

Answer 5

pulp polyp

Question 6

what is the sequelae of chronic bacterial pulpitis

Answer 6

• chronic apical periodontitis
• periapical granuloma
• periapical cyst

Question 7

what is the sequelae of acute bacterial pulpitis

Answer 7

• periapical abscess -> osteomyelitis -> chronic osteomyelitis or cellulitis or garre osteomyelitis

Question 8

what do you need to consider when looking at periapical lesions

Answer 8

• presence of opened or closed pulpitis
• virulence of involved microorganism
• extent of sclerosis of dentinal tubules
  -competency of host immune response

Question 9

what is a periapical granuloma and where is it located

Answer 9

mass of chronically inflamed granulation tissue
- most are asymptomatic
- apex of non vital tooth

Question 10

how does a periapical granuloma present on a radiograph

Answer 10

periapical radiolucency

Question 11

how do periapical granulomas occur

Answer 11

• initial periapical pathosis or after an initial periapical abscess

Question 12

what may a periapical granuloma transform into

Answer 12

a periapical cyst or abscess

Question 13

what is the treatment for a periapical granuloma

Answer 13

RCT

Question 14

what is a cyst

Answer 14

pathologic cavity located in soft tissue or bone lined by epitheliuma

Question 15

what are the 3 components of a cyst

Answer 15

-lumen
- wall
- lining

Question 16

what do all cysts have

Answer 16

epithelial lining

Question 17

what is a periapical cyst caused by

Answer 17

when inflammation causes rests of malassez to proliferate which causes the formation of cystic activity

Question 18

what is an apical periodontal cyst

Answer 18

• an inflammatory cyst
• asymptomatic slow growing lesion associated with the root apex of a non vital tooth
• external root resorption possible

Question 19

what is a periapical abscess

Answer 19

-accumulation of acute inflammatory cells at the apex of a non vital tooth
- generally symptomatic but may be asymptomatic if there is a lack of accumulation of purulent material due to chronic path of drainage

Question 20

what may a periapical abscess arise as

Answer 20

the initial periapical pathosis or as an acute exacerbation of chronic periapical lesion

Question 21

what is the way to determine between a periapical cyst, granuloma, and abscess

Answer 21

a biopsy/histology

Question 22

what cells are seen in periapical granuloma

Answer 22

all inflammatory cells

Question 23

what cells are seen in periapical cyst

Answer 23

acute inflammatory cells and fibrous CT and epithelium lining

Question 24

what cells are seen in periapical abscess

Answer 24

neutrophils

Question 25

what are the drainage pathways of acute periapical infections

Answer 25

- surface of the gingiva (parulis) - palate (palatal abscess) - maxillary sinus - soft tissue spaces (cellulitis) - floor of mouth (ludwig angina)

Question 26

what is a parulis (gum boil)

Answer 26

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

Question 27

what is a parulis

Answer 27

the intraoral opening of a sinus tract

Question 28

what does a parulis consist of

Answer 28

a mass of inflamed granulation tissue with an epithelialized sinus tract

Question 29

what is an abscess

Answer 29

a localized collection of pus that has accumulated in a tissue cavity, producing fluctuance

Question 30

what is the cutaneous sinus tract

Answer 30

a dental abscess that drains extraorally through the overlying skin

Question 31

what is a fistula

Answer 31

a communication between two anatomical sites

Question 32

where is the sinus tract

Answer 32

from within to the exterior

Question 33

what is the end of the sinus tract

Answer 33

the parulis

Question 34

what is an oroantral fistula

Answer 34

a fistula that connects the mouth and maxillary sinus

Question 35

what is cellulitis

Answer 35

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

Question 36

why does abscess in cellulitis accumulate

Answer 36

the abscess is unable to establish drainage into the oral cavity or onto the surface of skin (sinus tract)

Question 37

what types of cells are seen in a histological slide of cellulitis

Answer 37

many different inflammatory cells

Question 38

what is trismus

Answer 38

difficulty opening mouth

Question 39

what is Ludwig's angina

Answer 39

an aggressive, rapidly spreading cellulitis involving multiple anatomic spaces- submental, submandibualr, and sublingual spaces

Question 40

what can Ludwigs angina cause

Answer 40

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

Question 41

what is cavernous sinus thrombosis

Answer 41

valveless venous system may allow retrograde spread of infection from middle third of face - formation of a blood clot within cavernous sinus, a major dural venous sinus, life threatening

Question 42

what can cavernous sinus thrombosis be associated with

Answer 42

spread of infection from maxillary teeth

Question 43

what is inside the cavernous sinus

Answer 43

- internal carotid artery - CN III- oculomotor - CN IV - trochlear -CN V - trigeminal - only V1 and V2 -CNVI - abducens

Question 44

what is osteomyelitis

Answer 44

bacterial infection of bone

Question 45

what are the causes of osteomyelitis

Answer 45

-odontogenic infection - traumatic fracture of bone - NUG, NOMA

Question 46

what are the predispositions to osteomyelitis

Answer 46

-chronic systemic diseases - immunodeficiency - decreased vascularity of bone

Question 47

what is acute osteomyelitis

Answer 47

- spread through medullary spaces - minimal tissue reaction

Question 48

what is chronic osteomyelitis

Answer 48

- prominent tissue reaction - granulation tissue - fibrosis

Question 49

what can osteomyelitis occur after

Answer 49

mandibular fracture

Question 50

what is a sequestrum

Answer 50

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

Question 51

what are examples of sequestrum

Answer 51

bisphosphonates causes osteonecrosis of mandible and radiation therapy causes osteoradionecrosis

Question 52

what is involucrum

Answer 52

non vital bone, encased by vital bone

Question 53

what is another name for proliferative periostitis

Answer 53

Garre Osteomyelitis

Question 54

what is proliferative periostisis

Answer 54

- a form of chronic osteomyelitis - osteomyelitis with proliferative periostitis - a periosteal reaction in which layers of reactive vital bone are formed producing cortical expansion

Question 55

what population is proliferative periostitis seen in

Answer 55

children and young adults in the mandibular molar and premolar area involving the lower border of the buccal cortex

Question 56

what are the steps in proliferative periostitis

Answer 56

inflammtory focus -> periosteal reaction -> resolution

Question 57

what is another name for chronic focal sclerosing osteomyelitis

Answer 57

Condensing osteitis

Question 58

what is condensing osteitis

Answer 58

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

Question 59

what population is condensing osteitis seen in

Answer 59

children and young adults involving the mandibular molars and premolars

Question 60

what tooth type is associated with condensing osteitis

Answer 60

non vital tooth

Question 61

how does condensing osteitis appear on a radiograph

Answer 61

periapical radiopacity

Question 62

what is another name for actinomycosis

Answer 62

Ray fungus

Question 63

what are the actinomyces species in actinomycosis

Answer 63

- actinomyces israelli - actinomyces viscosus

Question 64

what are the filamentous bacteria in actinomycosis

Answer 64

- branching - gram positive - anaerobic

Question 65

what type of infection is actinomycosis

Answer 65

bacterial

Question 66

what are the classifications of actinomycosis and the prevalence of each

Answer 66

- cervico facial: 55% - abdomino pelvic: 25% - pulomary: 15%

Question 67

where can the organism enter to cause ccervico facial actinomycosis

Answer 67

- soft tissue injury - periodontal pocket - non vital tooth - extraction socket - infected tonsil

Question 68

describe cervico facial actinomycosis

Answer 68

- direct extension through soft tissue - disregards fascial planes, lymphatics - woody induration and fibrosis - draining sinus tracts - suppuration with sulfur granules

Question 69

what is another name for cervico facial actinomycosis

Answer 69

lumpy jaw disease

Question 70

what is the radiographic presentation of cervicofacial actinomycosis

Answer 70

radiolucency