15 Periapical and endo-associated pathology Flashcards Preview

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Flashcards in 15 Periapical and endo-associated pathology Deck (47)
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1

Pulpitis etiology

caries, trauma, dental restorative procedures (sometimes only the blood vessels are inflammed)

2

Pulpitis symptoms

pain (ex. traumatic occlusion can cause hyperemia and the dilation of blood vessels-->this incresaes intrapulpal pressure leading to the perception of pain)

3

Chronic hyperplastic pulpitis characteristics

Also called pulp polyp. Large carious lesion including exposure of the pulp. The pulp grows out from inside the tooth to produce a red soft tissue mass in the crown area. Very sensitive. Treatment: endo or extraction

4

Reversible pulpitis (definition)

A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.

5

Reversible pulpitis (characteristics)

Pain on hot and cold stimulation (more often cold than hot)
Pain fades away rapidly after stimulus is removed
Variable intensity of the pain (therefore intensity of pain is not a good indicator differentiating between reversible and irreversible pulpitis)
Intermittent, not always present or reproducible
Radiographic appearance normal
Treatment: remove cause if identifiable and time for resolution

6

Symptomatic irreversible pulpitis (definition)

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: lingering thermal pain, spontaneous pain, referred pain.

7

Symptomatic irreversible pulpitis (characteristics)

(soft rule-more often has sensitivity to hot than reversible pulpitis)
Pain typically lingers with removal of stimulus
Mild and intermittent to excruciating, intense pain
Pain can be stimulated by: Hot and cold, chewing pressure, percussion
Pain may be spontaneous
Lying down may precipitate “spontaneous” pain
Pain may be continuous
Radiographs may show slight widening of the periodontal ligament (inflammation in the pulp has exited the apex of the tooth causing inflammation in the PDL space)
Treatment: endo or extraction

8

Asymptomatic irreversible pulpitis (definition)

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: no clinical symptoms but inflammation produced by caries, caries excavation, trauma.

9

Pulp necrosis

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.

10

Pulp necrosis (characteristics)

Death of the pulp tissue due to overwhelming inflammation in a confined environment
Tooth may appear discolored (RBCs-->hemosiderin-->dentinal tubules-->discoloration)
Variable symptoms: No pain through intense pain
Often sensitive to percussion
Radiographs typically show thickening of the periodontal ligament area or destruction of bone in the periapical region

11

Describe the most common etiology of periapical lesions.

>95% are from the result of pulpal inflammation (pulpitis) that progresses to pulp necrosis.

12

What is the most common periapical pathology?

Periapical granuloma

13

Describe the clinical and radiographic features of pulpal pathology

Clinical - no response to hot and cold stimulli or electric pulp testing, tenderness to percussion and mastication may still be present. Radiographic - widening of the PDL space at root apex, longer duration lesions produce circumscribed, symmetric, radiolucent defect at apex in alveolar bone.

14

What four conditions should always be part of the differential diagnosis when apical radiolucent lesions are seen radiographically?

Periapical granuloma, apical periodontal cyst (AKA radicular cyst, periapical cyst), periapical abscess, periapical scar

15

Periapical granuloma: description and etiology

The most common periapical pathosis!
Accumulation of inflammatory (granulation tissue-highly vascular present in healing stages of inflammation) tissue at the periapex in response to noxious products of pulp necrosis
Chronic inflammation, not acute!!
May be found in transition from periapical abscess and/or apical periodontal cyst
Clinical presentation: Most are asymptomatic, Tooth not typically mobile
Usually not sensitive to percussion

16

periapical granuloma: radiographic presentation and treatment

Radiographic presentation: Most are discovered on routine radiographic survey
-Radiolucent lesion
-Variable size
-Symmetrical
-Well defined
-Punched out border most often
-May be somewhat diffuse
-Loss of lamina dura at the root tip in the area of the radiolucency
-Root resorption can be seen
Treatment:
-Conventional endodontic treatment
-Surgical endodontic treatment
-Extraction

17

apical periodontal cyst: description and etiology

Also called Periapical Cyst or Radicular Cyst
Inflammatory stimulation of epithelial remnants of Hertwig’s epithelial root sheath results in epithelial proliferation and cyst formation
Clinical presentation:
Typically asymptomatic
Usually not mobile
Displacement of the affected or adjacent teeth can occur
Usually do not produce clinically noticeable enlargement of the alveolar bone

18

apical periodontal cyst: radiographic presentation

Radiographic presentation: (if the lesion is larger than a nickel it is probably a cyst and not a granuloma) if there is a corticated border to the lesion rather than a punched out lesion you are more likely looking at a cyst—you will still see some loss of lamina dura
Often discovered on routine radiographic survey
Radiolucent lesion, variable size, may show static behavior or very slow growth, symmetrical, well-defined, punched out border most often
Loss of lamina dura in the area of the lesion is usually present
Root resorption can be seen

19

apical periodontal cyst: variations in radiographic presentation

Variations in radiographic presentation:
Classic pattern
Lesion surrounds the root tip
Lateral apical periodontal cyst (especially lateral incisors though any tooth can have one)
Found on the side of the root rather than right at the root tip
Probably arises in association with a lateral root canal
Residual apical periodontal cyst
Cyst remains following extraction of the tooth (cyst will persist until epithelium is disrupted some endodontists purposely try to pass a very small file through the apex to disturb the epithelial lining if it is a cyst)

20

apical periodontal cyst: treatment

Conventional endodontic treatment
Surgical endodontic treatment
Extraction

21

periapical abscess description and etiology

Acute inflammation due to pulpal necrosis with spread of noxious products into the periapical region
Transition from periapical granuloma and/or apical periodontal cyst is possible
Clinical presentation:
May be symptomatic or asymptomatic
Symptomatic:
Pain on percussion, mastication, and/or palpation over the periapical region
Intensity of pain may vary from mild to severe
Tends to increase in severity with time however
Swelling in the periapical region or vestibule may accompany it
It is an active infection—systemic symptoms may be noted
Headache, malaise, fever, chills
Asymptomatic:
Painless
Swelling in the periapical region or vestibule may accompany it

22

periapical abscess radiographic presentation and treatment

Radiographic findings (symptomatic or asymptomatic)
May not produce any obvious radiographic changes
Radiolucent lesion may be present
Often ill-defined
Thickening of the periodontal ligament space also is possible
Treatment: Conventional endodontic therapy, extraction, analgesics to control pain

23

periapical scar description

Arises due to scar formation in the site of a healing periapical granuloma, apical periodontal cyst, or periapical abscess
Typically occurs when there has been destruction of cortical bone on both the buccal and lingual aspects of the involved tooth
Most common following surgical endodontic therapy

24

Sinus tract emptying to the skin surface

Typically an enlarged nodular mass
Red lesion with other shades of yellow, white, purple mixed in
Mandibular teeth most commonly

25

What are the two types of cellulitis typically associated with dental infections?

Ludwig's angina & Cavernous sinus thrombosis

26

Ludwig's angina description

Typically results from abscess of a mandibular molar tooth, rapid swelling of the sublingual (elevates tongue), submandibular and submental areas. May extend to the spaces around the throat and close off airway - death can occur.

27

Sinus thrombosis description

Results from abscess of a maxillary anterior or premolar tooth, canine is most often the source of infection. Painful swelling involves periorbital tissues (eyelids, conjunctiva).

28

Potential sequelae to localized lesions: sinus tract description

A "hole" with surrounding redness, an enlarged nodular mass (most are found on buccal aspect)

29

Potential sequelae to localized lesions: osteomyelitis description

Periapical inflammation spreading into adjacent bone without drainage

30

Potential sequelae to localized lesions: cellulitis description

Ludwig's angina - rapid swelling can close off airway, death can occur. Cavernous sinus thrombosis - protrusion of eyeball, pupil dilation with photophobia, excessive lacrimation, loss of sight in the involved eye, meningitis, brain abscess, death is possible.

31

Normal apical tissues

Teeth with normal periradicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact, and the periodontal ligament space is uniform.

32

Symptomatic apical periodontitis

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.

33

Asymptomatic apical periodontitis

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

34

Acute apical abscess

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and swelling of associated tissues.

35

Chronic apical abscess

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

36

Condensing osteitis

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

37

A clinical diagnostic category in which the pulp is symptom-free and normally responsive to pulp testing.

Normal pulp

38

A clinical diagnosis based on subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.

Reversible pulpitis

39

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: lingering thermal pain, spontaneous pain, referred pain.

Symptomatic irreversible pulpitis

40

A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing. Additional descriptors: no clinical symptoms but inflammation produced by caries, caries excavation, trauma.

Asymptomatic irreversible pulpitis

41

A clinical diagnostic category indicating death of the dental pulp. The pulp is usually nonresponsive to pulp testing.

Pulp necrosis

42

Teeth with normal periradicular tissues that are not sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact, and the periodontal ligament space is uniform.

Normal apical tissues

43

Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation. It might or might not be associated with an apical radiolucent area.

Symptomatic apical periodontitis

44

Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area, and does not produce clinical symptoms.

Asymptomatic apical periodontitis

45

An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation, and swelling of associated tissues.

Acute apical abscess

46

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.

Chronic apical abscess

47

Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

Condensing osteitis