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Sequelae of pulpal disease Flashcards

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1
Q

pulpitis? classifications?

A

inflammation of the pulpal tissue
Reversible vs irreversible
Acute vs chronic
Symptomatic vs asymptomatic

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2
Q

Tx planning with pulpitis

A

determine extent with testing and use knowledge/ judgement

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3
Q

MECHANISM OF ACTION:
INFLAMMATION OF THE PULP

A

 Limited blood supply
 No collateral support
 Destructive, small space
 Expansile process due to…
▪ Blood vessel dilation
▪ Leakage of fluid into surrounding tissue
▪ Migration of cells

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4
Q

reversible pulpitis

A

pulp can recover

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5
Q

reversible pulpitis histo

A

vasodialtion with lymphocyte infiltration

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6
Q

irrreversible pulpitis, what is happening?

A

cannot recover, acute inflammation and abcess formation

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7
Q

pulpal necrosis

A

due to untreated pulpitis
tooth killed with blood supply lost, becomes discolored

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8
Q

acute pulpitis
histology similar to?
must be?
what parts of pulp usually affected?
due to?
commonly in what age group?

A

similar histology to an abcess, lots of PMN
must be no possible drainage
usually at one pulp horn or all pulp
due to bacterial invasion thru non-sclerosed dentin tubules, adolescents commonly

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9
Q

chronic pulpitis

A

little to no penentration of virulent bac into the pulp
usually in older teeth with previous restorations, slow caires
dentin tubules have narrowed and reparative dentin formed

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10
Q

is chronic hyperplastic pulpitis symptomatic

A

no, due to decreased nn fibers

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11
Q

CHRONIC HYPERPLASTIC PULPITIS

A

primary molars with rampant caries
forms a pulp pollup due to open foramen and ample blood supply
prolif of pulp and granulation tissue form the pollup

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12
Q
A

CHRONIC HYPERPLASTIC PULPITIS

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13
Q

CHRONIC HYPERPLASTIC PULPITIS histology

A

fibrotic pulp

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14
Q

POTENTIAL SEQUELLAE OF BACTERIAL PULPITIS flow chart

A
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15
Q

4 factors of PERIAPICAL LESIONS development

A

Presence of opened or closed pulpitis
Virulence of involved microorganism
Extent of sclerosis of dentinal tubules
Competency of host immune response

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16
Q

PERIAPICAL GRANULOMA
mass of?
located? what type of teeth?
symptomatic?

A

 mass of chronically inflammed granulation tissue-not true granuloma tissue (granulation tissue)
 apex of non-vital teeth ONLY
 mostly asymptomatic

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17
Q

PERIAPICAL GRANULOMA radiograph

A

radiolucency at apex

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18
Q

PERIAPICAL GRANULOMA may develop as?

A

 May develop as the inital periapical pathosis or arise after an initial periapical abscess

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19
Q

PERIAPICAL GRANULOMA could become?

A

a periapical cyst or abscess

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20
Q

periapical granuloma indication for what Tx?

A

RCT (or extraction if needed)

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21
Q

periapical granulomas and accessory canals

A

mostly occur on apex, can possibly occur laterally due to accessory canals

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22
Q

histology of a periapical granuloma
may be deposits of?

A

granulation tissue present (all inflammatory cells present)
may be cholesterol deposits and RC material

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23
Q

periapical granuloma healing

A

can be healed with good RCT

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24
Q

cyst, components?

A

 Pathologic cavity located in soft tissue or bone lined by
epithelium

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25
RESTS OF MALASSEZ role in cysts
will proliferate forming the epithelial lining of the cysts
26
APICAL PERIODONTAL CYST (PERIAPICAL CYST) inflammatory? most common in which arch? symptomatic? growth rate? tooth vital? root resorption?
 An inflammatory cyst, most common in mandible  Asymptomatic, slow - growing lesion associated with the root apex of a non - vital tooth  External root resorption possible
27
PA cyst radiograph
radioluceny at apex
28
can we know a cyst from radiography?
no we need histo/biopsy
29
are multiple PA cyst possible
yes, multiple non vital teeth
30
PA cyst histo/ strucutre
wall made of inflam cells lining usually hyperplastic epithelium empty lumen
31
PERIAPICAL ABSCESS cells? tooth vital? may arise as? symptomatic? why or why not?
 Accumulation of acute inflammatory cells at the apex of a non - vital tooth  May arise as the initial periapical pathosis or as an acute exacerbation of chronic periapical lesion ( P h oenix a b s ces s)  Generally symptomatic , but may be asymptomatic if there is a lack of accumulation of purulent material due to a chronic path of drainage
32
PA abscess histo
lots of PMN= similar to acute inflamm
33
PA abscess tx and healing
RCT indicated, removal of pulp may allow bone to heal
34
POTENTIAL DRAINAGE PATHWAYS OF ACUTE PERIAPICAL INFECTIONS determined by?
DETERMINED BY LOCATIONS OF APEX 1 . Surface of the gingiva (parulis) 2 .Palate (palatal abscess) 3 . Max sinus 4 . soft tissue spaces (cellulitis) 5 . Floor of mouth (ludwig's)
35
palatal abscess
36
PARULIS (GUM BOIL) due to? mechanism of formation? consists of?
acute PA inflammation purulent material perforates thru bone, periosteum, soft tissue, epithelium and drains through intraoral sinus Parilus=intraoral opening of the sinus tract consists of a mass of inflammed granulation tissue with an epithlialized sinus tract
37
gum boil/ parulis
38
abscess
localized collection of pus that has accumulated in a tissue cavity, producing flucutance
39
cutaneous sinus tract
dental abscesses can drain extraorally to the skin by forming these tracts thru bone
40
oroantral fistula usually from?
not from pathology, usually trauma open communication btwn the sinus and the oral cavity
41
oroantral fistulas commonly have?
granulation tissue form within them
42
SINUS TRACT VS. FISTULOUS TRACT
sinus tract: from interior to exterior, parulis is the end of the tract fistulous tract: connects two anatomic cavities (many types)
43
types of fistulas
oroantral (mouth to sinus) oronasal tracheoesphogeal
44
cellulitis
diffuse spread of an acute inflammatory process thru fasical planes/soft tissue producing the cardinal signs of inflamm abscess unable to establish a drainage path into the mouth or onto skin
45
what occurs with cellulitis often?
trismus= hard to open mouth
46
Ludwigs angina
agressive, rapidly spreading cellulitis involving multiple anatomic spaces: submental, sublingual and submandibular produces massive swelling of neck that can extend to the clavicles and block airway=death medical emergency
47
canvernous sinus thrombosis emergency? how can this happen? associated with infections in what teeth?
medical emergency valveless vv of face allow retrograde spread of infectious materials from middle third of face blood clot may form in the cavernous sinus which is life threatening associated with spread of infection from maxillary teeth
48
cavernous sinus contents
49
osteomyelitis can be caused by? predispositions?
bacterial infection of bone: odontogenic infections, trauma to bone, NUG, NOMA (developing countries) Predispositions: chronic systemic disease, immune def, decreased vascularity of bone
50
acute osteomyelitis spreads thru what part of bone? tissue rxn? due to?
spread thru medullary spaces minimal tissue reaction due to rapid onset/ minimal time to react
51
chronic osteomyelitis tissue rxn? what forms? what occurs? why would antibiotics be hard to use?
prominent tissue reaction-granulation tissue forms and fibrosis occurs granulation tissue may wall of site making Antibiotics hard to use
52
osteomyeltits possible drainage?
can occur via a sinus tract
53
traumas that can cause osteomyelitis?
extraction, fracture
54
chronic osteomyelitis radiograph
mixed lucent and opaque lesion, ill defined
55
acute osteomyelitis histo
lots of PMN in bone
56
acute osteomyelitis
57
sequestrum
fragment of necrotic bone separated from adjacent vital bone that usually undergoes spontaneous exfoliation
58
sequestrum histo with gram stain
would see bone and bacterial debris, lack of cells in lacunae
59
involucrum
non-vital bone encased by vital bone
60
PROLIFERATIVE PERIOSTITIS/ GARRE OSTEOMYELITIS form of? rxn? most frequently seen in? where?
form of chronic ostemyelitis, osteomylelitis with proliferative periostitis/garre osteomyelitis periosteal rxn occur which layers of reactive vital bone are formed producing cortical expansion (onion skin) seen most frequently in children/young adults in man molar/PM areas involving the lower border/ buccal cortex
61
proliferative periostitis radiograph
must be occlusal view to see onion skin
62
proliferative periostitis progression
may need to recontour bone
63
CHRONIC FOCAL SCLEROSING OSTEOMYELITIS/ CONDENSING OSTEITIS seen in? where?
localized area of bone sclerosis associated with the apices of teeth with pulpal disease seen in children/young adults involving the man molars and PM reaction of bone to inflammation
64
ACTINOMYCOSIS spp names morpholgy gram/O2 commensual?
means ray fungus but is bacterial infection caused by actinomyces spp A. israelii and A. vicosus filamentous bacteria: branching gram +/ anaerobic part of normal oral flora
65
CLASSIFICATION OF ACTINOMYCOSIS
Cervico-facial – 5 5 %  Abdomino-pelvic – 2 5 %  Pulmonary – 1 5 %
66
entry of actinomycoses? can extend thru? can disregard?
area of prior trauma: soft tissue injury, perio pocket, non-vital tooth, extraction site, infected tonsil direct extension thru soft tissue disregards fascial planes and lymphatics
67
presentation of cervico-facial actinomycosis
woody induration and fibrosis= hard draining sinus tracts suppuration with sulfur granules
68
cervicofacial actinomycosis radiograph
Ill defined lucency at the site of entry/ infection
69
CF actinomycosis, sinus tracts
70
sulfur granule
71
what is present in the radiolucency of actinomycosis
bacteria

Pathology (20 decks)

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