Bone infections and necrosis

Question 1

A peri-apical abscess forms form?

Answer 1

Pulpitis with subsequent pulpal necrosis
- acute process –> neutrophils

Question 2

Radiology of peri-apical abscess?

Answer 2

No changes for 3 days
Then widened PDL
Ill-defined radiolucent lesion at a later stage of the disease process

Question 3

what are a few complications of a peri-apical abscess?

Answer 3

Peri-apical granuloma
Radicular cyst ( chronic phase )
Perforation with sinus tract
Osteomyelitis

Question 4

Treatment of periapical abscess?

Answer 4

Endodontic treatment or extraction

Question 5

What are the 4 main types of noxious stimuli that cause pulpitis

Answer 5

Mechanical injury
Chemical irritation ( inappropriate use of acidic dental materials )
Thermal injury
Bacterial effects

Question 6

What do apical inflammatory lesions represent?

Answer 6

Formation of apical inflammatory lesions represents a defensive reaction secondary to the presence of microbial infection in the root canal with spread of related toxic products into the apical zone

Question 7

Describe the formation of the radioluceny

Answer 7

The involved inflammatory cells are primarily neutrophils and release prostaglandins, which activate osteoclasts to resorb the surrounding bone, leading to a detectable periapical radiolucency.

Question 8

how do symptoms differ between an abscess and granuloma ( peri apical )

Answer 8

Granulomas often present with low grade pain with percussion and tooth colour change

With abscesses a soft tissue component may be present
- tooth may be appear extruded
painful on percussion

Main radiolucent differances
- PAG = Well defined radiolucency
- PAA = more moth eaten appearance

Question 9

Name the types and sub types of osteomyelitis

Answer 9

Acute
- Children
- Suppurative ( pus forming )
- Localized alveolar

Chronic
- Sclerosing ( focal or diffuse )
- Proliferative periostitis
- Tuberculosis and others

Question 10

What are some systemic factors that predispose individuals to osteomyelitis?

Answer 10

Age
Diabetes Mellitus
Immune suppression ( HIV/AIDS )
Bisphosphonate therapy

Question 11

What are some local factors that may predispose individual to osteomyelitis

Answer 11

Peri-apical inflammation
- exposed bone ( penetrating injuries, open fracture, extraction sockets )

osseous dysplasia — dense bone make it hard for antibiotics to reach therapeutic levels

Question 12

What are for symptoms present in acute osteomyelitis in infants and children

Answer 12

Middle ear infection
Perforating into TMJ
Destruction of growth center
Unilateral hypoplasia

Question 13

Acute suppurative osteomyelitis radiographic features?

Answer 13

Poorly circumscribed
moth eaten
radiolucent with opaque masses ( squestrum )

Question 14

What is acute localized alveolar osteomyelitis?

Answer 14

Dry tooth socket

Question 15

Differential diagnosis of chronic focal sclerosing osteomyelitis?

Answer 15

Focal osseous dysplasia 9 Sclerotic margin )
Ideopathic osteosclerosis ( tooth is vital )
Cementoblastoma ( obliteration of pdl space )

Question 16

Complications of osteomyelitis?

Answer 16

Cellulitis
Abcess
SInus on skin
pathological fracture ( weakens bone
Septicemia with diffuse intravascular coagulation ( DIC )

Question 17

Proliferative periostitis ( garre’s ) clinical and radiological features

Answer 17

May form for periodontitis and peri-apical inflammations

• Clinical features
  young patients
  with bony hard expansion with asymmetry
• Radiology
  Onion skin periosteal bone deposits in area of inflammation

Question 18

DDX of proliferative periostitis

Answer 18

Fibrous dysplasia

Question 19

What is a osteosarcoma?

Answer 19

Is a malignancy of mesenchymal cells that have the ability to produce osteoid or immature bone.

Question 20

What are some predisposing factors towards osteosarcoma?

Answer 20

Radiation exposure, alkylating agents, Paget disease of bone, Li-Fraumeni syndrome, hereditary retinoblastoma, and Rothmund-Thompson syndrome.

Question 21

Common clinical of osteosarcoma

Answer 21

Clinical
- Swelling and pain
- Tooth mobility, paresthesia, and nasal obstruction

Question 22

Radiographic features of OsteoSarcoma

Answer 22

• Tooth mobility, paresthesia, and nasal obstruction
• Cortical destruction, cortical expansion, and a periosteal reaction also may be evident.
• The latter may appear as a “classic” sunburst pattern or a triangular elevation of the periosteum

Question 23

What are the some infectious routes that TB may take?

Answer 23

Direct
Productive cough
Hematogenous from lung

Question 24

Medication related osteonecrosis etiology and pathogenesis

Answer 24

Patients on long term bisphosphonate therapy
Bisphophonates suppress bone defence by neutralizing osteoclasts

Question 25

What type of drug is bisphophonates?

Answer 25

Anti-osteoporotic drug