The disease of Pulp and Periodontium Flashcards
What are the diagnosis that the pulp and periodontium can have?
- Caries
- Pulp hyperaemia
- Acute Pulpitis
- Chronic pulpitis
- Acute apical periodontitis
- Acute Apical abscess
- Chronic apical infection (granuloma)
- Chronic sinus
- Apical cyst (radicular)
- Infected apical radicular cyst (feel pain)
What are the Clinical features of Pulp hyperaemia?
- Pain lasting for seconds
- Pain stimulated by hot/cold or sweet foods
- Pain resolves after stimulus
- Caries approaching pulp but tooth can still be restored without treating pulp
What are the clinical features of Acute pulpitis?
- Constant severe pain
- Reacts to thermal stimuli
- Poorly localised pain
- Referral of pain
- No (or minimal) response to analgesics
- Open symptoms less severe
How do you diagnose Acute pulpitis?
- History
- Visual exam
- Negative tenderness to percussion (usually)
- Pulp testing
- Radiographs
- Diagnostic LA
What are the clinical findings for diagnosis of Acute Apical Periodontitis?
- Tenderness to percussion
- Tooth is non-vital (unless traumatic)
- Slight increase in mobility
What are the radiographic findings for diagnosis of acute apical periodontitis?
- Loss of clarity of lamina dura
- Radiolucent shadow - (may indicate old lesion e.g. flare up of apical granuloma
- Delay in changes at apex of tooth
- Widening of periodontal space
What are the causes of Traumatic periodontitis?
- Parafunction i.e. tooth clenching or grinding
What is the diagnosis of traumatic periodontitis?
- Clinical exam of occlusion (funtional positioning, posturing)
- Tender to percussion
- Normal vitality
- Radiographs may show generalised widening of periodontal space
What is the txt for traumatic periodontitis?
- Occlusal adjustment
- Therapy for parafunction e.g. splint
What is the most commonest pus producing infection?
- Acute apical abscess
What are some causes of pus producing infection (other than acute apical abscess?
- Periodontal abscess
- Pericoronitis
- Sialadenitis
What is sialadenitis?
- Inflammation of the salivary glands
What are some very rare infections that can cause dental abscess?
- Staphylococcal lymphadenitis of childhood
- Cervico-facial actinomycosis
What are the symptoms of Acute apical abscess?
- Severe unremitting pain
- Acute tenderness in function
- Acute tenderness on percussion
- No swelling, redness or heat yet.. (will show this when it perforates the bone)
What are the 5 cardinal signs of inflammation?
- Heat
- Redness
- Swelling
- Pain
- Loss of function
Once the acute apical abscess perforates through the bone what are the symptoms?
- Pain often remits (unless in palate)
- Swelling, redness and heat in soft tissues become increasingly apparent
- As swelling increases pain returns
- Initial reduction in tenderness to percussion of tooth as pus escapes into soft tissues
What factors determine the site of the swelling from Acute Apical Abscess?
- Position of tooth in arch
- Root length
- Muscle attachments
- Potential spaces in proximity to lesion inc
- Submental space
- Sublingual space
- Submandibular space
- Buccal space
- Infraorbital space
- Lateral pharyngeal space (aka Parapharyngeal space)
- Palate
What is the txt of Acute Apical Abscess?
Provide drainage
- Soft tissue incision intraorally
- Soft tissue incision extraorally
- Remove source/cause by XLA tooth/ Pulp extirpation/ Periradicular surgery
Provide antibiotics depending on
- Severity
- Absence of adequate drainage
- Pt medical condition
- Signs of spreading infection
What are some local factors you need to consider upon assessment of need for antibiotics?
- Toxicity
- Airway compromisation
- Dysphagia (difficulty swallowing)
- Trismus
- Lymphadenitis
- Location e.g. floor of mouth more worrying
What are some systemic factors you need to consider during assessment of need for antibiotics?
- Immunocompromised pts like
- Acquired causes e.g. HIV
- Drug induced e.g. steroids. cytostatics
- Blood disorders e.g. Leukaemia
- Uncontrolled diabetes
- Extremes of age
Describe a periapical granuloma (Chronic apical periodontitis)
- Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes and few histocytes with fibroblasts and capillaries
- It is not a TRUE granuloma as it is not granulomatous inflammation
What does granulomatous inflammation have that periapical granuloma does not?
- Epithelioid histiocytes mixed with lymphocytes and giant cells
What is the etiology of an apical (radicular) cyst?
- Caries , trauma, periodontal disease
- Death of dental pulp
- Apical bone inflammation
- Dental granuloma
- Stimulation of epithelial rests of malassez
What does radicular mean?
- Surrounding the root
