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Flashcards in inflammatory jaw lesions Deck (57):
1

#1 defense mechanism of body

inflammation - but in the 2nd line of defense

2

periapical abscess

accumulation of acute inflammatory cells (neutrophils, not time) and purulence a the apex of the tooth

3

cause of PA abscess

infection of trauma

4

t/f PA abscess can be symptomatic or asymptomatic

true

5

microscopically, the key cell to an acute abscess is

neutrophil

6

tx of pa abscess

elimination of infection focus
endo

7

pa granuloma

chronic apical periodontitis (lymphocytes)
mass of chronically inflamed tissue
defensive reaction
cytokines releases

8

75% of apical inflammatory lesions are

pa granulomas

9

cells of chronic pa granulomas

lymphocytes (no macrophages)

10

tx of pa granuloma

endo or extraction with curettage

11

radicular cyst arises from

stimulation of epithelium at apex of non vital tooth

12

variants of radicular cyst

lateral radicular and residual cyst

13

3 parts of cysts

EPITHELIUM, CT, lumen

14

t/f radiographically, you can't tell the difference bt cyst, granuloma, or abscess

true

15

rarefying osteitis

cannot be differentiates clinically
generally well defined and radiolucent
most common lesions (cysts, granuloma, abscess)
grow slow, focal

16

condensing osteitis

localized proliferative reaction of bone to low grade inflammatory stimulus

17

what is most commonly associated with apex of a nonvital tooth

condensing osteitis

18

what is critically associated with an area of inflammation

condensing osteitis

19

radiographic features of condensing osteitis

tooth root outline is visible
pdl is widened or shows rarefying oseitis
localized sclerotic radiopaque area in pa region outside the radiolucent area

20

sequence of events for condensing osteitis

1. disease, pulpal inflammation, pa inflammation, rarefying osteitis
2. bone deposited around rarefying osteitis

21

tx of condensing osteitis

endo, but left with a bone scar (sclerotic bone that doesn't go away)s

22

osteomyelitis

acute/chronic inflammation of bone away from initial site
diffuse area

23

osteomyelitis leads to

necrosis and sequestra

24

sequestrum

piece of necrotic bone that separated from surrounding viable bone

25

cause of osteomyelitis

tooth infection, bacterial infections (pyogenic staph and strep)

26

predisposing conditions of osteomyelitis

decreased host resistance, decreased vascular supply to bone

27

pathogenesis of osteomyleitis

acute suppurative inflammation, interruption of vascular supply, necrosis and resorption of bone

28

involucrum

dead bone that has new vital bone surrounding it

29

features of osteomyelitis

pain, paresthesia, swelling, drainage, fever, leukocytosis, tender lymphadenopathy

30

osteomyelitis is more common in

the mandible

31

radiographic features of osteomyelitis

nno changes in 1st week, later, diffuse radiolucent areas
radiopaque areas representing sequestra

32

tx of osteomyelitis

acute: abs, surgery maybe
chronic: difficult, surgery, IV abs

33

t/f you can get a pathologic fracture with osteomyelitis

true

34

onion skin pattern is seen in

osteomyelitis with proliferative periostitis

35

osteomyelitis with proliferative periostitis is

pa inflammation spreading to the periosteum
bony swelling, not painful

36

periosteum responds to osteomyl. with proliferative periostitis by

depositing bone

37

osteomyl. with proliferative periostitis occurs in

immmunocompromised/young people and mandible

38

radiographic appearance of osteomyelitits with proliferative periostitis

parallel layers of new bone depositied bt the cortex and periosteum

39

remodeling of bone occurs is how long with osteomyl. with proliferative periostitis

6-12 months

40

causes of periosteal new bone formation

osteomyelitis, neoplasms (ewings sarcoma, osteosarcoma), cysts, trauma

41

osteoradionecrosis

chronic infection of bone
follows high dose radiation therapy to bone
very painful

42

osteoradionecrosis is more common in

mandible

43

cause of osteoradionecrosis

greater than 75 grays
less than 60 grays there is a minimal risk

44

pathogenesis of osteoradionecrosis

thickening of bvs, destruction of osteoblastc/cytes, abscence of bone formation, trauma or infection

45

t/f. tx is easier than prevention in osteoradionecrosis

false

46

tx of osteoradionecrosis

abs, surgery, hyperbaric o2, radical surgical resection

47

complications of osteoradionecrosis

bony deformity and pathologic fracture
orocutaneous fistulas

48

BMU

basic multicellular unit: group of osteoclasts, blasts, and local vascular supply
final remodelong of bone

49

osteoclasts are used for

signaling, resorption, and lemellar bone deposition and angiogenesis

50

bisphosphonates are used for

cancer or oseteoporosis (oral, smaller dosage)
inhibiting apoptosis of osteoclasts

51

t/f decreased osteoclast function inhibits bone remodeling

true

52

zometa, boniva, aredia are IV drugs commonly seen with

jaw osteonecrosis

53

other meds that can lead to MRONJ

denossumab - antireorptive agent that prevents osteoclastic maturation; anti-neoplastic med or for osteoporosis
antiangiogenic agents - attempt to decrease blood supply to malignancy, vascular endothelial inhibitor

54

ARONJ

antiresorptive related osteonecrosis of the jaw

55

BRONJ clinical findings

IV bisphosphonates more likely to cause
intraorally show single or multifocal areas of exposed necrotic bone
radiographs may show increased radiopacity prior to necrosis
painful
mandible
post extraction

56

tx and prognosis for BRONJ

prevention
improve dental health before future procedures
symptomatic pts: systemic antibiotics and chorhexidine, asymptomatic pts: chorhexidine only
smooth exposed bone

57

what do you include on the differential with osteomyelitis

radiation induced osteonecrosis
MRONJ
metastatic disease