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OPath Block 2 > 1. Infection of the Jaw > Flashcards

1. Infection of the Jaw Flashcards

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1
Q

What are sources of infection in the jaw?

A

Apex of non-vital teeth

Marginal or furcational periodontium

Pericoronal space (partially inmpacted teeth)

Open injury

Hematogenous spread

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2
Q

S/S of acute periapical infection (periapical abscess)?

A

Pain

fever

malaise

swelling of soft tissues

sensitive in percussion (due to edema)

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3
Q

Are there radiographic signs of acute periapical inflammation?

A

NO

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4
Q

How is the periodontium affected in acute periapical inflammation?

A

Widening of PDL

thickening of lamina dura

Irregular trabeculae

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5
Q

What are two key radiographic features in chornic periapical inflammation?

A

Periapical granuloma

Radicular (periapical) cyst

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6
Q

What is periapical granuloma?

A

Extension of pulpitis in periapical tissues

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7
Q

How does periapical granuloma present?

A

relatively painless and slow progression

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8
Q

How can periapical granuloma evolve?

A

May involve into a periapical abscess or cyst

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9
Q

What is the most common cyst of the jaw?

A

Radicular cyst

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10
Q

How does a radicular cyst tend to arise?

A

Sequel of long-standing untreated periapical granuloma

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11
Q

Where does the epithelial lining in radicular cyst arise from?

A

rests of malassez (activated by inflammatory process, creating little cysts that begin growing and expanding)

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12
Q

how do periapical granuloma and radicular cyst compare radiographically?

A

Very similar radiographically when small

Eventually, cyst will become larger and have the apearance of a true cyst. At thispoint, the two are easily distinguishable esp with cone beam CT

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13
Q

Which apical periodontitis condition is not pathologic?

A

Osteosclerosis

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14
Q

Which kind of apical periodontitis does not require treatment?

A

Osteosclerosis

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15
Q

What is osteosclerosis?

A

Increase in bone density

Forms dense-bone islands composed of compact bone rather than trabecular bone

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16
Q

What are other names of apical periodontitis?

A

Periapical rarefying osteitis

Condensing osteitis

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17
Q
A

9 - widening of the PDL space; loss of lamina dura; irregular trabeculae

Lateral incisor - ill defined radiolucency in PA area

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18
Q
A

All the roots have abnormal bone: expansion of PDL space, loss continuity of floor of maxillary sinus.

Removing 3 could open a hole into maxillary sinus

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19
Q
A

Lesion at apex of premolar

May be described as PRO

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20
Q
A

Ill-defined PA dz

loss of lamina dura

widening of PDL space

Denser trabecular bone - marks extent of lesion (osteoblastic activity as yo umove away from lesion)

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21
Q
A

Carious lesion extending to pulp

widened PDL

increased bone density of trabecular bone

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22
Q
A

Increased density of trabecular bone

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23
Q
A

Two well-defined cortical radiolucencies at #7 and #10

Can suspect periapical cyst because of well corticated appearance

Cannot give definitive diagnosis from radiograph

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24
Q
A

Patient has enamel hypoplasia (see appearance of canine - increased risk of PA lesion in non crious teeth)

PA lesion on anterior tooth

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25
definitive PA cyst beginning from #10 cyst arrested tooth development of both teeth (open apex) Possibly from trauma
26
Lesion on pt's right possibly from extracting tooth without taing care of PA inflammation Not stafne's defect bc stafne's is usually lower than mandibular canal
27
PA lesion on MB root of #15 Addt'l CT showed lesion actually encompassed all roots throughout maxilla. Widening PDL space
28
Osteosclerosis PDL space is uniform lamina dura is continuous
29
Osteosclerosis by the second premolar Prof does not say anything about radiolucency.
30
How can you distinguish ostesclerosis opacity from ossifying fibromas or osteomas?
Osteosclerosis will be unfiromly opaque with normal adjacent bone
31
Hoes does an area of inner cortical bone from osteosclerosis affect a procedure such as implant placement?
The cortical bone will increase resistance from drilling which will caused increased heat during procedure. The cortical bone also will have poor vascularity and cellularity so it wont adapt well to implant
32
Ostoesclerosis - unifromly dense radioopacity To cofirm, check PDL (uniform), lamina dura (continuous) and tooth vitality. All should be normal
33
Socket sclerosis (socket fills up with compact bone rather than trabecular bone) Prof does not mention radiolucnet area
34
What are pericoronal infections?
Infection of the tooth around the crown or follicle of a tooth
35
When does pericoronitis usally occur?
Usually around the crown of partially soft-tissue impacted teeth
36
What is folliculitis?
Apical or furcational infection of a primary tooth that involves follicle of permanent tooth. May cause turner's teeth - disturbance of normal crown development
37
Why is it easier for an infection to spread to the furcation area of a primary tooth?
Dentin of primary tooth is underdeveloped in comparison to permanent teeth
38
How does inflammation of primary teeth affect the permanent tooth in folliculitis?
Unerupted permanent tooth may have undeveloped crown. Ameloblasts function can be interrupted by the inflammation from the primary tooth
39
Normal PA radiograph continuous follicular cortication around developing tooth nice lamina dura
40
Secondary caries Widening of PDL space at apex of the distal root of primary molar Loss of follicular cortication of developing premolar #29 Infection from apex of primary tooth has gone int othe follicle of the developing tooth
41
Normal #20. Abnormal #21 PA disease of #21: loss of lamina dura, widening of PDL space Fracture of distal root Expansion of follicle - loss of trabeculation, loss of cortication Crown has been exposed to inflammatory environment
42
Horizontally impacted premolar Abscess has formed around crown of #21 that communicates with oral environment due to impact
43
Pericoronitis around #17 becauseo f lack of room Follicular space has widened on distal
44
Why is it important to treat PA inflammation dz early?
It can spread to adjacent areas causing other damage
45
PA dz at #30
46
Widening of PDL space on mesial root No fracture on distal root -- line is not classic appearance of a fracture
47
What is osteomyelitis?
Inflammation of the bone and bone marrow
48
What is the difference between PRO/condensing osteitis and ostemyelitis?
PRO/condensing osteitis are inflammation of the bone but has not yet reached bone marrow. Maye have some trabecular destructoin but does not really affect BM
49
What are predisposing factors for osteomyelitis?
Systemic dz esp DM immunosuppresion decreased vascularity
50
How can an infection be introduced to cause osteomyelitis?
Through some tooth PA or periodontal infection Fracture of a tooth break of soft tissue
51
What are the three kinds of chornic osteomyelitis?
chronic osteomyelitis diffuse sclerosing ostemyelitis proliferative periostitis (Garre's osteo; reaction from periosteum)
52
S/S of acute ostemyelitis
Severe pain soreness loosening of teeth regional lymphadenopathy fever
53
Are there radiographic presentations of acute ostemyelitis?
not at initial stage. will see signs with progression
54
What are seein in radiographs of acute osteomyelitis?
widening of PDL irregular, fuzzy, blurred trabeculae solitary or multiple radiolucent foci
55
S/S of chornic osteomyelitis
tenderness swelling lymphadenopathy low grade fever mild leukocytosis suppuration fistulous tract formation
56
Does chornic ostemyelitis more often affect the mandible or maxillary?
Mandible
57
What is a possible complication from chronic osteomyelitis?
pathologic fracture
58
What are two hallmarks of osteomyelitis?
Sequestrum Involcrum
59
What is a sequestrum?
Segments of necrotic bone separated from adjacent bone. On radiograph, will see an area of radiolucent bone around an area of necrosis
60
What is involcrum?
New periosteal bone formed in response to the inflammatory process
61
What are the radiographic features of chronic osteomyelitis?
lucent to mixed to mostly opaque ill-defined borders usually sclerotic loss of trabecular architecture (rugged, indistinct fuzzy irregular; no general pattern of formation) changes in cortical outlines (thickening, irregularity, destruction) sequestrae periosteal reaction (involcrum) fistulae tract formation
62
Acute osteomyelitis after extraction of #32 classic appearance of acute ostemyelitis Trabeculae at mandibular border is a little indistinct bit of irregular bone in the socket cortication of the mandibular canal and inferior border of mandible are ok can't see much of what is going wrong
63
Chronic osteomyelitis radiolucent foci inferior border of mandible is interrupted Cannot see superior and inferior border of mandibular canal
64
Established chornic osteomyelitis ill-defined mixed radiolucency lesion on right mandible extending from the area of the canine to where #32 used to be loss of cortication of the inferior border of the mandible, mandibular canal and alveolar crest Some periosteal bone formation
65
Osteomyelitis extending from the left all the way to the right with sequestrum in mandibular right
66
Sequestrum
67
Fistulation and pus
68
Fistula tract formation from bone into soft tissue through skin and out to neck area for drainage
69
Patient with 3rd molar extractions #17 area all the way to coronoid process and inferiorly to the angle and anteriorly to the premolar area (radiolucency) Increased density around area of radiolucency anterior to premolars and back to ramus
70
periosteal bone formation on patients left mandible all the way up to the coronoid process
71
Double outline of the inferior border of the mandible Further inferior, periosteal bone formation
72
Mucoperiosteal bone formation on the buccal of the arch
73
PANX looks fine
74
Normal PA nice extraction socket
75
Osteomyelitis extending all the way to the condylar and coronoid process Infectoin spread from condyle to temporal bone Pt developed ankyloses of condyle -- couldnt open mouth

OPath Block 2 (10 decks)

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