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Flashcards in Chapter 2 Deck (182):
1

Abscess

A collection of purulent exudate that has accumulated in a contained space formed by the surrounding tissue

2

Actinic

Relating to or exhibiting chemical changes produced by radiant energy, especially the visible and ultraviolet parts of the spectrum; relating to exposure to the ultraviolet rays of sunlight

3

Acute

An injury or course of inflammation that is of short duration

4

Angiogenesis

The formation and differentiation of blood vessels

5

Atrophy

The decrease in size and function of a cell, tissue, organ, or whole body

6

Biochemical mediators

Chemicals in the body that activate responses

7

Central

Lesion is within bone

8

Chemotaxis

The movement of white blood cells as directed by biochemcial mediators, to an area of injury

9

Chronic

An injury or course of inflammation that is of long duration

10

C-reactive protein

A nonspecific protein, produced in the liver, that becomes elevated during episodes of acute inflammation or infection

11

Cyst

An abnormal sac or cavity lined by epithelium and surrounded by fibrous connective tissue

12

Cytolysis

The dissolution or destruction of a cell.

13

Demastication

When tooth wear is increased by chewing an abrasive surface

14

Edema

tissue swelling

15

Emigration

The passage of white blood cells through the walls of small blood vessels and into injured tissues

16

Epithelialization

Process of renewal of new surface of epithelium

17

Exudate

A body fluid with a high protein content that leaves the microcirculation during an inflammatory response that consists of serum that contains WBCs, fibrin, and other protein molecules

18

Fibroblasts

The cells that form fibers as well as intercellular substance

19

Fibroplasia

The formation of fibrous tissue as usually occurs in healing

20

Fistula

An abnormal passage that leads from an abscess to the body surface

21

Granulation tissue

The intial connective tissue formed in healing

22

Granuloma

A lesion composed of a collection of macrophages usually surrounded by a rim of lymphocytes that is a form of chronic inflammation

23

Hyperemia

Excess of blood within blood vessels

24

Hyperplasia

An enlargement of a tissue or organ resulting from an increase in the number of cells; the result of increased cell divison

25

Hypertrophy

An enlargement of a tissue or oran resulting from an increase in the size of its individual cells, but not the number of cells

26

Inflammation

Allows the body to eliminate injurious agents, contain injuries, and heal defectss

27

Injury

An alteration in the environment that causes tissue damage

28

Keloid

The excessive scarring that mainly occurs in skin in some cases with healing

29

Leukocytosis

An increase in the number of white blood cells circulating in the blood

30

Leukopenia

A decrease in the number of white blood cells circulating in the blood

31

Local

A disease process that is confined to a limited location in the body that is not general or systemic

32

Lymphadenopathy

Adnormal enlargement of a lymph node or nodes

33

Macrophage

The second type of WBC to arrive at a site of injury that was originally a monocyte; it participates in phagocytosis during inflammation and continues to be active in the immune response

34

Margination

A process during inflammation in which WBCs tend to move to the periphery of the blood vessel as the site of injury

35

Microcirculation

The small blood vessels, including arterioles, capillaries, and venues of the vascular system

36

Myofibroblasts

Fibroblasts that have some of the characteristics of smooth muscle cells, such as the ability to contract

37

Necrosis

The pathologic death of one or more cells or a part of tissue, or an organ that results from irreversible damage to cells

38

Neutrophil

The first WBC to arrive at a site of injury; the primary cell involved in acute inflammation also called polymorphonuclear leukocyte

39

Opacification

Process of becoming opaque

40

Opsonization

The enhancement of phagocytosis by a process in which a pathogen is marked, with opsonins, for destruction by phagocytes

41

Pavementing

Adherence of WBCs to blood vessel walls during inflammation

42

Peripheral

That the lesion is within the gingival tissue or alveolar mucosa

43

Phagocytosis

The ingestion and digestion of particulate material by cells

44

Purulent exudate

Exudate containing or forming pus

45

Pyrogens

The fever-inducing substances produced from either WBCs or pathogenic microorganisms

46

Radicular

Pertaining to the root of a tooth

47

Regeneration

Process by which injured tissue is replaced with tissue identical to that present before the injury

48

Repair

The restoration of damaged or diseased tissue by cellular change and growth

49

Serous exudate

Exudate that has a watery consistency; resembles serum

50

Systemic

Pertaining to or affecting the body as a whole, as well as a disease process pertaining to or affecting the body as a whole

51

Transudate

The extravascular fluid component of blood that passes through the endotherlial cell walls of the microcirculation

52

WBCs

Cells within the blood and surrounding tissue, also called leukocytes, that are involved in the inflammatory and immune response

53

Traumatic injury

A disease process that results from injury that causes tissue damage

54

Waldeyer's ring

The ring of lymphatic tissue formed by the two palatine tonsils, the pharyngeal tonsil, the lingual tonsil, and intervening lymphoid tissue

55

What are the innate defenses?

Physical barrier
Mechanical barrier
Antibacterial barrier
Removal of foreign substances
Inflammation process

56

Localized signs of inflammation

Redness
Swelling
Heat
Pain
Loss of normal tissue function

57

Systemic signs of inflammation

Fever
Leukocytosis
Elevated CRP
Lymphadenopathy

58

White blood cells in the inflammatory response

White blood cells or leukocytes
Monocytes circulating in blood --> macrophages in tissue
Lymphocytes and plasma cells
Eosinophils and mast cell

59

These are seen in chronic inflammation and the immune response

Lymphocytes and plasma cells

60

These are seen in both inflammation and immune response

Eosinophils and mast cells

61

What is the function of Neutrophils?

Phagocytosis

62

Multilobed nucleus and granular cytoplasm that contains lysosomal enzymes

neutrophil

63

Constitues 60% to 70% of WBC population

neutrophil

64

What is the functions of macrophages?

Phagocytosis; play a role in immune system

65

Single round nucleus and do not have granular cytoplasm

Macrophages

66

Constitues 3% to 8% of WBC population

Macrophages

67

What biochemical mediators may be derived from?

Blood
Endotherlial cells
White blood cells and platelets
Pathogenic organisms as they injure the tissue

68

Three interrelated systems

Interaction takes place during activation, among their products, and within their various actions

69

What are the three interrelated systems associated with biochemical mediators

Kinin system
Clotting mechanism
Complement system

70

Kinin system

*Active in early phase of inflammation
*Dilation of blood vessels at the site of injury
*Permeability of local blood vessels
*Induces pain

71

Clotting mechanism

Clots blood and midates inflammation

72

Complement system

*Involves the production of a sequential cascade of plasma proteins
*Some components cause WBCs known as mast cells to release histamine
*Other components cause cell death, from chemotactic factors for WBCs and enhance phagocytosis

73

Other biochemical mediators released by the body

Prostaglandins
Lysosomal enzymes

74

Prostaglandins

Cause increased vascular dilation and permeability, tissue pain and redness, and changed in connective tissue

75

Lysosomal enzymes (Released by body)

Act as chemotactic factors
May cause damage to connective tissue and to the clot

76

Other biochemical mediators released by pathogenic microorganisms

Endotoxin
Lysosomal enzyme

77

Endotoxin

*Produced by cell walls of gram-negative bacteria
*Serves as chemotacitc factor; can activate complement, function as an antigen, and damage bone and tissue

78

Fever (systemic manifestations)

*Controlled by hypothalamus
*Pyrogens
*Hypothalamus increases body temperature by way of prostaglandins

79

Leukocytosis (systemic manifestations)

Increase to 10,000 to 30,000/mm^3 of blood
It is the body's attempt to provide more cells for phagocytosis

80

increase in lymphocytes

viral infection

81

increase in neutrophils

bacterial infection

82

increase in eosinophils

allergic reaction

83

Used to monitor tissue healing

Elevated levels of C-reactive protein

84

Chronic inflammation

Cause by persistent injuries
Repair cannot be completed until source of injury is removed

85

Cells involved in chronic inflammation

Macrophages
Lymphocytes
Plasma cells
Neutrophils
Monocytes
Fibroblasts

86

Formulation of granulomas

Microscopic groupings of macrophages surrounded by lymphocytes and plasma cells
Associated with foreign body reactions and some infections such as TB

87

Nonsteroidal antinflammatory drugs (NSAIDs)

Acetylsalicylic acid (aspirin)
Ibuprofen

88

Sterodial antinflammatory drugs

Prednisone

89

Scar tissue

Matured, fibrous connective tissue
It is whiter and paler because of increased collagen and decreased vascularity

90

What are the types of repair for scar tissue

Primary intention
Secondary intention
Tertiary intention

91

Microscopic events 2 weeks after injury

Initial granulation tissue and its fibers have been remodeled
Matured, fibrous connective tissue is called scar tissue
It is whiter and paler because of increased collagen and decreased vascularity

92

Factors affecting amount of scar tissue

1.)Heredity
2.)Strength and flexibility needed in the tissue
3.)Tissue type
4.)Type of repair
-Healing by primary intention
-Healing by secondary intention
-Healing by tertiary intention

93

Healing by primary intention

Healing of an injury in which there is little loss of tissue
The margins are close together and very little granulation tissue forms

94

Healing by secondary intention

The edges of the injury cannot be joined during healing
A large clot forms, resulting in increased granulation tissue

95

Healing by tertiary intention

Delaying surgical tissue repair until infection is resolved
An injured area may become infected, especially with puncture wounds
In some situations, an infected injury is left open until infection is controlled

96

Osteoblasts create

New bone tissue

97

Factors delaying bone formation

Blood supply at site
Growth factors
Edema
Injury
Infection
Removal of osteoblast-producing tissues
Excessive or inadequate movement of bone tissue

98

Factors influencing repair of bone

Nutrition
Age
Tobacco use

99

Local factors that impair healing

Bacterial infection
Tissue destruction and necrosis
Hematoma
Excessive movement of injured tissue
Poor blood supply

100

Systemic factors that impair healing

Malnutrition
Immunosuppression
Genetic connective tissue disorders
Metabolic disorders

101

Injuries to Teeth

Attrition
-Bruxism
Abrasion
Abfraction
Erosion
-Bulimia
-Methamphetamine abuse

102

Attrition

Tooth-to-tooth wear
May be observed in both primary and permanent dentition

103

Bruxism

Grinding and clenching teeth for nonfunctional purposes, such as:
Occlusal interferences
Stress
Tension
Seizure disorders

104

Signs and symptoms of bruxism

Wear facets
Abnormal rate of attrition
Hypertrophy of masticatory muscles
Increased muscle tone
Muscle tenderness
Muscle fatigue
Cheek biting
Pain in the temporomandibular (TM) joint area
Tooth mobility
Pulpal sensitivity to cold

105

Management of bruxism

Occlusal adjustments to eliminate occlusal interferences and fabrication of an acrylic splint

106

Abrasion

Pathologic wearing away of tooth structure that results from a repetitive mechanical habit
Most frequently seen as a notching on root surfaces with gingival recession

107

Abfraction

Cause: Microfracture of tooth structure in areas of concentration of stress
-May be related to fatigue, flexure, fracture, and deformation of tooth structure
-May occur in combination with abrasion

108

Appearance of abfraction

Typically appears as wedge-shaped lesions at the cervical areas of teeth

109

Preventive treatment of abfraction

Fabricating an acrylic splint

110

Erosion

Loss of tooth structure as a result of chemicals, without bacterial involvement
-Tooth structure may be lost around a restoration, making the restoration stand out, distinguishing it from abrasion or attrition
-Correlate location of erosion and abrasion with patient’s history

111

Potential causes of Erosion

Industrial factors
Intraorally applied cocaine hydrochloride drug abuse
Overuse of soft drinks
Baby bottle caries
Sucking on lemons
Chronic vomiting (Bulimia)

112

Bulimia

An eating disorder characterized by food binges followed by self-induced vomiting
-The patient with bulimia maintains a normal body weight but is secretive about eating habits
-May see electrolyte imbalance and/or malnutritionIrritation of oral mucosa and lipsTraumatic lesions on the backs of the fingers

113

Management of bulimia

-Fluoride rinse and toothpaste
-Rinse with water after purging
-Avoid brushing immediately after vomiting
-Use very soft toothbrush
-May require full-coverage restorative dental treatment

114

Methamphetamine abuse (Meth Mouth)

Rapid destruction of teeth as a result of:
-Methamphetamine acid content
-Decreased salivary flow
-Cravings for high-sugar beverages
-Lack of oral hygiene

115

Injuries to oral soft tissue

-Aspirin burns
-phenol burns
-electric burns
-other burns
-lesions associated with cocaine use
-lesions from self-induced injury
-Hematoma
-traumatic ulcer
-Frictional keratosis
-Linea alba
-Nictotinic stomatitis
-Tobacco pouch keratosis
-Traumatic neuroma
-Amalgam tattoo
-Melanosis
-Solar Cheilitis
-Mucocele
-Necrotizing sialometaplasia
-Sialolith
-Acute and chronic sialadenitis

116

Aspirin burn

Topical application is a common misuse of this product
-The tissue becomes necrotic and white
-The surface may slough off, leaving a painful ulcer
-The ulcer usually heals in 7 to 21 days

117

Phenol burn

Used in dentistry as a cavity-sterilizing agent and a cauterizing agent
Will cause whitening and sloughing of the area as a result of tissue destruction

118

Dental materials that can cause burns

Phenol
Sodium hypochlorite
Ferric sulfate
Formocresol
Eugenol

119

Electric burn

-May be seen in infants or young children who have chewed an electrical cord
-May be quite extensive, damaging oral tissue and even tooth buds
-May cause permanent disfigurement and scarring
---Treatment
1.)Plastic surgery
2.)Oral surgery
3.)Orthodontic therapy

120

Thermal Burns

-Hot food burns:
From soup or cheese on pizza
-Products containing hydrogen peroxide or eugenol

121

Lesions associated with cocaine use

Lesions located at the midline of the hard palate may vary from ulcers to keratotic lesions to exophytic reactive lesions as a result of smoking crack cocaine
Necrotic ulcers of the tongue and epiglottis have been reported as a result of freebasing cocaine

122

Lesions from self-induced injuries

Chronic lip, cheek, or tongue biting
Trauma to the gingiva from a fingernail
Lesions may range from ulceration to epithelial hyperplasia and hyperkeratosis

123

Traumatic Ulcer

-Cheek, lip, or tongue biting
-Denture irritation
-Mucosal injury
-Overzealous brushing
---Treatment
1.)Usually heals within 7 to 14 days unless the trauma persists
2.)May require a biopsy

124

Traumatic granuloma

-The result of persistent trauma
Appearance: Hard (indurated), raised lesion
Heals rapidly after biopsy

125

Hematoma

-Accumulation of blood within tissue as a result of trauma
-Appears as a red to purple to bluish-gray mass
-Frequently seen on labial or buccal mucosa

126

Frictional Keratosis

A form of hyperkeratosis
Cause: Chronic rubbing or friction against an oral mucosal surface; resembles a callus on skin
Appearance: Opaque white

127

Treatment of frictional keratosis

-Identify the traumatic cause of the lesion
-Eliminate the cause
**Must be differentiated from idiopathic leukoplakia because leukoplakia may be premalignant

128

Linea Alba

-A white, raised line most commonly on the buccal mucosa at the occlusal plane
-May be the result of a teeth-clenching habit
-Sometimes the pattern of the teeth can be seen in the lesion
-Microscopic appearance: Epithelial hyperplasia and hyperkeratosis
--No treatment necessary

129

Nicotine Stomatitis

-A benign lesion typically associated with pipe and/or cigar smoking; may also occur with cigarette smoking
-Initial appearance: Erythema
-Increased opacity as keratinization occurs
-Raised red areas occur at the openings of ducts of inflamed minor salivary glands

130

Smokeless Tobacco Keratosis (STK)

-A white lesion located where chewing tobacco is placed, most often in the mucobuccal fold
-Early lesions may have a granular or wrinkled appearance
-Long-standing lesions may be more opaquely white and have a corrugated surface

131

Tobacco Pouch Keratosis

Treatment:
-Tobacco cessation
-May require biopsy
-Long-term exposure to chewing tobacco has been associated with increased risk of squamous cell carcinoma

132

Amalgam tattoo

-A flat, bluish-gray lesion of the oral mucosa, caused by the introduction of amalgam into tissue
-May occur during placement or removal of an amalgam restoration or during an extraction
-May be seen in any location in the oral cavity, most commonly on the gingiva or alveolar ridge
-Amalgam particles may be seen on radiograph, aiding in diagnosis
-Patient history may help
-Must be differentiated from malignant melanoma
**Treatment:
None, providing melanoma has been ruled out

133

Melanosis

-Normal physiologic pigmentation of oral mucosa
-May be genetic
-May occur as a result of inflammation: -Postinflammatory melanosis
-If presenting as a macule, a biopsy may be warranted
-Labial melanotic macule on vermilion of lips
-Smoker’s melanosis

134

Solar Cheilitis (Actinic Cheilitis)

-A degeneration of the tissue of the lips, caused by exposure to the sun
-Appearance:
*Lips appear dry and cracked
*The vermilion appears pale pink and mottled
*The interface between lips and skin is indistinct
-Microscopically: Epithelium is thinner than normal; degenerative CT changes
-Smoking and alcohol use increase risk of squamous cell carcinoma
-Biopsy may be indicated for persistent scaling or ulceration
*Prevention
Avoid sun exposure
Use sun-blocking agents

135

Mucocele (Mucous Retention lesion)

-A lesion formed when a salivary gland duct is severed and the mucous salivary gland secretion spills into the adjacent connective tissue
**Not a true cyst because it is not lined with epithelium


136

Mucous Retention Lesions: Mucocele, Mucous Cyst, or Mucous Retention Cyst

-Dilated salivary gland ducts that developed as a result of duct obstruction
*Treatment: Removal of affected minor salivary gland

137

Ranula

-A unilateral mucocele-like lesion that forms on the floor of the mouth
-Associated with the ducts of submandibular and sublingual glands

**Will only be found in the floor of the mouth

138

Sialolith

-A salivary gland stone
-May be found in both minor and major salivary glands
-Formed by precipitation of calcium salts around a central core
-May often be seen on radiographs

139

Treatment of Sialolith

Sometimes the calcification can be “milked” from the duct
It may require surgical removal; this may damage the duct

140

Necrotizing Sialometaplasia

A benign condition of salivary glands
Moderately painful swelling and ulceration
Thought to result from blockage of blood supply to affected area, resulting in salivary gland necrosis
Salivary gland epithelium is replaced by squamous epithelium
The ulcer usually heals by secondary intention
Biopsy is needed to establish diagnosis

141

Acute and Chronic Sialadenitis

Painful swelling of the involved salivary gland caused by obstruction of the salivary gland duct
Diagnosis
May involve injection of a radiopaque dye into the gland, followed by a radiograph (sialogram)
Treatment
May require antibiotics

142

Lesions from Reactive Connective Tissue Hyperplasia

Pyogenic granuloma
Giant cell granuloma
Irritation fibroma
Denture-induced fibrous hyperplasia
Papillary hyperplasia of the palate
Gingival enlargement
Chronic hyperplastic pulpitis

143

Reactive Connective Tissue Hyperplasia

-Proliferating, exuberant granulation tissue and dense fibrous connective tissue resulting from overzealous repair
-May be a response to a single event or chronic low-grade injury

144

Pyogenic Granuloma

A proliferation of connective tissue containing numerous blood vessels and inflammatory cells occurring as a response to injury
The name is a misnomer; the lesion is neither pyogenic (pus forming) nor a true granuloma

145

Appearance of pyogenic granuloma

Ulcerated
Soft to palpation
Bleeds easily
Deep red to purple
Generally elevated, may be sessile or pedunculated
Most commonly observed on the gingiva, it may be seen on other intraoral areas
May vary in size from a few millimeters to several centimeters
Usually develops rapidly and then remains static
Most common in teenagers and young adults, but may occur at any age
If seen in a pregnant female, it is called a pregnancy tumor

146

TX of pyogenic granuloma

Surgically excised if it does not regress spontaneously

147

Pregnancy Tumor

Pyogenic granuloma seen in pregnant women
-The lesions are identical to those seen in men and nonpregnant women
-May be caused by hormonal changes and increased response to plaque
-They often regress after delivery

148

Peripheral Giant Cell Granuloma

-A lesion that contains many multinucleated giant cells, well-vascularized connective tissue, RBCs, and chronic inflammatory cells
-Reactive lesion
**Clinical appearance resembles that of pyogenic granuloma
**Treatment: Surgical excision

149

Peripheral Ossifying Fibroma

-Exophytic, usually well-demarcated sessile or pedunculated gingival lesion
-Clinically it appears to emanate from the interdental papilla
-Has been reported in both children and adults
Composed of cellular fibrous connective tissue
-Treatment consists of complete surgical excision with thorough scaling of the adjacent teeth

150

Fibroma, Irritation Fibroma, Traumatic Fibroma, and Focal Fibrous Hyperplasia

**The most common mass on the gingiva
Caused by trauma

151

Appearance of Fibroma, Irritation Fibroma, Traumatic Fibroma, and Focal Fibrous Hyperplasia

Appearance: A broad-based, persistent exophytic lesion composed of dense, scarlike connective tissue with few blood vessels. Usually a small lesion, less than 1 cm in diameter

152

Denture-Induced Fibrous Hyperplasia

Cause: Ill-fitting denture
Location: In elongated folds of tissue adjacent to denture flange
Composed of dense, fibrous CT surfaced with stratified squamous epithelium

153

TX of Denture-Induced Fibrous Hyperplasia

Surgical removal
Relining of prosthesis
New denture

154

Inflammatory Papillary Hyperplasia of the Palate

Denture-induced hyperplasia
Appearance: Palatal mucosa covered by multiple erythematous papillary projections; “cobblestone” appearance

155

TX of Inflammatory Papillary Hyperplasia of the Palate

Treatment: Surgical removal of hyperplastic papillary tissue before new denture construction

156

Gingival Enlargement

An increase in the bulk of free and attached gingiva, especially the interdental papillae
Gingival margins are rounded
Color may vary from normal pink to pale or erythematous depending on the degree of inflammation and vascularity
May be generalized or localized

157

Gingival enlargement is a reactive response to:

Local irritants
Hormonal changes
Drugs
Hereditary conditions
Idiopathic factors
Leukemia

158

TX of gingival enlargement

Gingivoplasty
Gingivectomy
Meticulous oral hygiene

159

Chronic Hyperplastic Pulpitis (Pulp Polyp)

-An excessive proliferation of chronically inflamed dental pulp tissue
-Occurs in teeth with large, open carious lesions often in primary and permanent molars
-Usually asymptomatic
-Granulation tissue with inflammatory cells, primarily lymphocytes and plasma cells
-Neutrophils may be present
-Generally surfaced by stratified squamous epithelium

160

TX of Chronic Hyperplastic Pulpitis (Pulp Polyp)

Endodontic therapy
Extraction

161

Caries or trauma may result in:

Inflammation
Infection
Chronic hyperplastic pulpitis
Necrosis of the pulp

162

The inflammatory process begins

in pulp and then extends to the periapical area
Accessory canals may lead to areas of inflammation on the lateral portion of the root

163

Periapical Abscess

-Acute periapical abscess: Purulent exudate surrounded by connective tissue containing neutrophils and lymphocytes
-Inflammation produces severe pain
-Tooth may slightly extrude from tooth socket
-May or may not test positive with electric pulp testing

164

TX of periapical abscess

May develop directly from inflammation in the pulp
More commonly develops in an area of previously existing chronic inflammation
Treatment
Drainage and endodontic therapy
Extraction

165

Fistula formed from Periapical abscess

-comes from Fistulous tract
-takes the Channel of least resistance
**Presence of fistula warrants a radiographic evaluation

166

Periapical Granuloma

A localized mass of chronically inflamed granulation tissue that forms at the opening of the pulp canal, generally at the apex of a nonvital tooth root.
-Composed of granulation tissue containing lymphocytes, plasma cells, and macrophages
-May also contain neutrophils, areas of dense fibrous connective tissue, or epithelial rests of Malassez

167

Characteristics of Periapical granuloma

Chronic process
Most cases are asymptomatic
Tooth may be sensitive to pressure and percussion
Tooth may be slightly extruded from the socket

168

TX of periapical granuloma

1.)Endodontic therapy
2.)Extraction

169

Radicular cyst

*A true epithelium-lined cyst
-Associated with the root of a nonvital tooth
****The most commonly occurring cyst in the oral region
-A result of proliferation of the rests of Malassez
-Usually asymptomatic and discovered on radiograph

170

Radiographic appearance of radicular cyst

Radiolucent
Well circumscribed
Same as periapical granuloma

171

TX of radicular cyst

-Endodontic therapy
-Apicoectomy
-Extraction and curettage of periapical tissue

172

Residual Cyst

-Forms after tooth extraction and all or part of radicular cyst is left behind
*Treatment: Surgical removal

173

Root Resorption (RR)

External resorption: Nonreversible resorption of the tooth structure, beginning at the outside of the tooth

174

Causes of RR

1.)Inflammation
2.)Pressure
3.)Reimplantation (Tooth that has been knocked out but placed back in socket in an attempt to save tooth.)
4.)Idiopathic

175

Internal tooth or root resorption

Resorption often associated with an inflammatory response in the pulp or an idiopathic reason
Appearance

176

Clinical appearance of Internal RR

A pinkish area in the crown resulting from the vascular, inflamed connective tissue
Radiographically: Radiolucent

177

Treatment of internal or root resorption

-If the root is not perforated, calcium hydroxide is placed and endodontic treatment is performed in an attempt to save the tooth
-If the tooth is perforated, it must be removed

178

Focal Sclerosing Osteomyelitis (Condensing Osteitis)

-A change in the bone near the apices of teeth
-Thought to be a reaction to low-grade infection
-Generally asymptomatic
-If painful, may be associated with pulpal inflammatory disease
-Radiopaque
-Borders may be diffuse or well defined
-Commonly associated with the mandibular first molar

179

TX of Focal Sclerosing Osteomyelitis (Condensing Osteitis)

No treatment usually necessary
Biopsy to rule out other radiopaque lesions such as osteoma, complex odontoma, or ossifying fibroma

180

Alveolar Osteitis (“Dry Socket”)

-A postoperative complication following tooth removal in which the blood clot is lost before healing can take place, leaving raw, exposed nerve endings
-Most often occurring in mandibular third molar areas
-Patient may complain of pain, bad odor, and bad taste

181

Risk Factors for Alveolar Osteitis (“Dry Socket”)

Dissolution of the clot at the surgical site
Traumatic extraction
Presence of infection before extraction
Tobacco smoking after extraction

182

TX for Alveolar Osteitis (“Dry Socket”)

Gentle irrigation
Daily application of Dry Socket Paste containing eucalyptol until symptoms are relieved