Pulpal and Periapical Disease

Question 1

What are three kinds of pulpitis?

Answer 1

1-Reversible Pulpitis
2-Irreversible Pulpitis
3-Chronic hyperplastic pulpitis

Question 2

What are 3 periapical pathologies?

Answer 2

1-Periapical Granuloma
2-Apical Periodontal Cyst
3-Periapical Abscess

Question 3

What are 3 possible sequelae of not treating periapical pathology?

Answer 3

1-Sinus Tract
2-Osteomyelitis (bone marrow inflammation)
3-Cellulitis (soft tissue plane infection)

Question 4

What is the most common periapical pathology?

Answer 4

Periapical granuloma

*less common are apical periodontal cyst (rest of serres), Periapical abscess, periapical scar

Question 5

What is the earliest change at the apex of the root with a periapical granuloma?

Answer 5

Widening of the PDL space at the apex

Question 6

What are secondary acute inflammatory changes within a periapical granuloma called historically?

Answer 6

Phoenix abscess

Question 7

What are 4 clinical presentations of a periapical granuloma?

Answer 7

1-Mostly asymptomatic
2-Tooth not typically mobile
3-Not sensitive to percussion
4-Does not respond to thermal or electric pulp test

Question 8

What are 3 possible treatments for a periapical granuloma?

Answer 8

1-Conventional endodontic treatment
2-Surgical endodontic treatment
3-Extraction

Question 9

What cells do you typically see histologically in an abscess?

Answer 9

Neutrophils

Question 10

What are the three orientations of Apical Periodontal Cysts?

Answer 10

1-Classic pattern (centered on root tip)
2-Lateral Apical (apical 1/3 to the side of root)
3-Residual (edentulous space with radiolucency)

Question 11

What are two other names for Apical Periodontal Cysts?

Answer 11

• Perioapical cyst

- Radicular cyst

Question 12

A lumen with a spider web like appearance in the surrounding epithelium is typically of what?

Answer 12

Apical Periodontal Cyst

Question 13

The accumulation of acute inflammatory cells at the apex of a nonmetal tooth that gets worse with time is called what?

Answer 13

Periapical Abscess

*Lots of Neutrophils

Question 14

A defect created by periapical inflammatory lesions that fills with collagenous CT is called what?

Answer 14

Periapical Scar

Question 15

What is granulation tissue made up of?

Answer 15

Inflammatory cells, blood vessels and collagen

Question 16

What is it called when an inflamed pulp grows out of the tooth?

Answer 16

Chronic Hyperplastic pulpitis

Question 17

Granulation tissue growing out of an extraction site is called what?

Answer 17

Epulis Granulomatosa

*may be metastatic cancer if it is not granulation tissue

Question 18

What are the 4 main sequelae of Periapical Pathology?

Answer 18

1-Sinus tract
2-Ostemyelitis
3-Cellulitis (Ludwig’s Angina and Cavernous sinus thrombosis)
4-Condensing Osteitis

Question 19

A periapical abscess with pus that dissects through bone into soft tissue following the path of least resistance is called what?

Answer 19

Sinus Tract

*Has a point of exit to drain purulent material

Question 20

Also called a parulis or gum boil, what marks the exit point of a sinus tract on the oral mucosa?

Answer 20

Intraoral Sinus Tract

Question 21

Typically an enlarged external nodular mass, what lesion is more commonly found with mandibular teeth?

Answer 21

Cutaneous Sinus tract

*Red, yellow, white or purple

Question 22

Acute or chronic inflammation of the bone, usually due to bacterial infection is called what?

Answer 22

Osteomyelitis

*Actue infection does not produce Xray changes

Question 23

What is a sequestra?

Answer 23

Infected bone

Question 24

What is an involucrum?

Answer 24

Fragments of necrotic bone that become surrounded by new, vital bone

Question 25

When purulence perforates the cortex and spreads through overlying soft tissue it is called?

Answer 25

Cellulitis

Question 26

What are the two dangerous types of cellulitis associated with dentistry?

Answer 26

1-Ludwigs Angina

2-Cavernous Sinus thrombosis

Question 27

Deadly cellulitis of the submandibular region resulting in “woody tongue”(sublingual space) and “bull neck”(submandibular space) is called?

Answer 27

Ludwig’s Angina

*Obvious pus collections are not present

Question 28

What are 4 treatments for Ludwig’s Angina?

Answer 28

1-Maintenance of the airway
2-Incision and drainage
3-Antibiotic therapy
4-Elimation of infection source

Question 29

What typically results from an abscess of Maxillary anterior (most often Canine) and is an edematous periorbital enlargement?

Answer 29

Cavernous Sinus Thrombosis

*Also may have swelling along the lateral border of the nose

Question 30

What is the typical treatment for Cavernous Sinus Thrombosis?

Answer 30

Surgical drainage and High dose antibiotics

Question 31

What are 6 possible sequelae for Cavernous Sinus Thrombosis?

Answer 31

1-Protrusion and fixation of eyeball
2-Pupil dilation with photophobia
3-Excessive lacrimation
4-Loss of sight in involved eye
5-Meningitis
6-Brain Abscess

Question 32

Also known as focal sclerosing osteomyelitis, what is a localized area of bone sclerosis associated with the apices of teeth with pulpitis called?

Answer 32

Condensing Osteitis

*Associated inflammation is critical. Residual areas are called bone scars

Question 33

Though Condensing Osteitis appears similar to idiopathic osteosclerosis, what distinguishes it?

Answer 33

The radiopaque region is not separated form the apex