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BDS4 Oral Surgery > Diseases of the pulp and periodontium > Flashcards

Diseases of the pulp and periodontium Flashcards

1
Q

What is pulp hyperaemia?

A

Increased blood supply due to trauma or caries (reversible pulpitis)

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2
Q

What are the clinical features of pulp hyperaemia?

A

Pain lasting for seconds

Pain stimulated by hot/cold or sweet foods

Pain resolves after stimulus

Caries approaching pulp but tooth can still be restored without treating pulp

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3
Q

What are the features of acute pulpitis?

A

Constant Severe Pain

Reacts to Thermal Stimuli

Poorly Localised Pain/Referred pain- brain struggles to realise which branch of CN5

No (or Minimal) Response to analgesics- cannot reach pulp

Open Symptoms Less Severe

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4
Q

How is diagnosis of acute pulpitis achieved?

A

History- best method

Visual examination

Negative Tenderness to Percussion (usually)

Pulp testing is equivocal

Radiographs- pulp chamber will look no different on radiographs

Diagnostic’ Local Anaesthetic

Removal of Restorations

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5
Q

What can acute pulpitis go on to become?

A

Chronic pulpitis

Acute Apical Periodontitis

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6
Q

What is chronic pulpitis?

A

When inflammation and infection is underlying and flares up (becomes acute) intermittently

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7
Q

What occurs in acute periodical peridontitis?

A

Inflammation progresses out of pulp chamber and into surrounding periodontal tissue

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8
Q

What are the features of AAP?

A

Very TTP- feels high in mouth

Tooth is non-vital (unless traumatic)

Slight increase in mobility

Radiographically:
Loss of clarity of Lamina Dura

Delay in changes at the apex of the tooth- widening of apical periodontal space

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9
Q

What may a radiolucent shadow suspected to be AAP actually be?

A

May indicate an ‘old’ lesion e.g. Flare up of apical granuloma

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10
Q

What causes Traumatic Periodontitis?

A

Parafunction (Tooth clenching or grinding)

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11
Q

What are the features of traumatic periodontitis?

A

Occlusally- posturing, functional positioning

TTP

Vital

Widening of PDL space radiographically

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12
Q

How do you treat traumatic periodontitis?

A

Occlusal adjustment

Therapy for parafunction

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13
Q

What can AAP progress onto?

A

Acute apical abscess

Chronic apical infection (granuloma)

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14
Q

What are the types of pus producing dental infections?

A

Acute apical abscess (most common)

Periodontal Abscess

Pericoronitis

Sialadenitis

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15
Q

What is pus made of?

A

Dead neutrophils and immune cells

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16
Q

What organisms are involved in a dental abscess?

A

Polymicrobial- anaerobes are most important

17
Q

What are some examples of unusual infections that can be the causes of chronic infections which do not resolve?

A

Staphylococcal lymphadenitis of childhood

Cervico-facial actinomycosis- can occur following extraction (rare)

18
Q

What are the 5 cardinal signs of inflammation?

A

Heat

Redness

Swelling

Pain

Loss of function

19
Q

What occurs in an AAA?

A

Initially it is almost identical to AAP, then infection erodes through bone and soft tissues following the path of least resistance

Once the abscess perforates through bone:
Pain often remits (unless it’s in the palate)

Swelling, redness and heat (in the soft tissues) become increasingly apparent

As swelling increases pain returns

There is an initial reduction in tenderness to percussion of the tooth as pus escapes into the soft tissues

20
Q

How is the site of swelling in an AAA determined?

A

The position of the tooth in the arch

Root length

Muscle attachments

Potential spaces in proximity to lesion

21
Q

How is an AAA treated

A

Provide Drainage- soft tissue incision intraorally/extraorally

Remove source/cause- Extract tooth, Pulp extirpation, Periradicular surgery

AB

22
Q

What is the patients need for antibiotics to treat an AAA based on?

A

Severity

Absence of adequate drainage

Patient’s medical condition

23
Q

What is a chronic sinus?

A

Infection around apex perforates bone and drains into mouth

-> appears as blister with poor taste on discharge

24
Q

What is a chronic apical infection?

A

Occurs when abscess subsides but low grade infection remains ongoing (susceptible to flare ups)

25
Q

What can granulomas become?

A

Apical cyst (not painful but is inflammatory and can grow/become infected)

26
Q

What is a periodontal abscess?

A

Development of abscess within PDL (similar symptoms to AAA

27
Q

What is pericoronitis?

A

Inflammation around the crown of a tooth (usually partial erupted)

-> can become an abscess

28
Q

What is sialadenitis and its features?

A

Infection off salivary gland (usually major)

-> Facial swelling, mouth dryness, redness, pus coming from duct

29
Q

What are the systemic factors for assessing whether patient needs Antibiotics?

A

Immunocompromised pts
Acquired causes (e.g. HIV)
Drug Induced (e.g. Steroids, Cytostatics)
Blood disorders (e.g. Leukaemias)

Diabetes- affects neutrophils

Elderly

30
Q

What are local factors to consider when assessing patient need for ABP?

A

Toxicity- systemic symptoms

Airway compromisation

Dysphagia

Trismus

Lymphadenitis

Location (e.g. floor of mouth)- can affect breathing

31
Q

What is reversible pulpitis and its symptoms?

A

Denotes a level of inflammation in which returning to a normal state is possible if noxious stimuli removed

Mild-moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds (<5 secs), no mobility, no pain on percussion (hasn’t reached PA tissues)

32
Q

What is irreversible pulpitis?

A

Denotes a higher level of inflammation in which dental pulp has been damaged beyond point of recovery (requires RCT/extraction)

Sharp, throbbing, severe pain upon stimulation, and pain may be spontaneous or occur without stimulation, pain persists after stimulation removed (>5 secs)
33
Q

Describe periapical granuloma (chronic apical periodontitis):

A

Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries)

*NOT a true granuloma because not granulomatous inflammation! (Note that granulomatous inflammation has epithelioid histiocytes mixed with lymphocytes and giant cells)

34
Q

What is the etiology of periapical (radicular) cyst?

A

Caries, trauma, periodontal disease

Death of dental pulp

Apical bone inflammation

Dental Granuloma

Stimulation of epithelial rests of Malassez- Proliferation pf epithelium

Periapical Cyst Formation

BDS4 Oral Surgery (19 decks)

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