Focal Inflammatory Lesions Flashcards
(27 cards)
1
Q
Periapical Abscess
A
- Accumulation of acute inflammatory cells & purulence at the apex of the tooth
- Neutrophils
- Rads: Looks like PDL widening and poorly defined RL
- Often has draining sinus tract to ST
- Can arise as initial pathosis or from acute exacerbation of prior lesion
- Symptomatic or asymptomatic
2
Q
Periapical Abscess Tx
A
- Drainage & removing infection focus
- S/S go away after 48hr
- NSAIDs pre-op, post-op, pain control
- Abx for medically compromised
- Endo tx or extraction
3
Q
Focal vs. Generalized/diffuse
A
Focal: Width of one tooth
Generalized: Across multiple teeth
4
Q
Other name(s) for Periapical Granuloma
A
Chronic Apical Periodontitis
5
Q
Periapical Granuloma
A
- Mass of chronically inflamed tissue at the apex of non-vital tooth
- Lymphocytes
- Rad: RL at apex of tooth; punched out border
- Sometimes lesion is barely seen and affected teeth have loss of lamina dura @ root tip
- Usually asymptomatic
- Defensive rxn to microbes in canal & apex
- Inflammatory cells release cytokines that destroy bone
-
75% of apical inflammatory lesions
*
6
Q
Periapical Granuloma Tx
A
- Successful tx depends on complete reduction/control of bacteria
- If tooth can be maintained, RCT can be performed
- Non-restorable, extraction & curettage
- All ST should be evaluated histopathologically
7
Q
What lesion represents 75% of apical inflammatory lesions?
A
Periapical granuloma
AKA chronic apical periodontitis
8
Q
What lesion represents 15% of all periapical RLs?
A
Periapical Cyst
AKA Radicular Cyst
AKA Apical Periodontal Cyst
9
Q
What are other names for Periapical Cyst?
A
Radicular Cyst
Apical Periodontal Cyst
10
Q
Periapical (Radicular) Cyst
A
- Represents 15% of all periapical RLs
- Stimulation of epithelium @ apex of non-vital tooth
- Variants:
- Lateral radicular cyst
- Residual cyst
- Cyst lined by stratified squamous epithelium
- CT wall contains chronic inflammatory infiltrate
- Rad: Well-circumscribed RL intimately associated w/ apex; RL may or may not have RO rim
11
Q
What are variants of Periapcial (Radicular) Cyst?
A
- Lateral radicular cyst
- Residual cyst
12
Q
Lateral Radicular Cyst
A
Variant of Periapical (Radicular) Cyst
- Inflammatory cyst on lateral aspect of root
13
Q
Residual Cyst
A
Variant of Periapical (Radicular) Cyst
- Cyst remaining post-extraction
14
Q
Periapical Cyst Tx
A
- Tooth restorable: RCT
- Tooth non-restorable: Extraction & curettage
- >2cm, periapical surgery
- Recurrence not expected
15
Q
Rarefying Osteitis
A
- Radicular granuloma, cyst, abscess cannot be differentiated radiographically
- All are generally well-defined and RL
- Collectively known as rarefying osteitis
- Rarefy: To make thin or less dense
- Most common lesion in the jaw
- Most grow slowly and don’t reach large sizes
- ALL included in differential dx
- Abscess
- Granuloma
- Cyst
16
Q
What is the most common lesion in the jaw?
A
Rarefying Osteitis
- Inflammatory thinning of bone
- Must include abscess, cyst, granuloma in differential dx
17
Q
Condensing Osteitis
A
- AKA sclerosing osteitis
- Localized proliferative rxn of bone to low-grade inflammatory stimulus
- Inflammation is causing bone deposition rather than resorption
- Bone is walling off infection as inflammatory rxn
- Bone does not return to normal after endo tx. Instead you get bone scar
- Association w/ area of inflammation is critical
- Inflammation is causing bone deposition rather than resorption
- Most commonly associated w/ apex of non-vital tooth
- Rad: Root outline visible; PDL widened or shows rarefying osteitis; localized sclerotic RO area in periapical region outside RL area; denser around molar
- Condensing osteitis implies rarefying osteitis is present
18
Q
Sequence of events for condensing osteitis
A
- Tooth disease
- Pulpal inflammation & necrosis
- PA inflammation
- Rarefying osteitis
- Bone deposition (sclerosing/condensing osteitis) around rarefying osteitis
19
Q
What is another name for condensing osteitis?
A
Sclerosing osteitis
20
Q
Condensing Osteitis Tx
A
- Resolution of infection focus
- W/ surgery or endo, 85% regress fully or partially
- RO area remains after inflammation resolution and is known as “bone scar”
21
Q
Buccal Bifurcation Cyst
A
- Develops on the buccal of MN permanent M1s
- Occurs in children ~10yo
- Associated w/ buccal enamel extensions
- Predisposes teeth to pocket formation
- Size ranges from 1.2-2.5cm
- Rad: Well circumscribed, unilocular RL involving buccal bifurcation & root
- Root apices tipped toward lingual MN cortex
- Same histology as inflamed dentigerous cyst & radicular cyst; need location/history
22
Q
Buccal Bifurcation Cyst Tx
A
- Enucleation
- Involved tooth can often be maintained
- W/in 1yr, complete clinical & radiographic healing
23
Q
Other names for Alveolar Osteitis
A
Dry socket
Fibrinolytic Alveolitis
24
Q
Alveolar Osteitis
A
- Destruction of initial clot or inappropriate healing
- Risk factors: Impacted M3s, poor OH, inexperienced surgeons, traumatic extractions, contraceptive use, pre-surgical infections
- 20% of smokers (40% if you smoke w/in 24hr of op)
- Vasoconstriction = interferes w/ clot formatin
25
Alveolar Osteitis Tx
* Rad exam to r/o root tip or foreign body
* Irrigate w/ warm saline
* Avoid curettage
* Analgesics + home irrigation
* Antiseptic dressing? Controversial
26
Inflammation
Rxn of vascularized tissues against an offending agent, characterized by the exit of fluids and blood cells to the interstitium
27
What are the Focal Inflammatory Lesions?
* Periapical Abscess
* Periapical Granuloma
* AKA Chronic Apical Periodontitis
* Periapical Cyst
* AKA Radicular Cyst, Apical Periodontal Cyst
* Rarefying Osteitis
* Condensing Osteitis
* Buccal Bifurcation Cyst
* Alveolar Osteitis
* AKA Dry Socket, Fibrinolytic Alveolitis
