Pulp & PA disease

Question 1

What is pulp hyperaemia?

Answer 1

Where there is an increase in blood supply to the pulp chamber = reversible

Question 2

What causes pulp hyperaemia? (2)

Answer 2

Caries

Trauma

Question 3

What are the clinical features of pulp hyperaemia? (4)

Answer 3

• Short lasting pain (few seconds)
• Pain stimulated by hot, cold or sweet foods
• Pain resolves once stimulus removed
• Caries getting close to the pulp however the tooth doesn’t require to be RCT (reversible pulpitis)

Question 4

What is acute pulpitis caused by?

Answer 4

Progression of pulpal hyperaemia – conditions start to become irreversible

Question 5

What are the clinical features of an acute pulpitis? (6)

Answer 5

• Constant and severe pain (throbbing)
• Reacts to thermal stimulus
• Poorly localised pain
• Referred pain
• No/little response to analgesia
• Open symptoms (where the pulp chamber is open) less severe since there is a pressure release

Question 6

What special tests can we use to diagnose an acute pulpits? Describe the results (3)

Answer 6

• TTP = no response since the inflammation not reached the periodontal tissues yet, can have early inflammation
• pulp tests = no/negative repones
• diagnostic LA: anaesthetise a tooth/teeth, does the pain go away?

Question 7

Describe what acute apical periodontitis looks like on a radiograph. (4)

Answer 7

• May not be obvious signs yet (just beginning to spread)
• loss of lamina dura clarity
• no radiolucency if px having this for the first time. If there is a radiolucent shadow it could be indication of an old lesion? E.g. flare up
• delay in changes at the apex of the tooth (widening of apical periodontal space) as this takes time.

Question 8

What causes traumatic periodontitis?

Answer 8

Parafunction = clenching and grinding

Question 9

How do we diagnose traumatic periodontitis? think special tests and Hx(5)

Answer 9

• Examination of the occlusion – functional positioning and posturing
• Assess TTP = yes
• Vitality testing = normal
• No Hx of trauma to a tooth
• Radiographs = generalised widening of PDL space

Question 10

How do we treat traumatic periodontitis? (2)

Answer 10

Adjusting the occlusion – if tooth is high from a restoration

Therapy for parafunction – gumshield etc

Question 11

What infection is the most pus producing?

Answer 11

acute apical abscess

Question 12

What other pathology produces similar symptoms (including pus) to an acute apical abscess? (3)

Answer 12

1. Periodontal abscess
2. Pericoronitis – inflammation around the crown of a tooth (usually PE wisdom) can become abscess.
3. Sialadenitis – infection of the salivary glands

Question 13

What organisms have an important role in dental abscesses?

Answer 13

anaerobes

Question 14

what are the INITIAL clinical features of an acute apical abscess? (4)

Answer 14

• Severe constant pain - can be spontaneous
• Acute tenderness in function e.g biting
• Acute TTP
• No swelling, redness or heat initially (if abscess still contained within the jaw bone) however once the abscess perforates bone the symptoms change)

Question 15

what are the ADVANCED clinical features of an acute apical abscess? (4)

Answer 15

• Pain stops (unless in the palate)
• Swelling, redness and heat of soft tissues appears
• Once swelling advances pain returns
• TTP reduces initially as pus escapes into soft tissues

Question 16

List the 5 cardinal signs of inflammation/infection

Answer 16

1. Heat
2. Swelling
3. Pain
4. Redness
5. Loss of function

Question 17

For an acute apical abscess, what anatomical features dictates where the swelling occurs? (4)

Answer 17

• Tooth position in the arch
• Root length
• Muscle attachments surrounding
• Potential spaces around the lesion i.e submental, sublingual, submandibular, buccal, infraorbital, lateral pharyngeal space and the palate.

Question 18

How do we treat an acute apical abscess? (3)

Answer 18

• Drainage of the site via IO&EO incisions
• Remove the cause = Extract tooth or Pulp extirpation
• occasionally Provide antibiotics - if swelling doesn’t resolve after draining and removal of the cause or if the patient has local or systemic factors which merit AB’s.

Question 19

In an acute apical abscess, What local factors determine if antibiotics should be used? (6)

Answer 19

• Toxicity: is the patient systemically unwell?
• Airway compromission
• Dysphagia present
• Trismus present
• Severe lymphadenitis
• Location of spread i.e. FOM as it can affect breathing

Question 20

In an acute apical abscess, What systemic/patient factors determine if antibiotics should be used? (3)

Answer 20

• Immunocompromised patients (acquired – HIV (controversial now), drug induced – steroids or cytostatic, blood disorders – leukaemia)
• Diabetic patients if uncontrolled
• Extremes of age: Elderly & young patients

Question 21

What is a periodical granuloma?

Answer 21

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

Not a true granuloma as it isn’t granulomatous inflammation and does have giant cells present.

Question 22

What can periapical granulomas develop into?

Answer 22

an apical radicular cyst

Question 23

What are the causes/aetiology of periapical (radicular) cysts? (9)

Answer 23

• Caries
• Trauma
• Periodontal disease
• Death of dental pulp
• Apical bone inflammation
• Dental granuloma develops into a cyst
• Stimulation of epithelial rests of malassez (embryological remnants stimulated by chronic inflammation)
• Epithelial proliferation
• PA cyst formation

Question 24

Do patients with periapical (radicular) cysts have symptoms?

Answer 24

No - unless the cyst becomes infected = pain