Sequellae of Pulp Necrosis

Question 1

What is a periapical granuloma?

Answer 1

• chronic
• focus of granulation tissue infiltrated by variable numbers of chronic inflammatory cells
• inflammation initiated and maintained by the degradation products of necrotic pulp tissue
• collagenase and osteoclast-activating factor (OAF) are present

Question 2

What is a periapical cyst?

Answer 2

• inflammatory proliferation of cell rests of Malassez
• generally do not expand bone
• lumen may contain abundant cellular debris
• lined by nonkeratinized stratified squamous epithelium

Question 3

What two influences lead to an enlargement of a periapical cyst?

Answer 3

• epithelial growth factor

- osmotic pressure

Question 4

What is a follicular cyst?

Answer 4

• non-inflammatory cysts of developmental origin

- fluid accumulation between reduced enamel epithelium and enamel

Question 5

What is a periapical abscess?

Answer 5

• acute abscess associated with severe pain from pressure and effects of chemical mediators on nerve tissue
• develop rapidly
• direction of spread is determined by relation of root apex to bone cortex

Question 6

What are space abscesses?

Answer 6

• Abscess the falls within specific facial planes/spaces
• submanidublar- below mylohyoid
• sublingual - above mylohyoid
• inside mouth on medical buccintor, extraorally within the cheek on lateral of buccinator
• NOTE: roots of posterior teeth are more likely above mylohyoid

Question 7

What is Cavernous Sinus Thrombosis?

Answer 7

venous drainage of superior facial structures (including maxillary teeth) is through the facial veins - these anastomose with the opthalamic veins and thus can result in the spread of infection to the cavernous sinus

Question 8

Which cranial nerves may be affected by cavernous sinus thrombosis?

Answer 8

iii - oculomotor
iv - trochlear
vi - abducens
v - opthalmic and max branch of trigeminal

Question 9

What is osteomyelitis?

Answer 9

• most frequent results from extension of periapical abscess (pain, fever, elevated WBC’s)
• moth-eaten pattern of radiolucency
• may see sequestra of necrotic bone

Question 10

What is Garré’s osteomyelitis?

Answer 10

• especially infected manidublar molars in young paitents
• asymptomatic bony hard swelling
• periosteal reaction of cortical bone

Question 11

What is Focal Sclerosing Osteomyelitis?

Answer 11

• aka condensing osteitis, focal osteosclerosis
• common focal bony reaction to a low-grade inflammatory stimulus
• usually seen at apex of tooth with chronic pulpitis but can sometimes affect vital tooth

Question 12

What are differential diagnoses of focal sclerosing osteromyelitis?

Answer 12

• periapical cemental dysplasia
• hypercementosis
• no intervening periodontal ligament space between root outline and sclerotic