sequelae of pulpal disease Flashcards

1
Q

mechanism of action: inflammation of the pulp

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

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

A

chronic hyperplastic pulpitis

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3
Q

chronic apical periodontitis-> _______->_______

A

periapical granuloma->periapical cyst

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4
Q

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

A

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

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5
Q

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

A
  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
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6
Q

mass of chronically inflamed granulation tissue (most are asymptomatic)

A

periapical granuloma

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7
Q

where does a periapical granuloma occur

A

apex of non-vital tooth

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8
Q

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

A

periapical granuloma

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9
Q

what can periapical granuloma transform into

A

periapical cyst or abscess

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10
Q

pathologic cavity located in soft tissue or bone lined by epithelium

A

cyst

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

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11
Q

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

external root resorption possible

A

periapical cyst

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12
Q

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

A

periapical abscess

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13
Q

a periapical abscess may arise as the

A

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

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14
Q

is periapical abscess symptomatic or asymptomatic

A

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

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15
Q

what are the 5 drainage pathways of acute periapical infections

A
  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)
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16
Q

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

A

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

[biopsy to find the difference]

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17
Q

intraoral opening of a sinus tract.

mass of inflamed granulation tissue with epithelialized sinus tract

A

parulis (gum boil)

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18
Q

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

A

parulis

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19
Q

is parulis acute periapical inflammation or chronic periapical inflammation

A

acute

20
Q

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

A

abscess

21
Q

dental abscess that drains extraorally, through the overlying skin

A

cutaneous sinus tract

22
Q

opening into sinus

A

oroantral fistula

23
Q

sinus tract vs. fistulous tract
what is this^

-from within to the exterior
-parulis is the end

A

sinus tract

24
Q

sinus tract vs. fistulous tract
what is this^

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

A

fistula

25
Q

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

A

cellulitis

26
Q

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

A

cellulitis

27
Q

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

A

Ludwig’s Angina

spaces:
submental, sublingual, submandibular

28
Q

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

A

ludwig’s angina
[medical emergency!]

29
Q

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

A

cavernous sinus thrombosis

30
Q

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

A

cavernous sinus thrombosis

31
Q

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

A

osteomyelitis

32
Q

what are predispositions that can cause osteomylitis

A

-chronic systemic diseases
-immunodeficiency
-decreased vascularity of bone

33
Q

acute vs chronic osteomylitis

A

acute
-spread through medullary spaces
-minimal tissue reaction
-more painful

chronic
-prominent tissue reaction: granulation tissue and fibrosis
-less painful

34
Q

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

A

sequestrum

35
Q

non-vital bone, encased by vital bone

A

involucrum

(dots inside bone)

36
Q

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

A

proliferative periostitis

37
Q

osteomyelitis with proliferative periostitis =

A

garre osteomyelitis

38
Q

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

A

proliferative periostitis (when you see onion on scan)

39
Q

what occurs with proliferative periostitis

A

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

40
Q

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

A

condensing osteitis
(focal chronic sclerosing osteomyelitis)

41
Q

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

A

actinomycosis

42
Q

actinomyces species “ray fungus”

A

actinomyces israelii
and
actinomyces viscosus

43
Q

most common classification of actinomycosis

A

cervico-facial 55%

44
Q

cevical-facial actinomycosis:

A

-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”

45
Q

“lumpy jaw disease”

A

cervico-facial actinomyocosis

46
Q

sulfur granules found in

A

cervico-facial actinomyocosis

47
Q
A