The diseases of pulp and periodontium

Question 1

what is pulp hyperaemia?

Answer 1

increase blood supply within pulp chamber

Question 2

if it is acute what is it mean?

Answer 2

sudden onset

Question 3

what is an abscess?

Answer 3

collection of dead neutrophils

Question 4

what is apical periodontitis?

Answer 4

inflammation of pulp comes out of apex of tooth to cause this

Question 5

what is a sinus?

Answer 5

abscess perforate through bone and soft tissues and starts to drain into mouth.
You get a chronic blister like a bubble on gum bursts and gives bad taste. Not much pain but bad taste every time it bursts

Question 6

what is apical cyst (radicular)?

Answer 6

not painful but can grow to large sizes.
cyst is fluid filled material lined cavity

Question 7

what does caries lead to?

Answer 7

pulp hyperaemia

Question 8

what does pulp hyperaemia lead to?

Answer 8

acute pulpitis

Question 9

what does acute pulpitis lead to?

Answer 9

• chronic pulpitis which can go back and forth to acute pulpitis
• can also go to acute apical periodontitis

Question 10

what does acute apical periodontitis lead to?

Answer 10

• acute apical abscess
• sometimes go straight to chronic apical infection (granuloma)

Question 11

what does acute apical abscess lead to?

Answer 11

• chronic apical infection (granuloma and can go back and forth to acute apical abscess
• can also lead to chronic sinus and can go back and forth to acute apical abscess
• when it is chronic apical infection or chronic sinus it can go back and forth between these 2 as well

Question 12

what does chronic apical infection (granuloma) lead to?

Answer 12

• apical cysts (radicular)

Question 13

what does apical cyst (radicular) lead to

Answer 13

infected apical radicular cyst

Question 14

what are symptoms of pulp hyperaemia?

Answer 14

• Pain lasting for seconds
• Pain stimulated by hot/cold or sweet foods
• Pain resolves after stimulus
• Caries approaching pulp but tooth can still be restored without treating pulp (reversible pulpitis)

Question 15

what are clinical features of acute pulpitis?

Answer 15

• Constant Severe Pain
• Reacts to Thermal Stimuli
• Poorly Localised Pain
• Referral of pain - come from somewhere else not source
• No (or Minimal) Response to analgesics - can’t get into pulp chamber
• Open Symptoms Less Severe

Question 16

how do you diagnose acute pulpitis?

Answer 16

• History
• Visual examination
• Negative Tenderness to Percussion (usually) - because PDL not inflamed yet
• Pulp testing is equivocal
• Radiographs
• Diagnostic’ Local Anaesthetic - numb them beside tooth and see if pain goes away
• Removal of Restorations - filling was so big and close to pulp only way to work out is removing filling

Question 17

at what stage do symptoms change?

Answer 17

acute apical periodontitis

Question 18

what is diagnosis for acute periodontitis?

Answer 18

• Easy to make
• Tenderness to Percussion
• Tooth is non-vital (unless traumatic)
• Slight increase in mobility - because pdl space increases slightly
• Radiographs

Question 19

what would you see on radiograph for acute periodontitis?

Answer 19

• loss of clarity in lamina dura
• won’t really see radiolucency yet if you do it may indicate an ‘old’ lesion e.g. Flare up of apical granuloma
• there will be a delay in changes at the apex of the tooth and widening of apical periodontal space takes time

Question 20

traumatic periodontitis
causes?
diagnosis?
treatment?

Answer 20

• Parafunction (Tooth clenching or grinding)
• Clinical Examination of the Occlusion
  >Functional positioning
  >Posturing
  Tender to Percussion
  Normal Vitality
  Radiographs
  >May show generalised widening of periodontal space
• Occlusal adjustment - filling maybe high
  Therapy for parafunction - gumshield

Question 21

what are other possible causes for a dental abscess instead of acute apical abscess/

Answer 21

• Periodontal Abscess - not result of pulp
• Pericoronitis - inflammation around crown usually partially erupted wisdom tooth, premolar or canine
• Sialadenitis - infection of glands, usually one of major salivary glands. Result in facial swelling and redness, dryness of mouth and puss out of duct in gland

Question 22

dental abscess
- what are organisms?
- what are unusual infections

Answer 22

• Polymicrobial
  Aanaerobes play an important part
• Staphylococcal lymphadenitis of childhood Cervico-facial actinomycosis

Question 23

acute apical abscess
- how does clinical features reflect stage of abscess?

Answer 23

• The Clinical features will reflect the stage of the abscess.
• Initially almost identical to Acute Apical Periodontitis(Prior to eroding through bone and into soft tissues).
• Usually drain into mouth but can into face where it ends up depends on muscle it drains into

Question 24

acute apical abscess
- symptoms?

Answer 24

• Severe unremitting pain
  Acute tenderness in function - bite
  Acute tenderness on percussion - tap

BUT no swelling, redness or heat (yet….) - if abscess still contained within jaw bone

Question 25

what are 5 signs of cardinal inflammation?

Answer 25

- heat - redness - swelling - pain - loss of function

Question 26

what happens with an acute apical abscess once it perforated through bone?

Answer 26

- Pain often remits (unless it’s in the palate) Swelling, redness and heat (in the soft tissues) become increasingly apparent As swelling increases pain returns There is an initial reduction in tenderness to percussion of the tooth as pus escapes into the soft tissues

Question 27

what does the site of the swelling depend on for acute apical abscess?

Answer 27

- The position of the tooth in the arch - Root length - Muscle attachments - Potential spaces in proximity to lesion Submental Space Sublingual Space Submandibular Space Buccal Space Infraorbital Space Lateral Pharyngeal Space (a.k.a. Parapharyngeal Space) Palate

Question 28

what is treatment for acute apical abscess?

Answer 28

- Provide Drainage Soft tissue incision intraorally Soft tissue incision extraorally Remove source/cause Extract tooth Pulp extirpation Periradicular surgery - unusual

Question 29

what is need for antiobiotics detemrined by?

Answer 29

- Need for antibiotics determined by Severity Absence of adequate drainage Patient’s medical condition

Question 30

what is assessment of need for antibiotics?

Answer 30

local factors - Toxicity- systemically unwell - Airway compromisation - Dysphagia - difficulty swallowing - Trismus - severely limited mouth opening - Lymphadenitis - Location (e.g. floor of mouth) - FOM will affect your breathing systemic factors - Immunocompromised pts Acquired causes (e.g. HIV) Drug Induced (e.g. Steroids, Cytostatics) Blood disorders (e.g. Leukaemias) - Diabetes - Elderly

Question 31

where does the caries end results usually stop?

Answer 31

- chronic apical infection (granuloma) only in some people goes to apical cyst (radicular)

Question 32

what is reversible pulpitis?

Answer 32

Denotes a level of inflammation in which returning to a normal state is possible if noxious (harmful) stimuli removed Mild-moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds (<5 secs), no mobility, no pain on percussion

Question 33

what is irreversible pulpitis?

Answer 33

Denotes a higher level of inflammation in which dental pulp has been damaged beyond point of recovery Sharp, throbbing, severe pain upon stimulation, and pain may be spontaneous or occur without stimulation, pain persists after stimulation removed (>5 secs); tx: RCT or extraction

Question 34

describe a periapical granuloma (chronic apical periodontitis)?

Answer 34

Mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes, and few histiocytes with fibroblasts and capillaries).  NOT a true granuloma because not granulomatous inflammation! (Note that granulomatous inflammation has epithelioid histiocytes mixed with lymphocytes and giant cells)

Question 35

what is the etiology of peripaical (radicular) cyst?

Answer 35

- Caries, trauma, periodontal disease - Death of dental pulp - Apical bone inflammation - Dental Granuloma - Stimulation of epitheialial rests of Malassez - Epithelial Proliferation - Periapical Cyst Formation

Question 36

what is radicular mean?

Answer 36

around root