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BDS4 Oral Surgery > The diseases of pulp and periodontium > Flashcards

The diseases of pulp and periodontium Flashcards

1
Q

what is pulp hyperaemia?

A

increase blood supply within pulp chamber

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2
Q

if it is acute what is it mean?

A

sudden onset

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3
Q

what is an abscess?

A

collection of dead neutrophils

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4
Q

what is apical periodontitis?

A

inflammation of pulp comes out of apex of tooth to cause this

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5
Q

what is a sinus?

A

abscess perforate through bone and soft tissues and starts to drain into mouth.
You get a chronic blister like a bubble on gum bursts and gives bad taste. Not much pain but bad taste every time it bursts

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6
Q

what is apical cyst (radicular)?

A

not painful but can grow to large sizes.
cyst is fluid filled material lined cavity

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7
Q

what does caries lead to?

A

pulp hyperaemia

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8
Q

what does pulp hyperaemia lead to?

A

acute pulpitis

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9
Q

what does acute pulpitis lead to?

A
  • chronic pulpitis which can go back and forth to acute pulpitis
  • can also go to acute apical periodontitis
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10
Q

what does acute apical periodontitis lead to?

A
  • acute apical abscess
  • sometimes go straight to chronic apical infection (granuloma)
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11
Q

what does acute apical abscess lead to?

A
  • chronic apical infection (granuloma and can go back and forth to acute apical abscess
  • can also lead to chronic sinus and can go back and forth to acute apical abscess
  • when it is chronic apical infection or chronic sinus it can go back and forth between these 2 as well
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12
Q

what does chronic apical infection (granuloma) lead to?

A
  • apical cysts (radicular)
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13
Q

what does apical cyst (radicular) lead to

A

infected apical radicular cyst

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14
Q

what are symptoms 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 (reversible pulpitis)
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15
Q

what are clinical features of acute pulpitis?

A
  • Constant Severe Pain
  • Reacts to Thermal Stimuli
  • Poorly Localised Pain
  • Referral of pain - come from somewhere else not source
  • No (or Minimal) Response to analgesics - can’t get into pulp chamber
  • Open Symptoms Less Severe
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16
Q

how do you diagnose acute pulpitis?

A
  • History
  • Visual examination
  • Negative Tenderness to Percussion (usually) - because PDL not inflamed yet
  • Pulp testing is equivocal
  • Radiographs
  • Diagnostic’ Local Anaesthetic - numb them beside tooth and see if pain goes away
  • Removal of Restorations - filling was so big and close to pulp only way to work out is removing filling
17
Q

at what stage do symptoms change?

A

acute apical periodontitis

18
Q

what is diagnosis for acute periodontitis?

A
  • Easy to make
  • Tenderness to Percussion
  • Tooth is non-vital (unless traumatic)
  • Slight increase in mobility - because pdl space increases slightly
  • Radiographs
19
Q

what would you see on radiograph for acute periodontitis?

A
  • loss of clarity in lamina dura
  • won’t really see radiolucency yet if you do it may indicate an ‘old’ lesion e.g. Flare up of apical granuloma
  • there will be a delay in changes at the apex of the tooth and widening of apical periodontal space takes time
20
Q

traumatic periodontitis
causes?
diagnosis?
treatment?

A
  • Parafunction (Tooth clenching or grinding)
  • Clinical Examination of the Occlusion
    >Functional positioning
    >Posturing
    Tender to Percussion
    Normal Vitality
    Radiographs
    >May show generalised widening of periodontal space
  • Occlusal adjustment - filling maybe high
    Therapy for parafunction - gumshield
21
Q

what are other possible causes for a dental abscess instead of acute apical abscess/

A
  • Periodontal Abscess - not result of pulp
  • Pericoronitis - inflammation around crown usually partially erupted wisdom tooth, premolar or canine
  • Sialadenitis - infection of glands, usually one of major salivary glands. Result in facial swelling and redness, dryness of mouth and puss out of duct in gland
22
Q

dental abscess
- what are organisms?
- what are unusual infections

A
  • Polymicrobial
    Aanaerobes play an important part
  • Staphylococcal lymphadenitis of childhood Cervico-facial actinomycosis
23
Q

acute apical abscess
- how does clinical features reflect stage of abscess?

A
  • The Clinical features will reflect the stage of the abscess.
  • Initially almost identical to Acute Apical Periodontitis(Prior to eroding through bone and into soft tissues).
  • Usually drain into mouth but can into face where it ends up depends on muscle it drains into
24
Q

acute apical abscess
- symptoms?

A
  • Severe unremitting pain
    Acute tenderness in function - bite
    Acute tenderness on percussion - tap

BUT no swelling, redness or heat (yet….) - if abscess still contained within jaw bone

25
Q

what are 5 signs of cardinal inflammation?

A
  • heat
  • redness
  • swelling
  • pain
  • loss of function
26
Q

what happens with an acute apical abscess once it perforated through bone?

A
  • Pain often remits (unless it’s in the palate)
    Swelling, redness and heat (in the soft tissues) become increasingly apparent
    As swelling increases pain returns
    There is an initial reduction in tenderness to percussion of the tooth as pus escapes into the soft tissues
27
Q

what does the site of the swelling depend on for acute apical abscess?

A
  • The position of the tooth in the arch
  • Root length
  • Muscle attachments
  • Potential spaces in proximity to lesion
    Submental Space
    Sublingual Space
    Submandibular Space
    Buccal Space
    Infraorbital Space
    Lateral Pharyngeal Space (a.k.a. Parapharyngeal Space)
    Palate
28
Q

what is treatment for acute apical abscess?

A
  • Provide Drainage
    Soft tissue incision intraorally
    Soft tissue incision extraorally
    Remove source/cause
    Extract tooth
    Pulp extirpation
    Periradicular surgery - unusual
29
Q

what is need for antiobiotics detemrined by?

A
  • Need for antibiotics determined by
    Severity
    Absence of adequate drainage
    Patient’s medical condition
30
Q

what is assessment of need for antibiotics?

A

local factors
- Toxicity- systemically unwell
- Airway compromisation
- Dysphagia - difficulty swallowing
- Trismus - severely limited mouth opening
- Lymphadenitis
- Location (e.g. floor of mouth) - FOM will affect your breathing

systemic factors
- Immunocompromised pts
Acquired causes (e.g. HIV)
Drug Induced (e.g. Steroids, Cytostatics)
Blood disorders (e.g. Leukaemias)
- Diabetes
- Elderly

31
Q

where does the caries end results usually stop?

A
  • chronic apical infection (granuloma) only in some people goes to apical cyst (radicular)
32
Q

what is reversible pulpitis?

A

Denotes a level of inflammation in which returning to a normal state is possible if noxious (harmful) stimuli removed

Mild-moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds (<5 secs), no mobility, no pain on percussion

33
Q

what is irreversible pulpitis?

A

Denotes a higher level of inflammation in which dental pulp has been damaged beyond point of recovery

Sharp, throbbing, severe pain upon stimulation, and pain may be spontaneous or occur without stimulation, pain persists after stimulation removed (>5 secs); tx: RCT or extraction

34
Q

describe a periapical granuloma (chronic apical periodontitis)?

A

Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries).

NOT a true granuloma because not granulomatous inflammation! (Note that granulomatous inflammation has epithelioid histiocytes mixed with lymphocytes and giant cells)

35
Q

what is the etiology of peripaical (radicular) cyst?

A
  • Caries, trauma, periodontal disease
  • Death of dental pulp
  • Apical bone inflammation
  • Dental Granuloma
  • Stimulation of epitheialial rests of Malassez
  • Epithelial Proliferation
  • Periapical Cyst Formation
36
Q

what is radicular mean?

A

around root

BDS4 Oral Surgery (7 decks)

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