Sequelae of Pulpal Disease Flashcards
inflammation of the pulpal tissue:
pulpitis
What are the three classifications of pulpitis?
- reversible vs. irreversible
- acute vs. chronic
- symptomatic bs. asymptomatic
During inflammation of the pulp, describe the blood supply and collateral support:
limited blood supply; no collateral support
The expansile process of inflammation of the pulp includes:
- blood vessel dilation
- leakage of fluid into surrounding tissue
- migration of cells
pulp is alive, tooth can heal:
reversible pulpitis
pulp is dead, tooth cannot heal, even once irritant is removed
irreversible pulpitis
can occur as a result of irreversible pulpitis:
pulpal necrosis
- blood supply of tooth is severed
- tooth is discolored (grey)
pulpal necrosis
pulpitis characterized by sudden onset and symptomatic:
acute pulpitis
In acute pulpitis there is a collection of ____ ( ____)
neutrophils; abscess
exudate enclosed within chambers, builds pressure:
abscess
acute pulpitis can progress to:
- osteomyelitis
- PA abscess
pulpitis characterized by longer process and asymptomatic:
chronic pulpitis
Less irritant within the pulpal chamber occurs with:
chronic pulpitis
chronic pulpitis can progress to:
- periodontitis
- PA granuloma
- PA cyst
Chronic hyperplastic pulpitis is seen mostly in:
primary teeth (children)
What might cause the pulpal tissue to become hyperplastic in chronic hyperplastic pulpitis?
constant, long-standing irritant
Discuss the symptoms of chronic hyperplastic pulpitis:
asymptomatic
What causes the pulp polyp in chronic hyperplastic pulpitis?
proliferation of granulation tissue
due to the pulp being contained in a rigid, non-expansive tooth cavity, ____ occurs in pulpal inflammation
destruction
The presence of open or closed pulpitis occurs in:
periapical lesions
virulence of involved ____ occurs in periapical lesions
microorganism
In a periapical lesion we may see extent of ____ of ____
sclerosis; dentinal tubules
What is important in resolving PA lesions?
competency of host immune response
Cysts, granulomas and abscesses on a radiograph all appear:
radiolucent
Mass of chronically-inflamed granulation tissue:
PA granuloma
Where is a PA granuloma located?
apex of non-vital tooth
Most PA granulomas are:
asymptomatic
What is an absolute must in order to have a periapical granuloma?
NON-VITAL TOOTH
Is a PA granuloma considered a true granuloma?
NO- its just granulation tissue (not true granulomatous inflammation)
What is seen in this image?
periapical radiolucency (PA granuloma)
A periapical granuloma may develop as the initial ____ or arise after an initial ____.
periapical pathosis; periapical abscess
A periapical granuloma may transform into:
- periapical cyst
- periapical abscess
What type of inflammation is involved with periapical granulomas? What cells are present?
chronic inflammation; plasma cells, macrophages & lymphocytes
What are frequently seen with PA granulomas?
cholesterol clefts; giant multinucleated cells
This image shows:
periapical granuloma
This image shows:
periapical granuloma
This image shows:
periapical granuloma
This image shows a periapical granuloma. What helps to diagnose this?
presence of neutrophils, plasma cells, and macrophages
pathologic cavity located in soft tissue or bone lined by epithelium:
cyst
In order to have a cyst, what is an absolute must?
epithelial lining
Components of a cyst include:
- wall (connective tissue wall)
- lumen (can be filled or empty)
- lining (epithelial lining)
creates epithelial lining surrounding cavity of a cyst:
rest of malassez
The epithelial lining of a cyst is derived from:
rest of malassez
This image shows:
rest of malassez
A periapical cyst may also be called: (2)
radicular cyst or apical periodontal cyst
Pathologically, how can you differentiate a periapical cyst from a periapical granuloma?
The presence of an epithelial lining
An inflammatory cyst that is an asymptomatic, slow-growing lesion associated with the root apex of a non-vital tooth:
periapical cyst
external root resorption may be possible with:
PA cyst
Accumulation of acute inflammatory cells at the apex of a non-vital tooth:
periapical abscess
What is an absolute must for a periapical abscess?
NON-VITAL TOOTH!
A periapical abscess may arise as the initial ____ or as an ____ (____).
Initial periapical pathosis; an acute exacerbation of chronic periapical lesion (phoenix abscess)
Acute exacerbation of chronic periapical lesion:
phoenix abscess
A localized collection of pus that has accumulated in a tissue cavity, producing swelling:
abscess
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
When might a periapical abscess be asymptomatic?
If there is a lack of accumulation of purulent material due to a chronic path of drainage
Pathologically how can you differentiate between a periapical abscess vs. a periapical granuloma?
by the presence of acute or chronic inflammatory cells
PA Abscess: Acute inflammation = neutrophils
PA granuloma: Chronic inflammation = plasma cells, macrophages & lymphocytes
This image shows a _____. How can we be sure?
PA abscess; lots of neutrophils
List the drainage pathways of acute periapical infections: (5)
- surface of gingiva (parulis)
- palate (palatal abscess)
- maxillary sinus
- soft tissue spaces (cellulitis)
- floor of mouth (ludwig angina)
Label the following drainage pathways of acute inflammation:
- surface of gingiva (parulis)
- palate (palatal abscess)
- maxillary sinus
- soft tissue spaces (cellulitis)
- floor of mouth (ludwig angina)
The following image shows:
dental abscess
Gum boil:
parulis
- acute periapical inflammation in which purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus:
parulis
What does a parulis consist of?
a mass of inflamed granulation tissue with an epithelized sinus tract
The intraoral opening of a sinus tract/ terminal end of sinus tract:
parulis
What can be seen in the following image?
parulis
What can be seen in the following image?
parulis
A localized collection of pus that has accumulated (consolidated) in a tissue cavity, producing fluctuance:
abscess
Microscopically what do you see in an abscess?
neutrophils
A dental abscess that drains extraorally, through the overlying skin (from within):
cutaneous sinus tract
What can be seen in this image?
cutaneous sinus tract
connects two anatomic cavities:
fistula
connects sinus to oral cavity:
oroantral fistula
Fistulas are usually the result of:
some kind of trauma or surgery
Give two examples of fistulas:
- oroantral fistula
- tracheo-esophageal fistula
Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth and pain:
cellulitis
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
If a patient has trouble opening mouth secondary to cellulitis:
trismus
An aggressive, rapidly spreading cellulitis involving multiple anatomic spaces:
Ludwig’s Angina
What are some anatomic spaces that Ludwigs angina may involve?
- submental space
- sublingual space
- submandibular space
What makes Ludwigs angina a medical emergency?
produces massive swelling of neck that may extend close to clavicles and cause airway obstruction
Valveless venous system may allow retrograde spread of infection from middle third of the face:
cavernous sinus thrombosis
Cavernous sinus thrombosis is considered a:
medical emergency
Cavernous sinus thrombosis is characterized by the formation of a _____ within the ____, a major dural venous sinus resulting in a life-threatening infection
blood clot; cavernous sinus
The cavernous sinus is a major:
dural venous sinus
Cavernous sinus thrombosis may be associated with spread of infection from:
maxillary teeth
This image shows:
Trismus (secondary to cellulitis)
This image shows:
Ludwig’s Angina
This image shows:
Cavernous Sinus Thrombosis
What are the significant anatomical structures passing through the cavernous sinus? (5)
A) internal carotid artery
B) CN 3- Oculomotor
C) CN4- Trochlear
D) CN 5- Trigeminal (V1- opthalmic, V2-maxillary)
E) CN6- Abducens
Bacterial infection of bone:
osteomyelitis
Odontogenic infection or traumatic fracture of bone are both causes for:
osteomyelitis
NUG
Necrotizing ulcerative gingivitis
NOMA
Necrosis that extends to cutaneous tissue
Both NOMA and NUG are associated with:
Osteomyelitis
Predispositions to osteomyelitis include: (3)
- chronic systemic diseases
- immunodeficiency
- decreased vascularity of bone
Type of osteomyelitis characterized by spread through medullary spaces with minimal tissue reaction:
acute osteomyelitis
Type of osteomyelitis characterized by a prominent tissue reaction involving granulation tissue and fibrosis:
chronic osteomyelitis
How does osteomyelitis appear radiographically?
radiopaque
A fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation:
sequestrum
Non-vital bone encased by vital bone (death bone surrounded by viable bone)
Involucrum
Proliferative periostitis may also be called:
Garre Osteomyelitis
A form of chronic osteomyelitis:
proliferative periostitis
Periostitis occurs on the ____ of bone
outside
In proliferative periostitis, a ____ reaction occurs in which layers of ____ are formed producing cortical expansion
periosteal reaction; reactive vital bone
Discuss where proliferative periostitis is most frequently seen:
Seen most frequently in children and young adults in the mandibular molar and proemial area involving the lower border or buccal cortex
Cortical expansion is characteristic of what disease?
proliferative periostitis
If onion staining is seen on the radiograph, this is characteristic of:
proliferative periostitis
Chronic focal sclerosis osteomyelitis may also be called:
Condensing osteitis
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:
non-vital tooth; radiopaque
Localized area of bone sclerosis associated with the apices of teeth with pupal disease:
condensing osteitis (focal chronic sclerosis osteomyelitis)
Where do we see condensing osteitis most frequently?
Seen most frequently in children and young adults involving the mandibular molars and premolars
This image is characteristic of:
condensing osteitis
actinomycosis may also be called:
ray fungus
Actinomycosis is a _____ infection
bacterial (NOT FUNGAL)
Actinomycosis is caused by: (species)
- actinomyces israelii
- actinomyces viscosus
Describe the actinomyces that cause actinomycosis: (5)
- filamentous
- branching
- gram positive
- anaerobic
- normal oral flora
What can be seen in the following image?
actinomycosis (ray fungus)
Actinomycosis can be classified as: (3) (include percentages)
- cervico-facial (55%)
- abdomino-pelvic (25%)
- pulmonary (15%)
This image shows:
cervico-facial actinomycosis
Where is the entry for the organism in cervico-facial actinomycosis?
area of prior trauma
The entry for cervico-facial actinomycosis is often an area of prior trauma and this includes: (5)
- soft-tissue injury
- periodontal pocket
- non-vital tooth
- extraction socket
- infected tonsil
Describe the extension of cervico-facial actinomycosis:
direct extension through soft tissue
What does cervico-facial actinomycosis disregard?
fascial planes & lymphatics
“woody” induration and fibrosis are terms associated with:
Cervico-fascial actinomycosis
In cervico-facial actinomycosis describe the drainage:
Draining sinus tracts & suppuration with sulfur granules
Sulfur granules (purulent exudate- yellowish crusty areas) are associated with:
cervico-facial actinomycosis
Cervico-fascial actinomycosis may also be called:
lumpy jaw disease
What disease is shown in this image?
cervico-facial actinomycosis (lumpy jaw disease)
What does this image show? What disease is this associated with?
sulfur granules; cervico-facial actinomycosis
What can be noted in this image? What disease is this associated with?
sulfur granules; cervico-facial actinomycosis
