Sequelae of Pulpal Disease Flashcards
what is pulpitis
inflammation of pulpal tissue
what are the types of pulpitis
reversible and irreversible
- acute vs chronic
- symptomatic vs asymptomatic
what is the mechanism of action of the inflammation of pulp
- limited blood supply
- no collateral support
- destructive
-expansile process: BV dilation, leakage of fluid into surrounding tissue, migration of cells
what patients get chronic hyperplastic pulpitis
pediatric patients
what is another name for chronic hyperplastic pulpitis
pulp polyp
what is the sequelae of chronic bacterial pulpitis
- chronic apical periodontitis
- periapical granuloma
- periapical cyst
what is the sequelae of acute bacterial pulpitis
- periapical abscess -> osteomyelitis -> chronic osteomyelitis or cellulitis or garre osteomyelitis
what do you need to consider when looking at periapical lesions
- presence of opened or closed pulpitis
- virulence of involved microorganism
- extent of sclerosis of dentinal tubules
-competency of host immune response
what is a periapical granuloma and where is it located
mass of chronically inflamed granulation tissue
- most are asymptomatic
- apex of non vital tooth
how does a periapical granuloma present on a radiograph
periapical radiolucency
how do periapical granulomas occur
- initial periapical pathosis or after an initial periapical abscess
what may a periapical granuloma transform into
a periapical cyst or abscess
what is the treatment for a periapical granuloma
RCT
what is a cyst
pathologic cavity located in soft tissue or bone lined by epitheliuma
what are the 3 components of a cyst
-lumen
- wall
- lining
what do all cysts have
epithelial lining
what is a periapical cyst caused by
when inflammation causes rests of malassez to proliferate which causes the formation of cystic activity
what is an apical periodontal cyst
- an inflammatory cyst
- asymptomatic slow growing lesion associated with the root apex of a non vital tooth
- external root resorption possible
what is a periapical abscess
-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
what may a periapical abscess arise as
the initial periapical pathosis or as an acute exacerbation of chronic periapical lesion
what is the way to determine between a periapical cyst, granuloma, and abscess
a biopsy/histology
what cells are seen in periapical granuloma
all inflammatory cells
what cells are seen in periapical cyst
acute inflammatory cells and fibrous CT and epithelium lining
what cells are seen in periapical abscess
neutrophils
what are the drainage pathways of acute periapical infections
- surface of the gingiva (parulis)
- palate (palatal abscess)
- maxillary sinus
- soft tissue spaces (cellulitis)
- floor of mouth (ludwig angina)
what is a parulis (gum boil)
- acute periapical inflammation
- purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus
what is a parulis
the intraoral opening of a sinus tract
what does a parulis consist of
a mass of inflamed granulation tissue with an epithelialized sinus tract
what is an abscess
a localized collection of pus that has accumulated in a tissue cavity, producing fluctuance
what is the cutaneous sinus tract
a dental abscess that drains extraorally through the overlying skin
what is a fistula
a communication between two anatomical sites
where is the sinus tract
from within to the exterior
what is the end of the sinus tract
the parulis
what is an oroantral fistula
a fistula that connects the mouth and maxillary sinus
what is cellulitis
diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth, and pain
why does abscess in cellulitis accumulate
the abscess is unable to establish drainage into the oral cavity or onto the surface of skin (sinus tract)
what types of cells are seen in a histological slide of cellulitis
many different inflammatory cells
what is trismus
difficulty opening mouth
what is Ludwig’s angina
an aggressive, rapidly spreading cellulitis involving multiple anatomic spaces- submental, submandibualr, and sublingual spaces
what can Ludwigs angina cause
massive swelling of neck that may extend close to clavicels and cause airway obstruction
what is cavernous sinus thrombosis
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
what can cavernous sinus thrombosis be associated with
spread of infection from maxillary teeth
what is inside the cavernous sinus
- internal carotid artery
- CN III- oculomotor
- CN IV - trochlear
-CN V - trigeminal - only V1 and V2
-CNVI - abducens
what is osteomyelitis
bacterial infection of bone
what are the causes of osteomyelitis
-odontogenic infection
- traumatic fracture of bone
- NUG, NOMA
what are the predispositions to osteomyelitis
-chronic systemic diseases
- immunodeficiency
- decreased vascularity of bone
what is acute osteomyelitis
- spread through medullary spaces
- minimal tissue reaction
what is chronic osteomyelitis
- prominent tissue reaction
- granulation tissue
- fibrosis
what can osteomyelitis occur after
mandibular fracture
what is a sequestrum
a fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation
what are examples of sequestrum
bisphosphonates causes osteonecrosis of mandible and radiation therapy causes osteoradionecrosis
what is involucrum
non vital bone, encased by vital bone
what is another name for proliferative periostitis
Garre Osteomyelitis
what is proliferative periostisis
- a form of chronic osteomyelitis
- osteomyelitis with proliferative periostitis
- a periosteal reaction in which layers of reactive vital bone are formed producing cortical expansion
what population is proliferative periostitis seen in
children and young adults in the mandibular molar and premolar area involving the lower border of the buccal cortex
what are the steps in proliferative periostitis
inflammtory focus -> periosteal reaction -> resolution
what is another name for chronic focal sclerosing osteomyelitis
Condensing osteitis
what is condensing osteitis
localized area of bone sclerosis associated with the apices of teeth with pulpal disease
what population is condensing osteitis seen in
children and young adults involving the mandibular molars and premolars
what tooth type is associated with condensing osteitis
non vital tooth
how does condensing osteitis appear on a radiograph
periapical radiopacity
what is another name for actinomycosis
Ray fungus
what are the actinomyces species in actinomycosis
- actinomyces israelli
- actinomyces viscosus
what are the filamentous bacteria in actinomycosis
- branching
- gram positive
- anaerobic
what type of infection is actinomycosis
bacterial
what are the classifications of actinomycosis and the prevalence of each
- cervico facial: 55%
- abdomino pelvic: 25%
- pulomary: 15%
where can the organism enter to cause ccervico facial actinomycosis
- soft tissue injury
- periodontal pocket
- non vital tooth
- extraction socket
- infected tonsil
describe cervico facial actinomycosis
- direct extension through soft tissue
- disregards fascial planes, lymphatics
- woody induration and fibrosis
- draining sinus tracts
- suppuration with sulfur granules
what is another name for cervico facial actinomycosis
lumpy jaw disease
what is the radiographic presentation of cervicofacial actinomycosis
radiolucency
