Term
| 3 Periapical inflammatory disorders |
|
Definition
| Periapical granuloma, apical periodontal cyst ("periapical cyst") periapical abscess |
|
|
Term
|
Definition
Reactive/inflammatory
External stimulus: mechanical, thermal, chemical, microorganisms
Inflammation (mast cells release, decrease nutrient flow, cellular damage)
|
|
|
Term
|
Definition
| Irreversible & reversible |
|
|
Term
| Histo of reversible pulpitis |
|
Definition
|
|
Term
| Histo of irreversible pulpitis |
|
Definition
| Hyperemia, edema, fibrosis, chronic inflammation, +/- abscess (vide infra) |
|
|
Term
| Another name for pulp polyps |
|
Definition
| Chronic hyperplastic pulpitis |
|
|
Term
| Characteristics of pulp polyps |
|
Definition
| Recently erupted tooth w/ open apices; mass of red tissue (pyogenic granuloma-like) emanating from exposed pulp |
|
|
Term
| Stages of typical progression for diseased tooth |
|
Definition
1. Healthy tooth = asymptomatic, 2. mild-moderate caries, 3. severe pulpal insult, 4. Leads to non-vital ("necrotis") pulp, 5. Acute pain resolves (if untreated), 6. over time, mediators of inflammation may stimulate proliferation of residual epithelial cells in jaws
|
|
|
Term
| Periapircal granuloma etiology |
|
Definition
| Non-vital tooth, chronically inflamed granulation tissue at apex, not a cyst |
|
|
Term
| Demographics of periapical granuloma |
|
Definition
| Very common, more common than periapical cyst |
|
|
Term
| Radiology of periapical granuloma |
|
Definition
| Unilocular radiolucency, apex or lateral root, +/- root resorption, can't distinguish radiographically from periapical cyst, most periapical radiolucencies = periapical granuloma |
|
|
Term
| Treatment of periapical granuloma |
|
Definition
|
|
Term
| Histo of periapical granuloma |
|
Definition
| Granulation tissue; chronic inflammatory cell infiltrate, CT, NO epithelial lining, not "granulomatous inflammation" |
|
|
Term
|
Definition
| Epithelial-lined pathologic cavity |
|
|
Term
|
Definition
| Isolated epithelial cells in tissue stim to divide, forms continuous sheet of epi cells (lining), enlarges slowly, destroying neighboring normal tissue, result = hole in bone lined by epi, on x-ray = black (radiolucency) |
|
|
Term
| Etiology of periapical (radicular) cyst/apical periodontal cyst |
|
Definition
| Non-vital tooth (caries, trauma); epithelial rests of Malassez (PDL) |
|
|
Term
| Demographics of Apical periodontal cyst |
|
Definition
Most common jaw cyst
Uncommon in primary dentition |
|
|
Term
| Radiology of radicular cyst |
|
Definition
Unilocular radiolucency, apex or lateral root, contiguous w/ LD of involved tooth
Can't distinguish radiographically from periapical granuloma
+/- root resorption |
|
|
Term
|
Definition
| Non-keratinized epi lining, chronic inflammatory cells + fibrovascular CT |
|
|
Term
| Treatment of Radicular cyst |
|
Definition
Extraction + curettage of socket vs. RCT
Persistent lesions following RCT require root end surgery |
|
|
Term
| Periapical granuloma review |
|
Definition
NON-VITAL tooth
Erupted tooth
Unilocular radiolucency |
|
|
Term
| Periapical cyst = radicular cyst review |
|
Definition
NON-VITAL tooth
Erupted tooth
Unilocular radiolucency
presence of epi/cyst lining = only difference |
|
|
Term
| etiology of residual cyst |
|
Definition
| If tooth w/ periapical cyst at apex removed but cyst not removed |
|
|
Term
| Treatment for residual cyst |
|
Definition
| Conservative surgical enucleation (open into bone defect and remove any soft tissue by scraping w/ a curette) |
|
|
Term
|
Definition
| Acute osteomyelitis, diffuse sclerosing osteomyelitis, proliferative periostitis, chronic supportive osteomyelitis |
|
|
Term
| Definition of osteomyelitis |
|
Definition
| Acute or chronic inflammation of bone (medullary space or cortical bone) |
|
|
Term
| etiology of osteomyelitis |
|
Definition
| Bacteremia (most cases), bone fracture, dental infection, surgery, spread from adjacent tissue (diabetic gangrene) |
|
|
Term
| Pathogenesis (mandible) of osteomyelitis |
|
Definition
| Common site: limited blood supply and presence of tooth (pulpal/perio infection) |
|
|
Term
| Additional contributing factors of osteomyelitis |
|
Definition
| Decreased vascularity of bone (radiation tx, osteopetrosis); immunocomp states (diabetes, alcholism); chronic systemic diseases (collagen vascular diseases) |
|
|
Term
| Clinical of osteomyelitis |
|
Definition
| General (tooth mobility, altered sensation); acute (fever, malaise, leukocytosis); chronic (+/- drainage, bone sclerosis) |
|
|
Term
| Clinical features of osteomyelitis |
|
Definition
Esp males (75%+), esp. mandible
|
|
|
Term
|
Definition
| Fragment of necrotic bone that has separated from the adjacent vital bone |
|
|
Term
|
Definition
| Fragment of necrotic bone surrounded by new vital bone |
|
|
Term
| Diagnostic tests for osteomyelitis Radiographs: |
|
Definition
| varies depending on type; esp CT, +/- sequestrum, +/- periosteal reaction, irregular radiolucency, +/- increased radiopacity |
|
|
Term
| Diagnostic tests for osteomyelitis (everything else) |
|
Definition
| Bone scan (radioactively-labeled WBC/gallium scans - increased signal); histologic examination of tissue, microbilogic culture of affected bone (esp if acute) |
|
|
Term
| Treatment for osteomyelitis |
|
Definition
| Resolve any source of infection; long-term antibiotic treatment (depending on type); +/- surgical debridement (remove sequestrae); +/- decortication (remove dense cortical bone, allow granulation tissue); +/- hyperbaric oxygen (debate as to effectiveness) |
|
|
Term
| Classification of osteomyelitis |
|
Definition
Can be based on microbiologic etiology:
- Pyogenic osteomyelitis
- Tuberculous osteomyelitis
- Less common: herpes zoster |
|
|
Term
| Classification of osteomyelitis in dentistry usually based on... |
|
Definition
| Acute, chronic, +/- sclerosis |
|
|
Term
| Etiology of acute osteomyelitis |
|
Definition
| Most cases are infectious in nature |
|
|
Term
| Clinical acute osteomyelitis |
|
Definition
| Usually less than one month duraction, pain, +/- lymphadenopathy and other features of acute inflammation; +/- purulent exudate |
|
|
Term
| Radiographics of acute osteomyelitis |
|
Definition
| Often no radiographic change, since ~60% of bone must be demineralized to see radiographic change; some cases may see bone changes esp CT |
|
|
Term
| Definition of chronic supportive osteomyelitis |
|
Definition
| Suppuration: formation or discharge of pus |
|
|
Term
| Etiology of chronic suppurative osteomyelitis |
|
Definition
| Progression from acute osteomyelitis or long term low grade inflammatory process which never went through acute phase |
|
|
Term
| Clinical of chronic supportive osteomyelitis |
|
Definition
| Mild to moderate pain, purulent discharge, swelling, esp. mandibular molar area |
|
|
Term
| Etiology of chronic osteomyelitis w/ proliferative periostitis |
|
Definition
| Usually associated w/ an abscessed mandibular molar (esp. in children) or post extraction |
|
|
Term
| Clinical of chronic osteomyelitis w/ proliferative periostitis |
|
Definition
| Asymptomatic to mildly tender bony hard swelling with normal appearing overlying mucosa |
|
|
Term
| Radiographics of chronic osteomyelitis w/ proliferative periostitis |
|
Definition
Prominent periosteal reaction; trabeculae of bone perpendicular to long axis of bone (expanded cortex on occlusal view) = "Onion-skinning"
+/- Moth eaten appearance |
|
|
Term
| Etiology of diffuse sclerosing osteomyelitis |
|
Definition
| Inflammatory reaction of organism of low virulence; chronic periodontal disease is common portal of entry |
|
|
Term
| Clinical and radiographic of diffuse sclerosing osteomyelitis |
|
Definition
| Asymptomatic, crestal portion of tooth-bearing areas of mandible |
|
|
Term
| Histology of chronic osteomyelitis |
|
Definition
Chronically inflamed and reactive fibrous CT filling the intertrabecular spaces
Nonvital bone exhibits loss of osteocytes from lacunae; peripheral bone resorption; bacterial colonization; +/- surrounding inflammatory infiltrate |
|
|
Term
| Etiology of condensing osteitis |
|
Definition
| Reaction of bone to LOW GRADE CHRONIC pulpal inflammation |
|
|
Term
| Another name for condensing osteitis |
|
Definition
| Focal sclerosing osteitis |
|
|
Term
| Clinical of condensing osteitis |
|
Definition
| VERY COMMON, Tooth VITAL (large restoration, caries); tooth may subsequently become non-vital (after bone sclerosis has occurred) |
|
|
Term
| Another name for idiopathic osteosclerosis |
|
Definition
|
|
Term
| Definition of idiopathic osteosclerosis |
|
Definition
Area of increased density within medullary area of bone of jaws of unknown etiology
Like "tori" on inside of jaw bone |
|
|
Term
| Clinical of idiopathic osteosclerosis |
|
Definition
| VERY COMMON, focal area of increased bone density (radiopacity); not associated w/ root of inflamed tooth; NB: Difference re"condensing osteitis" |
|
|
Term
| Definition of Dry socket (alveolar osteitis) |
|
Definition
| Failure to maintain clot after extraction; esp surgical; esp mandible |
|
|
Term
|
Definition
| Increased risk for dry socket if: BCP, alcohol, smoker, debilitated, vomiting |
|
|
