Signs of Inflammation Flashcards by Joshua Toh

What is the best way to identify an acute apical abscess?

Acute apical abscess contains an infiltrate of lymphocytes and neutrophils.
Acute apical abscess presents asymptomatically
Acute apical abscess presents clinically with severe pain, swelling, mobility and is tender to percussion and palpation
Acute apical abscess presents radiographically with loss of apical lamina dura and resorption of apical bone

Acute apical abscess presents clinically with severe pain, swelling, mobility and is tender to percussion and palpation

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Which of the following medication increases the risk of MRONJ?
Abciximab
Dabigatran
Fosamax
Valsartan

Fosamax

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Which of the following is not a possible risk factor for MRONJ?

Increased duration of anti-resorptive therapy
Increasing age
Osteoporosis patients taking Denosumab
Cancer patients on bisphosphonates

Increasing age

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Patient might present with mobile teeth that are tender to percussion
Which of the following lesions will not present with a well-defined border?

Cemento-ossifying fibroma
Multiple myeloma
Radicular cyst
Fibrous dysplasia

Fibrous dysplasia

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On a dental radiograph, a circumscribed, well-defined radiolucent lesion of 1.5 cm diameter is observed at the apex of a tooth. Pulp vitality tests indicate presence of pulpal inflammation. Histologic tests reveal that the central cavity of the lesion is lined by stratified squamous epithelium. Which of the following is the most likely diagnosis?

Periapical granuloma
Periapical cyst
Condensing osteitis
Ameloblastoma

Periapical cyst

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A 40 year old male patient complains of pain on his lower right molar. Clinical examination reveals an amalgam restoration covering the buccal, mesial and occlusal surfaces. On taking a periapical radiograph, a diffuse radiopaque lesion is seen around the root of the tooth with widened PDL space. Which of the following is the most likely diagnosis?

condensing osteitis
Dense bone island
periapical osseous dysplasia
periapical granuloma

condensing osteitis

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What is true of Chronic Osteomyelitis of the Jaw?

Rapid onset, pain, swelling of adjacent soft tissues, fever, lymphadenopathy and leukocytosis. Mobile teeth that are TTP
Radiographic appearance starts to appear sclerotic; Lesion is often mixed RL/RO internally
Radiographically, lesion is radiolucent, round and corticated
Immunosuppression is not a risk factor

Radiographic appearance starts to appear sclerotic; Lesion is often mixed RL/RO internally

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A 35 year old patient has tooth #47 that is NTTP, NTTPp, negative to cold test and non responsive to EPT. What is the radio-opaque lesion?

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Hypercementosis
Cemento-osseous dysplasia
Enostosis
Condensing osteitis

Condensing osteitis

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Which of the following is true about MRONJ?

It is more common in the maxilla than mandible
MRONJ is more likely in malignancy group than osteoporosis group
Among osteoporosis patients, those taking Denosumab are at lower risk than those taking Bisphosphonates
Prevalence of MRONJ among males is higher than females

MRONJ is more likely in malignancy group than osteoporosis group

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Which of the following is an underlying inflammatory change of condensing osteitis?

Chronic inflammatory infiltrate of lymphocytes, histiocytes and plasma cells
Increase in trabecular bone in response to persistent irritation
Acute inflammatory infiltrate of lymphocytes and neutrophils
Central cavity lined with stratified squamous epithelium

Increase in trabecular bone in response to persistent irritation

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A patient presents with a radiopaque lesion with diffuse borders surrounding the root of a tooth as seen from radiograph. Clinically, sensibility tests conducted on that tooth suggest that it is non-vital. What is the most likely diagnosis?

Condensing osteitis
Periapical osseous dysplasia
Radicular cyst
Enostosis

Condensing osteitis

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Which of the following is NOT true about the radiographic appearance of an acute apical abscess?
May not be able to see any changes radiographically
Loss of the lamina dura
Widening of the PDL
Resorption of the apical bone

Widening of the PDL

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Which of the following Periapical lesions is NOT an indication for Orthograde Root Canal Treatment?
Periapical Granuloma
Condensing osteitis
Periapical Rarefying osteitis
Periapical osseous dysplasia

Periapical osseous dysplasia

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Which of the following is a feature of MRONJ stage 0?

asymptiomatic, exposed and necrotic bone or fistula that probes to the bone
oral-antral/oral-nasal communication
altered neurosensory function
osteolysis extending to inferior border of mandible or sinus floor

altered neurosensory function

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A 65 yo woman came in complaining of a toothache. She had undergone radiotherapy 3 years ago and is on bisphosphonates for her osteoporosis. After conducting pulp sensibility tests, it is shown that #48 is tender to both percussion and palpation, cold test is +ve (lingering). Which of the following is the correct periapical diagnosis?

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A) Symptomatic irreversible pulpitis
B) Symptomatic apical periodontitis
C) Condensing osteitis
D) Acute apical abcess

C) Condensing osteitis

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A patient walks into your clinic with the following extraoral and intraoral findings. Which of the following statements is true?

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The patient has osteoradionecrosis, which refers to exposed bone more than 3 months after radiotherapy
The patient has osteoradionecrosis, which occurs most commonly in the posterior mandible due to richer blood supply
The patient has Stage 3 MRONJ, with an extra-oral fistula that probes to bone
The patient has Stage 3 MRONJ, which refers to exposed bone that has persisted for more than 8 weeks

The patient has osteoradionecrosis, which refers to exposed bone more than 3 months after radiotherapy

A 70 year old man walks into your clinic, complaining of pain and swelling on his right mandible. He mentions that occasionally there is yellow liquid that oozes out of that area. You checked his medical history and he has been taking bisphosphonates. What is true of this condition?

This condition is more likely in an osteoporotic patient than a patient with cancer
This condition is genetic
This condition is caused by anti-resorptive drugs that inhibit osteoclast formation, differentiation and function.
Oral hygiene has no effect on this condition

This condition is caused by anti-resorptive drugs that inhibit osteoclast formation, differentiation and function.

Mr Tan, a 40 year old male with history with Type I diabetes presents to your clinic with swelling of the lower left side of the face and a mild fever of 37.5deg. He laments that this was the 3rd time he has felt these symptoms in the last year, but this time he also has some loss in sensation of his lower lip. Upon taking an OPG, you notice onion skin layers of bone at the left mandible.
What is true of this condition?

The onion skin layer appearance is due to osteoclastic activity
Under histopathology, the predominant cells seen are lymphocytes
Supportive treatment such as prescription of paracetamol is sufficient
Besides OPG, CBCT scan is also commonly used for the investigation of this condition

Besides OPG, CBCT scan is also commonly used for the investigation of this condition

A patient comes to see you for screening. You notice pathology in the DPT taken. The patient says that she does not experience any pain or sensitivity in the area and you decide to investigate further by taking a periapical radiograph. You are unsure if the lesion presented is a lateral radicular cyst or lateral periodontal cyst. What should your next course of action be?

Carry out excisional biposy
Carry out vitality testing
Monitor for signs and symptoms
Carry out conservative enucleation of cyst

Carry out vitality testing

A 65 year old female patient comes into your dental clinic due to a toothache. She is taking bisphosphonates for her osteoporosis. Upon further examination, the tooth is grossly carious and deemed non-restorable, and is indicated for an extraction. What should be your next course of action in managing this patient?

Tell patient to stop taking bisphosphonates before performing the extraction due to risk of MRONJ.
Refrain from performing the extraction completely.
Consult with patient’s medical practitioner regarding bisphosphonates before planning next steps.
Prescribe painkillers for the patient and leave the patient be.

Consult with patient’s medical practitioner regarding bisphosphonates before planning next steps.

A patient presents to your clinic complaining of severe pain in the upper right jaw. Upon examination, you notice a swelling in the #15 area and decide to take a periapical radiograph. The radiograph shows a periapical radiolucency with loss of lamina dura and resorption of the apical bone. Which is the most likely diagnosis?

Acute apical abscess
Chronic apical abscess
Periapical granuloma
Radicular cyst

Acute apical abscess

Patient present with a periapical lesion above teeth #23. It is a rounded, radiolucent lesion without resorption of the apical root. After clinical examination, we found out tooth #23 is not tender to percussion or palpation and has no pus formation. The sensitivity test shows that #23 is vital. Which of the following condition might this patient have?

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Acute apical abscess
Condensing osteitis
Periapical granuloma
Periapical osseous dysplasia

Periapical osseous dysplasia

Which of the following is true about condensing osteitis?

Due to the hapazard deposition of lamellar bone around the apex of the tooth
It is one of the first signs of peri-apical infammation
The associated tooth has variable responses to vitality and peri-apical tests.
Usually presents with canal calcifications.

The associated tooth has variable responses to vitality and peri-apical tests.

Which of the following structures does a radicular cyst originate from?

Cell rests of Malassez
Stellate Reticulum
Stratum Intermedium
Osteoid

Cell rests of Malassez

Which of the following best describes Osteomyelitis? Inflammation of compact bone More common in maxilla than mandible Predominantly mononuclear cells present Presence of periosteal bone reaction

Presence of periosteal bone reaction

Mr Loh presents to the clinic with mild pain from his lower first molar region. He has had his breakfast of honey stars, and he always has sweet food for breakfast. Upon intraoral examination, a large carious lesion was noted on #36 and the radiograph showed the following picture. What is the primary treatment option when it comes to such a case? https://ibb.co/ctjBWsm Leave alone, it is normal Pulpotomy Drainage of abscess, and antibiotic therapy RCT

RCT

Mrs Lim went to the nearest dental clinic when she started experiencing pain and swelling of her right posterior mandibular gums. She developed a fever a day after the swelling and it was noted that her #46 and #47 were mobile and tender to percussion. Upon taking an OPG, and running a histopathology test, she was diagnosed with acute osteomyelitis. Which of the following does NOT correspond with her diagnosis? The lesion at the #46, #47 region is ill defined with non corticated borders. There is a subtle increase in bone trabeculation noted on the OPG, at the #46, #47 region. There is an onion layering appearance around the inferior border of the right mandible. When the histology slide was analysed, a loss of osteocytes from lacunae was noted.

There is a subtle increase in bone trabeculation noted on the OPG, at the #46, #47 region.

A 30 year old lady came to your clinic saying she detected a hole in her #25. On examination, you notice that the entire lingual cusp has fractured off and her pulp chamber is visible. You ran the EPT and cold test, as well as palpation and percussion diagnostic tests but results were negative. To get a better understanding of her situation, you ordered a PA for #25. When the xray came out, you noted that #25 has a well-circumscribed periapical radiolucency, with a dimension of 2mm by 2mm, surrounded by dense sclerotic bone. There is also widening of the lamina dura. Which of the following is the most likely diagnosis? Acute apical abscess Condensing osteitis Periapical granuloma Periapical osseous dysplasia

Periapical granuloma

Which of the following is true? Osteomyelitis occurs more in the maxilla than the mandible. Malnutrition increases the risk of osteomyelitis There is increase in osteocytes from the lacunae Manage with hyperbaric oxygen and antibiotics

Malnutrition increases the risk of osteomyelitis

A 75 year-old man comes into your clinic complaining that he is experiencing a dull aching bone pain in his mandible. Upon clinical examniation, you find that he has some mobile teeth in his mandible, but no exposed bone can be seen. He is a regular dental attendee and does not show signs of chronic periodontal disease. An OPG was taken and lamina dura thickening and decrease in PDL space can be seen. In his medical questionnaire, you notice that he is currently taking Fosamax. Which stage of MRONJ is this patient likely to be at? Stage 0 Stage 1 Stage 2 Stage 3

Stage 0

Which of the following is true regarding a periapical cyst? It is diagnosed primarily based on radiographs It has an epithelial lining seen via histology It is associated with a vital pulp It is an acute condition and always presents with pain

It has an epithelial lining seen via histology