Chapter 3: Pulpal and Periapical Disease Flashcards by Jade Giwa

what are the three types of pulpitis?

reversible pulpitis, irreversible pulpitis, or chronic hyperplastic pulpitis

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chronic hyperplastic pulpitis

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chronic hyperplastic pulpitis

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what are the 3 types of periapical pathologies?

periapical granuloma, apical periodontal cyst, periapical abscess

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what are the 4 sequelae of periapical pathology?

sinus tract, osteomyelitis, cellulitis, condensing osteitis

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95% of all lesions found at the periapical region are ___ in etiology

pulpal

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what are the localized lesions of periapical pathology?

periapical granuloma, apical periodontal cyst, periapical abscess, periapical scar

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periapical abscess

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how does the beginning of any inflammation of the PDL present radiographically?

widening of the lamina dura (PDL space)

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what is the most common periapical pathosis?

periapical granuloma

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periapical granuloma is also called ___

apical periodontitis

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a ___ is a mass of inflamed granulation tissue at the apex of a nonvital tooth

periapical granuloma

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a periapical granuloma may be found in transition from ___ and/or ___

periapical abscess and/or apical periodontal cyst

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what is described as secondary acute inflammatory changes within a periapical granuloma?

phoenix abscess

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what is the clinical presentation of a periapical granuloma?

most are asymptomatic
tooth not typically mobile
usually not sensitive to percussion
tooth does not respond to thermal or electric pulp tests

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what is the radiographic presentation of periapical granuloma?

radioluscent 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 radioluscency
root resorption can be seen

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most periapical granulomas are discovered how?

on routine radiographic survey

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what is the treatment for periapical granuloma?

conventional endodontic treatment
surgical endodontic treatment
extraction

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what are two other names for apical peridontal cyst?

periapical cyst
radicular cyst

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what is the result of inflammatory stimulation of epithelium in the area (rests of malassez)

apical periodontal cyst

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the radiographic presentation of an apical periodontal cyst is the same as ___

periapical granuloma

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what is the radiographic presentation of an apical peridontal cyst?

radioluscent 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

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___ is the accumulation of acute inflammatory cells at the apex of a nonvital tooth

periapical abscess

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___ is a defect created by periapical inflammatory lesions that may fill with dense collagenous tissue

periapical scar

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periapical scars occur most frequently when both the ___ and ___ have been lost

facial and lingual cortical plates

periapical scars occur most commonly following \_\_\_

surgical endodontic therapy

what are the two types of cellulitis that are sequelae of periapical pathology (dangerous types associated with dental infections)?

ludwig's angina and cavernous sinus thrombosis

periapical granuloma

periapical fibrous scar

periapical cyst

periapical cyst radioluscency extends from mandibular frist molare to the contralateral first molar

periapical cyst

lateral radicular cyst

residual periapical cyst

periapical abscess

all four maxillary incisors exhibit pulpal necrosis

periapical abscess

intraoral sinus tract aka parulis or "gum boil"

\_\_\_ is a periapical abscess with pus formation; the pus dissects through the bone and destroys the bone; perforates the cortical plate of bone, extending into soft tissue; finds a point of exit and drains purulent material

sinus tract

\_\_\_ tend to follow the path of least resistance

sinus tract

sinus tracts may have ___ drainage

intermittent

what does the location of a sinus tract depend on?

the involved tooth and path of least resistance

an intraoral sinus tract is also called \_\_\_

parulis or "gum boil"

intraoral sinus tracts mark what?

the exit point of the sinus tract on the oral mucosa

\_\_\_ is typically an enlarged nodular mass that presents as a red lesion with other shades of yellow, white, or purple

cutaneous sinus tract

cutaneous sinus tract affect which teeth most commonly?

mandibular teeth

periapical abscess

cutaneous sinus tract

intraoral sinus tract aka parulis aka gum boil

hint: this is an aggressive and rapidly spreading form of cellulitis that involves the sublingual, submandibular, and submental spaces bilaterally

ludwig angina

acute **osteomyelitis**

acute **osteomyelitis** with sequestrum

pulp stones

diffuse sclerosing **osteomyelitis**

osteitis

what is the concern associated with pulp stones?

they can occlude the pulp canal, creating issues with endodontic therapy

\_\_\_ is described as acute or chronic inflammation in bone, usually due to bacterial infection

osteomyelitis

what 3 things can result from osteomyelitis?

* expanding lytic destruction * suppuration * sequestra formation

epulis granulomatosa

is osteomyelitis common in developed countries?

what is an epulis granulomatosa?

hyperplastic granulation tissue post-extraction

most cases of osteomyelitis arise after what?

odontogenic infections or traumatic fracture

75% of osteomyelitis cases are in \_\_\_(males/females)\_\_\_, and mostly occur in the \_\_\_(maxilla/mandible)\_\_\_

* males * mandible

what are symptoms of acute osteomyelitis infection?

* fever * lymphadenopathy * sensitivity * soft tissue swelling

will an acute osteomyelitis infection produce radiographic changes?

what is an involucrum?

during an acute osteomyelitis infection, fragments of necrotic bone may become surrounded by new, vital bone

\_\_\_ occurs when the purulence from an infection perforates the cortex and spreads diffusely through the overlying soft tissue; the purulence is unable to establish a drainage point

cellulitis

how does the purulence spread in cellulitis?

it begins to spread through soft tissues, typically through tissue layers

\_\_\_ is cellulitis of the submandibular region

ludwig's angina

70% of ludwig's angina cases develop from what?

abscess of a mandibular molar tooth

ludwig's angina involves the rapid swelling of the ___ spaces, which may extend to the spaces around the \_\_\_

* sublingual, submandibular, and submental spaces * throat (may cut off airway) * creates a massive swelling of the neck \*DEATH CAN OCCUR

ludwig's angina with sublingual invovlement causes \_\_\_

swelling and elevation of the tongue ("woody tongue")

ludwig's angina that spreads to the submandibular space causes \_\_\_

enlargement and tenderness of the neck ("bull neck")

what are symptoms of ludwig's angina with submandibular space involvement?

* pain * restricted neck movement * dysphagia, dysphonia, dysarthria * drooling * sore throat * respiratory obstruction

what are the signs of ludwig's angina with submandibular space involvement?

* tachypnea * dyspnea * tachycardia * stridor * restlessness * patients need to maintain an erect position * fever and chills

are obvious collections of pus present in ludwig's angina?

what is the treatment (in order) for ludwig's angina?

1. maintenance of the airway 2. incise and drain 3. antibiotic therapy 4. elimination of original focus of infection

\_\_\_ typically results from abscess of a maxillary anterior or premolar tooth

cavernous sinus thrombosis

which tooth is most often the source of infection in cavernous sinus thrombosis?

canine

cavernous sinus thrombosis appears as an \_\_\_

edematous periorbital enlargement

in cavernous sinus thrombosis, swelling typically is present where?

along the lateral border of the nose

what are the possible sequelae of cavernous sinus thrombosis?

* protrusion and fixation of the eyeball * pupil dilation with photophobia * excessive lacrimation (tearing) * loss of sight in the involved eye * meningitis * brain abscess

is death possible in cases of cavernous sinus thrombosis?

yes

what is the treatment of cavernous sinus thrombosis?

surgical drainage and high-dose antibiotics

cavernous sinus thrombosis

condensins osteitis is also called \_\_\_

focal sclerosing osteomyelitis

\_\_\_ is described as a localized area of bone sclerosis associated with apices of teeth with pulpitis

condensing osteitis

association with ___ is critical in the diagnosis of condensing osteitis

inflammation (aka pulpitis) radiographically identical to idiopathic osteosclerosis

what are radiographic changes seen in condensing osteitis?

* increased radio-opacity adjacent to tooth apex that has thickened PDL or apical inflammatory lesion * no radioluscent border (distinguishes from focal cemento-osseous dysplasia) * not separated from apex (distinguishes from idiopathic osteosclerosis)

in condensing osteitis, there is no clinical ___ of bone

expansion

tooth is symptomatic