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Pathology I > Sequelae of Pulpal Disease > Flashcards

Sequelae of Pulpal Disease Flashcards

1
Q

what is pulpitis

A

inflammation of pulpal tissue

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2
Q

what are the types of pulpitis

A

reversible and irreversible
- acute vs chronic
- symptomatic vs asymptomatic

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3
Q

what is the mechanism of action of the inflammation of pulp

A
  • limited blood supply
  • no collateral support
  • destructive
    -expansile process: BV dilation, leakage of fluid into surrounding tissue, migration of cells
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4
Q

what patients get chronic hyperplastic pulpitis

A

pediatric patients

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5
Q

what is another name for chronic hyperplastic pulpitis

A

pulp polyp

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6
Q

what is the sequelae of chronic bacterial pulpitis

A
  • chronic apical periodontitis
  • periapical granuloma
  • periapical cyst
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7
Q

what is the sequelae of acute bacterial pulpitis

A
  • periapical abscess -> osteomyelitis -> chronic osteomyelitis or cellulitis or garre osteomyelitis
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8
Q

what do you need to consider when looking at periapical lesions

A
  • presence of opened or closed pulpitis
  • virulence of involved microorganism
  • extent of sclerosis of dentinal tubules
    -competency of host immune response
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9
Q

what is a periapical granuloma and where is it located

A

mass of chronically inflamed granulation tissue
- most are asymptomatic
- apex of non vital tooth

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10
Q

how does a periapical granuloma present on a radiograph

A

periapical radiolucency

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11
Q

how do periapical granulomas occur

A
  • initial periapical pathosis or after an initial periapical abscess
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12
Q

what may a periapical granuloma transform into

A

a periapical cyst or abscess

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13
Q

what is the treatment for a periapical granuloma

A

RCT

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14
Q

what is a cyst

A

pathologic cavity located in soft tissue or bone lined by epitheliuma

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15
Q

what are the 3 components of a cyst

A

-lumen
- wall
- lining

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16
Q

what do all cysts have

A

epithelial lining

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17
Q

what is a periapical cyst caused by

A

when inflammation causes rests of malassez to proliferate which causes the formation of cystic activity

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18
Q

what is an apical periodontal cyst

A
  • an inflammatory cyst
  • asymptomatic slow growing lesion associated with the root apex of a non vital tooth
  • external root resorption possible
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19
Q

what is a periapical abscess

A

-accumulation of acute inflammatory cells at the apex of a non vital tooth
- generally symptomatic but may be asymptomatic if there is a lack of accumulation of purulent material due to chronic path of drainage

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20
Q

what may a periapical abscess arise as

A

the initial periapical pathosis or as an acute exacerbation of chronic periapical lesion

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21
Q

what is the way to determine between a periapical cyst, granuloma, and abscess

A

a biopsy/histology

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22
Q

what cells are seen in periapical granuloma

A

all inflammatory cells

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23
Q

what cells are seen in periapical cyst

A

acute inflammatory cells and fibrous CT and epithelium lining

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24
Q

what cells are seen in periapical abscess

A

neutrophils

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25
Q

what are the drainage pathways of acute periapical infections

A
  • surface of the gingiva (parulis)
  • palate (palatal abscess)
  • maxillary sinus
  • soft tissue spaces (cellulitis)
  • floor of mouth (ludwig angina)
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26
Q

what is a parulis (gum boil)

A
  • acute periapical inflammation
  • purulent material perforates through bone, periosteum, soft tissue, epithelium and drains through intraoral sinus
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27
Q

what is a parulis

A

the intraoral opening of a sinus tract

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28
Q

what does a parulis consist of

A

a mass of inflamed granulation tissue with an epithelialized sinus tract

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29
Q

what is an abscess

A

a localized collection of pus that has accumulated in a tissue cavity, producing fluctuance

30
Q

what is the cutaneous sinus tract

A

a dental abscess that drains extraorally through the overlying skin

31
Q

what is a fistula

A

a communication between two anatomical sites

32
Q

where is the sinus tract

A

from within to the exterior

33
Q

what is the end of the sinus tract

A

the parulis

34
Q

what is an oroantral fistula

A

a fistula that connects the mouth and maxillary sinus

35
Q

what is cellulitis

A

diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth, and pain

36
Q

why does abscess in cellulitis accumulate

A

the abscess is unable to establish drainage into the oral cavity or onto the surface of skin (sinus tract)

37
Q

what types of cells are seen in a histological slide of cellulitis

A

many different inflammatory cells

38
Q

what is trismus

A

difficulty opening mouth

39
Q

what is Ludwig’s angina

A

an aggressive, rapidly spreading cellulitis involving multiple anatomic spaces- submental, submandibualr, and sublingual spaces

40
Q

what can Ludwigs angina cause

A

massive swelling of neck that may extend close to clavicels and cause airway obstruction

41
Q

what is cavernous sinus thrombosis

A

valveless venous system may allow retrograde spread of infection from middle third of face
- formation of a blood clot within cavernous sinus, a major dural venous sinus, life threatening

42
Q

what can cavernous sinus thrombosis be associated with

A

spread of infection from maxillary teeth

43
Q

what is inside the cavernous sinus

A
  • internal carotid artery
  • CN III- oculomotor
  • CN IV - trochlear
    -CN V - trigeminal - only V1 and V2
    -CNVI - abducens
44
Q

what is osteomyelitis

A

bacterial infection of bone

45
Q

what are the causes of osteomyelitis

A

-odontogenic infection
- traumatic fracture of bone
- NUG, NOMA

46
Q

what are the predispositions to osteomyelitis

A

-chronic systemic diseases
- immunodeficiency
- decreased vascularity of bone

47
Q

what is acute osteomyelitis

A
  • spread through medullary spaces
  • minimal tissue reaction
48
Q

what is chronic osteomyelitis

A
  • prominent tissue reaction
  • granulation tissue
  • fibrosis
49
Q

what can osteomyelitis occur after

A

mandibular fracture

50
Q

what is a sequestrum

A

a fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation

51
Q

what are examples of sequestrum

A

bisphosphonates causes osteonecrosis of mandible and radiation therapy causes osteoradionecrosis

52
Q

what is involucrum

A

non vital bone, encased by vital bone

53
Q

what is another name for proliferative periostitis

A

Garre Osteomyelitis

54
Q

what is proliferative periostisis

A
  • a form of chronic osteomyelitis
  • osteomyelitis with proliferative periostitis
  • a periosteal reaction in which layers of reactive vital bone are formed producing cortical expansion
55
Q

what population is proliferative periostitis seen in

A

children and young adults in the mandibular molar and premolar area involving the lower border of the buccal cortex

56
Q

what are the steps in proliferative periostitis

A

inflammtory focus -> periosteal reaction -> resolution

57
Q

what is another name for chronic focal sclerosing osteomyelitis

A

Condensing osteitis

58
Q

what is condensing osteitis

A

localized area of bone sclerosis associated with the apices of teeth with pulpal disease

59
Q

what population is condensing osteitis seen in

A

children and young adults involving the mandibular molars and premolars

60
Q

what tooth type is associated with condensing osteitis

A

non vital tooth

61
Q

how does condensing osteitis appear on a radiograph

A

periapical radiopacity

62
Q

what is another name for actinomycosis

A

Ray fungus

63
Q

what are the actinomyces species in actinomycosis

A
  • actinomyces israelli
  • actinomyces viscosus
64
Q

what are the filamentous bacteria in actinomycosis

A
  • branching
  • gram positive
  • anaerobic
65
Q

what type of infection is actinomycosis

A

bacterial

66
Q

what are the classifications of actinomycosis and the prevalence of each

A
  • cervico facial: 55%
  • abdomino pelvic: 25%
  • pulomary: 15%
67
Q

where can the organism enter to cause ccervico facial actinomycosis

A
  • soft tissue injury
  • periodontal pocket
  • non vital tooth
  • extraction socket
  • infected tonsil
68
Q

describe cervico facial actinomycosis

A
  • direct extension through soft tissue
  • disregards fascial planes, lymphatics
  • woody induration and fibrosis
  • draining sinus tracts
  • suppuration with sulfur granules
69
Q

what is another name for cervico facial actinomycosis

A

lumpy jaw disease

70
Q

what is the radiographic presentation of cervicofacial actinomycosis

A

radiolucency

71
Q
A

Pathology I (24 decks)

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