sequelae of pulpal disease

Question 1

mechanism of action: inflammation of the pulp

Answer 1

1. limited blood supply
2. no collateral support
3. destructive
4. expansile process (bv dilation, leakage of fluid into surrounding tissue, migration of cells)

Question 2

when soft tissue comes through tooth (pyogenic granuloma)
found in kids and not painful

Answer 2

chronic hyperplastic pulpitis

Question 3

chronic apical periodontitis-> _______->_______

Answer 3

periapical granuloma->periapical cyst

Question 4

acute= periapical abscess-> _______-> 1. 2. 3.

Answer 4

osteomylitis-> 1. chronic osteomylitis 2. cellulitis 3. garre osteomyelitis

Question 5

periapical lesions:
1. presence of _____ or _____ _____
2. virulence of involved _______
3. extent of _____ of dentinal tubules
4. competency of host _____ ______

Answer 5

1. presence of open or closed pulpitis
2. virulence of involved microorganism
3. extent of sclerosis of dentinal tubules
4. competency of host immune response

Question 6

mass of chronically inflamed granulation tissue (most are asymptomatic)

Answer 6

periapical granuloma

Question 7

where does a periapical granuloma occur

Answer 7

apex of non-vital tooth

Question 8

may develop as the initial periapical pathosis
or
arise after an initial periapical abscess

Answer 8

periapical granuloma

Question 9

what can periapical granuloma transform into

Answer 9

periapical cyst or abscess

Question 10

pathologic cavity located in soft tissue or bone lined by epithelium

Answer 10

cyst

*all cysts have lumen (empty), CT wall, lining

Question 11

asymptomatic, slow growing lesion associated with the root apex of a non-vital tooth

external root resorption possible

Answer 11

periapical cyst

Question 12

accumulation of acute inflammatory cells at the apex of a non-vital tooth

Answer 12

periapical abscess

Question 13

a periapical abscess may arise as the

Answer 13

initial periapical pathosis or as an acute exacerbation of chronic periapical lesion (phoenix abscess)

Question 14

is periapical abscess symptomatic or asymptomatic

Answer 14

generally symptomatic, but may be asym. if there is a lack of accumulation of purulent material due to chronic path of drainage

Question 15

what are the 5 drainage pathways of acute periapical infections

Answer 15

1. surface of the gingiva (parulis)
2. palate (palatal abscess)
3. soft tissue spaces (cellulitis)
4. maxillary sinus
5. floor of mouth (Ludwig Angina- ER)

Question 16

how can you tell the difference between cyst, abscess, and granuloma since all deal with non-vital tooth?

Answer 16

cyst- epithelial lining
abscess- sea of neutrophils
granuloma- granulation tissue

[biopsy to find the difference]

Question 17

intraoral opening of a sinus tract.

mass of inflamed granulation tissue with epithelialized sinus tract

Answer 17

parulis (gum boil)

Question 18

when purulent material perforates through bone, periosteum, soft tissue, epithelium, and drains through intraoral sinus

Answer 18

parulis

Question 19

is parulis acute periapical inflammation or chronic periapical inflammation

Answer 19

acute

Question 20

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

Answer 20

abscess

Question 21

dental abscess that drains extraorally, through the overlying skin

Answer 21

cutaneous sinus tract

Question 22

opening into sinus

Answer 22

oroantral fistula

Question 23

sinus tract vs. fistulous tract
what is this^

-from within to the exterior
-parulis is the end

Answer 23

sinus tract

Question 24

sinus tract vs. fistulous tract
what is this^

-connects two anatomic cavities
-oroantral, oronasal
-tracheo-esophageal

Answer 24

fistula

Question 25

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

Answer 25

cellulitis

Question 26

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

Answer 26

cellulitis

Question 27

aggressive, rapidly spreading cellulitis involving multiple anatomic spaces such as:

Answer 27

Ludwig's Angina spaces: submental, sublingual, submandibular

Question 28

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

Answer 28

ludwig's angina [medical emergency!]

Question 29

valveless venous system may allow retrograde spread of infection from middle third of the face (can lead up to brain)

Answer 29

cavernous sinus thrombosis

Question 30

formation of a blood clot within the cavernous sinus, a major dural venous sinus, life-threatening infection -may be associated with spread of infection from maxillary teeth

Answer 30

cavernous sinus thrombosis

Question 31

bacterial infection of bone -odontogenic infection -traumatic fracture of bone -NUG, NOMA (developing countries)

Answer 31

osteomyelitis

Question 32

what are predispositions that can cause osteomylitis

Answer 32

-chronic systemic diseases -immunodeficiency -decreased vascularity of bone

Question 33

acute vs chronic osteomylitis

Answer 33

acute -spread through medullary spaces -minimal tissue reaction -more painful chronic -prominent tissue reaction: granulation tissue and fibrosis -less painful

Question 34

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

Answer 34

sequestrum

Question 35

non-vital bone, encased by vital bone

Answer 35

involucrum (dots inside bone)

Question 36

-form of chronic osteomyelitis -periosteal reaction in which layers of reactive vital bone are formed, producing cortical expansion

Answer 36

proliferative periostitis

Question 37

osteomyelitis with proliferative periostitis =

Answer 37

garre osteomyelitis

Question 38

what is seen most frequently in children and young adults in the mandibular molar and premolar area involving the lower border or buccal cortex

Answer 38

proliferative periostitis (when you see onion on scan)

Question 39

what occurs with proliferative periostitis

Answer 39

periosteal reaction in which layers of reactive vital bone are formed, producing cortical expansion

Question 40

localized area of bone sclerosis associated with apices of teeth with pulpal disease -seen mostly in children and young adults involving the mandibular molars and premolars

Answer 40

condensing osteitis (focal chronic sclerosing osteomyelitis)

Question 41

"ray fungus" -root fungal infection, bacterial infection -gram positive -anaerobic -normal oral flora

Answer 41

actinomycosis

Question 42

actinomyces species "ray fungus"

Answer 42

actinomyces israelii and actinomyces viscosus

Question 43

most common classification of actinomycosis

Answer 43

cervico-facial 55%

Question 44

cevical-facial actinomycosis:

Answer 44

-area of prior trauma- entry for organism -direct extension through soft tissue -disregards fascial plans, lymphatics -"woody" induration and fibrosis (hardened areas) -draining sinus tracts -suppuration with "sulfur granules"

Question 45

"lumpy jaw disease"

Answer 45

cervico-facial actinomyocosis

Question 46

sulfur granules found in

Answer 46

cervico-facial actinomyocosis