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BDS4 Oral surgery > The disease of Pulp and Periodontium > Flashcards

The disease of Pulp and Periodontium Flashcards

1
Q

What are the diagnosis that the pulp and periodontium can have?

A
  • 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)
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2
Q

What are the Clinical features of Pulp hyperaemia?

A
  • 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
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3
Q

What are the clinical features of Acute pulpitis?

A
  • Constant severe pain
  • Reacts to thermal stimuli
  • Poorly localised pain
  • Referral of pain
  • No (or minimal) response to analgesics
  • Open symptoms less severe
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4
Q

How do you diagnose Acute pulpitis?

A
  • History
  • Visual exam
  • Negative tenderness to percussion (usually)
  • Pulp testing
  • Radiographs
  • Diagnostic LA
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5
Q

What are the clinical findings for diagnosis of Acute Apical Periodontitis?

A
  • Tenderness to percussion
  • Tooth is non-vital (unless traumatic)
  • Slight increase in mobility
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6
Q

What are the radiographic findings for diagnosis of acute apical periodontitis?

A
  • 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
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7
Q

What are the causes of Traumatic periodontitis?

A
  • Parafunction i.e. tooth clenching or grinding
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8
Q

What is the diagnosis of traumatic periodontitis?

A
  • Clinical exam of occlusion (funtional positioning, posturing)
  • Tender to percussion
  • Normal vitality
  • Radiographs may show generalised widening of periodontal space
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9
Q

What is the txt for traumatic periodontitis?

A
  • Occlusal adjustment
  • Therapy for parafunction e.g. splint
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10
Q

What is the most commonest pus producing infection?

A
  • Acute apical abscess
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11
Q

What are some causes of pus producing infection (other than acute apical abscess?

A
  • Periodontal abscess
  • Pericoronitis
  • Sialadenitis
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12
Q

What is sialadenitis?

A
  • Inflammation of the salivary glands
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13
Q

What are some very rare infections that can cause dental abscess?

A
  • Staphylococcal lymphadenitis of childhood
  • Cervico-facial actinomycosis
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14
Q

What are the symptoms of Acute apical abscess?

A
  • 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)
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15
Q

What are the 5 cardinal signs of inflammation?

A
  • Heat
  • Redness
  • Swelling
  • Pain
  • Loss of function
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16
Q

Once the acute apical abscess perforates through the bone what are the symptoms?

A
  • 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
17
Q

What factors determine the site of the swelling from Acute Apical Abscess?

A
  • 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
18
Q

What is the txt of Acute Apical Abscess?

A

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

19
Q

What are some local factors you need to consider upon assessment of need for antibiotics?

A
  • Toxicity
  • Airway compromisation
  • Dysphagia (difficulty swallowing)
  • Trismus
  • Lymphadenitis
  • Location e.g. floor of mouth more worrying
20
Q

What are some systemic factors you need to consider during assessment of need for antibiotics?

A
  • Immunocompromised pts like
    • Acquired causes e.g. HIV
    • Drug induced e.g. steroids. cytostatics
    • Blood disorders e.g. Leukaemia
  • Uncontrolled diabetes
  • Extremes of age
21
Q

Describe a periapical granuloma (Chronic apical periodontitis)

A
  • 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
22
Q

What does granulomatous inflammation have that periapical granuloma does not?

A
  • Epithelioid histiocytes mixed with lymphocytes and giant cells
23
Q

What is the etiology of an apical (radicular) cyst?

A
  • Caries , trauma, periodontal disease
  • Death of dental pulp
  • Apical bone inflammation
  • Dental granuloma
  • Stimulation of epithelial rests of malassez
24
Q

What does radicular mean?

A
  • Surrounding the root
25
Q
A

BDS4 Oral surgery (15 decks)

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