differential diagnosis

Question 1

Differential Diagnosis of non odontogenic pain

Answer 1

P – psychogenic – Manchausens

I – Inflammatory – Sinusitis

N – Neurovascular – Cluster headaches

S – Systemic – Myocardial Infarct

M – Musculoskeletal – Myofacial pain (TMD)

Question 2

Give a differential diagnosis for a periapical radiolucency

Answer 2

1. Granulom
2. Cyst
3. Abscess
4. Scar
5. Foreign body reaction
6. OKC
7. Ameloblastoma (multilocular)
8. Central Giant Cell Granulom (multilocular)
9. Metastatic malignancy (breast, prostate, kidney)

Bhaskar – no distinction radiographically between cyst and granuloma

Nair – Incidence of Cyst, Abscess, and Granuloma
Cyst 15%, (True 61%, Pocket 39%), Granuloma 50%, Abscess 35%

Question 3

Give a differential diagnosis for a periapical radioopacity

Answer 3

1. Periapical cemental dysplasia – cementoma
2. Focal sclerosing osteomyelitis
3. Idiopathic osteoscleroses
4. cementoblastoma
5. calcifying odontogenic cyst
6. calcifying epithelial odontogenic tumor
7. adenomatoid odontogenic tumor

Question 4

What are the current theories of cyst formation?

Answer 4

1. Epithelial proliferation – Seltzer, epithelial cells proliferate to line abscess cavity
2. Cavitational Breakdown Theory – Ten Cate / Cohen, continuous growth of epithelial cells removes central cells from nutrition – innermost cells die and cyst cavity forms
3. Breakdown Theory of Cyst formation – Toller, osmotic pressure buildup due to semi-permiable membrane (Starlings Law)
4. Immunological Theory – Torabinejad, continued immune reaction to antigens – bacteria, in infected root canal system. Immune reaction responsible for proliferation of epithelium.

NAIR - POCKET CYSTS HEAL AFTER RCT / TRUE CYSTS DO NOT