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23 Endodontics > 5 - Periradicular (Periapical) Pathosis > Flashcards

5 - Periradicular (Periapical) Pathosis Flashcards

1
Q

what are the periradicular conditions

A
  1. Normal
  2. Symptomatic apical periodontitis
  3. Asymptomatic apical periodontitis
  4. Condensing Osteitis
  5. Acute Apical Abscess
  6. Chronic Apical Abscess (Supurative apical periodontitis)
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2
Q

what is shown in normal PA tissues

A
  1. No radiolucencies in periradicular tissues
  2. No sensitivity to percussion
  3. No swelling or sinus tracts
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3
Q

is systomatic apical periodontitis associated with vital pulp or a necrotic pulp?

A

EITHER!

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4
Q

etiology of symptomatic apical periodontitis

A
  1. inflammatory mediators (from inflamed pulp)
  2. microbial toxins (from nectrotic pulp)
  3. hyper-occlusion
  4. post endo: mechanical and/or chemical irritants
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5
Q

inflammatory mediators are from what type of pulp

A

inflamed pulp

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6
Q

microbial toxins are from what type of pulp

A

nectrotic pulp

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7
Q

signs and symptoms of apical perio

A
  1. spontaneous pain
  2. radiograph appearance varies
  3. PAIN TO CHEWING
  4. PAIN TO PERCUSSION
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8
Q

what diagnosis

A

systemic apical periodontitis

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9
Q

what is the most diagnostic symptom of symptomatic apical periodontitis

A

sensitivity to touch/chewing

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10
Q

how do you verify sensitivity to touch/chewing

A

doing a percussion test

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11
Q

what is the percussion test

A
  1. first w/ finger
  2. if not sensitive, use mirror handle
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12
Q

how to treat symptomatic apical periodontitis

A

remove the cause!

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13
Q

what is symptomatic irreversible pulpitis w/ symptomatic apical periodontitis

A
  1. vital pulp
  2. LINGERING PAIN TO COLD
  3. SENSITIVITY TO PERCUSSION
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14
Q

what is SIPSAP

A

symptomatic irreversible pulpitis w/ symptomatic apical periodontitis

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15
Q

what is pulpal necrosis with SAP

A
  1. no response to cold
  2. sensitive to percussion
  3. no swelling, no sinus tracts
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16
Q

etiology of asymptomatic apical periodontitis

A
  1. bacteria from pulpal necrosis
  2. asymptomatic lesion
  3. no pain to percussion
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17
Q

what does asymptomatic apical periodontitis xray look like

A

range from small to large radiolucency

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18
Q

treatment of asymptomatic apical perio

A

endodontic therapy or extraction

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19
Q

what is the most diagnostic sign of asymptomatic apical periodontitis

A

radiolucency at apex. there are no other symptoms

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20
Q

etiology of condensing osteitis

A

low grade, long standing irritants from pulp

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21
Q

what does xray of condensing osteitis look like

A

radiopaque area at apex of tooth

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22
Q

do you do root canal on condensing osteitis

A

depends.

if you do pulp test and normal, you do not do root canal. if pulp is not normal, then you root canal.

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23
Q

histology of condensing osteitis

A
  1. increase in trabeclular bone density
  2. less cellular
  3. chronic inflammatory infiltrate
  4. can be associated with either vital inflamed pulps of necrotic pulps
24
Q

what is a normal pulp that has condensing osteitis in radiograph called

A

enostosis

25
Q

is acute apical abscess localized or diffuse

A

either

26
Q

acute apical abscess is associated with what pulp

A

necrotic pulp

27
Q

acute apical abscess affects what spaces

A

FACIAL spaces and is called cellulitis

28
Q

is cellulitis a symptom or diagnosis

A

symptom

29
Q

signs and symptoms of acute apical abscess

A
  1. Spontaneous pain
  2. Pain to percussion/palpation
  3. SWELLING (MUST)
  4. Systemic manifestations
  5. Variable radiographic appearance
30
Q

what diagnosis

A

acute apical abscess

31
Q

what is a recrudescent abscess or phoenix abscess? this is a type of what

A

exacerbation of previous chronic lesion with large radiolucency

type of acute apical abscess

32
Q

what is the most diagnostic sign of AAA

A

swelling

33
Q

treatment of AAA

A
  1. release pressure: drainage
  2. systemic support: antibiotics
  3. remove cause: endodontic therapy
34
Q

what is chronic apical abscess (CAA)

A
  1. associated w/ nectrotic pulps
  2. abscess that drains to surface
  3. draining sinus tract
35
Q

is chronic apical absecess symptomatic or asymptomatic

A

usually asymptomatic

36
Q

does chronic apical abscess have variable radiograph appearance

A

yes

37
Q

chronic apical abscess is also called what

A

suppurative apical perio

38
Q

CAA can drain how

A
  1. into oral mucosa (most common)
  2. occasionally extra oral)
  3. gingival sulcus (can look like perio pocket)
39
Q

why trace sinus tract w/ gutta percha point

A
  • determine origin of drainage
  • sometimes not possible if sinus not closed

take a radiograph with gp cone in place

40
Q

what is the most diagnostic sign/symptom for chronic apical abcess

A

presence of sinus tract

41
Q

what are histological diagnoses for PA lesions that can only determine from biopsy

A

granuloma, cyst, abscess

42
Q

what is this

A

granuloma

43
Q

what is a granuloma

A
  1. Granulomatous tissue
  2. Mast cells, macrophages, lymphocytes , plasma cells, and occasional PMN’S
  3. Multinucleated giant cells, foam cells, cholesterol clefts and epithelium are often found

very vascular with collagen fibers

44
Q

what is cyst

A

Apical or radicular cyst
Central cavity filled with EOSINOPHILIC FLUID and is lined by STRATIFIED SQAMOUS EPI
In turn this lesion is surrounded by granulomatous tissue ( A CYST WITHIN A GRANULOMA )

45
Q

cyst is filled with ___ and lined by ___

A

filled: eosinophil fluid
lined: stratified sqamous

46
Q

cyst is surrounded by what tissue

A

granulomatous tissue (cyst within a granulmoa)

47
Q

where does epithelium for cysts come from

A

cell rests of malassez

48
Q

what is an area of liquefaction necrosis

A

acute abscess

49
Q

what is in acute abscesses

A

Disintegrating PMN’s
Purulent exudate
Debris and dead cells
All surrounded by granulomatous tissue (abscess within a granuloma)

50
Q

acute abscess is surrounded by what

A

granulomatous tissue (abscess within a granuloma)

51
Q

histology of chronic abscess

A

Lymphocytes, plasma cells, and macrophages

52
Q

T/F: If the damaged tissues and microbial products are removed periapical tissues return to their original arquitecture

A

TRUE

53
Q

what repair is done in periapical tissue repair

A

osseous, cementum, and PDL

54
Q

how long does it take to get PA repair

A

6 months to over 1 year

55
Q

you should always make how many diagnoses

A

two (one for pulp and one for periradicular tissue)

56
Q

what is this

A

cyst

23 Endodontics (12 decks)

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