inflammatory jaw lesions

Question 1

1 defense mechanism of body

Answer 1

inflammation - but in the 2nd line of defense

Question 2

periapical abscess

Answer 2

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

Question 3

cause of PA abscess

Answer 3

infection of trauma

Question 4

t/f PA abscess can be symptomatic or asymptomatic

Answer 4

true

Question 5

microscopically, the key cell to an acute abscess is

Answer 5

neutrophil

Question 6

tx of pa abscess

Answer 6

elimination of infection focus

endo

Question 7

pa granuloma

Answer 7

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

Question 8

75% of apical inflammatory lesions are

Answer 8

pa granulomas

Question 9

cells of chronic pa granulomas

Answer 9

lymphocytes (no macrophages)

Question 10

tx of pa granuloma

Answer 10

endo or extraction with curettage

Question 11

radicular cyst arises from

Answer 11

stimulation of epithelium at apex of non vital tooth

Question 12

variants of radicular cyst

Answer 12

lateral radicular and residual cyst

Question 13

3 parts of cysts

Answer 13

EPITHELIUM, CT, lumen

Question 14

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

Answer 14

true

Question 15

rarefying osteitis

Answer 15

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

Question 16

condensing osteitis

Answer 16

localized proliferative reaction of bone to low grade inflammatory stimulus

Question 17

what is most commonly associated with apex of a nonvital tooth

Answer 17

condensing osteitis

Question 18

what is critically associated with an area of inflammation

Answer 18

condensing osteitis

Question 19

radiographic features of condensing osteitis

Answer 19

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

Question 20

sequence of events for condensing osteitis

Answer 20

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

Question 21

tx of condensing osteitis

Answer 21

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

Question 22

osteomyelitis

Answer 22

acute/chronic inflammation of bone away from initial site

diffuse area

Question 23

osteomyelitis leads to

Answer 23

necrosis and sequestra

Question 24

sequestrum

Answer 24

piece of necrotic bone that separated from surrounding viable bone

Question 25

cause of osteomyelitis

Answer 25

tooth infection, bacterial infections (pyogenic staph and strep)

Question 26

predisposing conditions of osteomyelitis

Answer 26

decreased host resistance, decreased vascular supply to bone

Question 27

pathogenesis of osteomyleitis

Answer 27

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

Question 28

involucrum

Answer 28

dead bone that has new vital bone surrounding it

Question 29

features of osteomyelitis

Answer 29

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

Question 30

osteomyelitis is more common in

Answer 30

the mandible

Question 31

radiographic features of osteomyelitis

Answer 31

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

Question 32

tx of osteomyelitis

Answer 32

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

Question 33

t/f you can get a pathologic fracture with osteomyelitis

Answer 33

true

Question 34

onion skin pattern is seen in

Answer 34

osteomyelitis with proliferative periostitis

Question 35

osteomyelitis with proliferative periostitis is

Answer 35

pa inflammation spreading to the periosteum | bony swelling, not painful

Question 36

periosteum responds to osteomyl. with proliferative periostitis by

Answer 36

depositing bone

Question 37

osteomyl. with proliferative periostitis occurs in

Answer 37

immmunocompromised/young people and mandible

Question 38

radiographic appearance of osteomyelitits with proliferative periostitis

Answer 38

parallel layers of new bone depositied bt the cortex and periosteum

Question 39

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

Answer 39

6-12 months

Question 40

causes of periosteal new bone formation

Answer 40

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

Question 41

osteoradionecrosis

Answer 41

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

Question 42

osteoradionecrosis is more common in

Answer 42

mandible

Question 43

cause of osteoradionecrosis

Answer 43

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

Question 44

pathogenesis of osteoradionecrosis

Answer 44

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

Question 45

t/f. tx is easier than prevention in osteoradionecrosis

Answer 45

false

Question 46

tx of osteoradionecrosis

Answer 46

abs, surgery, hyperbaric o2, radical surgical resection

Question 47

complications of osteoradionecrosis

Answer 47

bony deformity and pathologic fracture | orocutaneous fistulas

Question 48

BMU

Answer 48

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

Question 49

osteoclasts are used for

Answer 49

signaling, resorption, and lemellar bone deposition and angiogenesis

Question 50

bisphosphonates are used for

Answer 50

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

Question 51

t/f decreased osteoclast function inhibits bone remodeling

Answer 51

true

Question 52

zometa, boniva, aredia are IV drugs commonly seen with

Answer 52

jaw osteonecrosis

Question 53

other meds that can lead to MRONJ

Answer 53

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

Question 54

ARONJ

Answer 54

antiresorptive related osteonecrosis of the jaw

Question 55

BRONJ clinical findings

Answer 55

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

Question 56

tx and prognosis for BRONJ

Answer 56

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

Question 57

what do you include on the differential with osteomyelitis

Answer 57

radiation induced osteonecrosis MRONJ metastatic disease