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F09 Oral Path 2a
Pulpal/Periapical Inflammatory Disease
54
Other
Professional
10/08/2009

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Term
Pulpitis
Definition
___ = inflammation of pulp.
Term
Pulpitis
Definition
___ appears as increased redness at the coronal aspect of the pulp chamber.
Term
True! Classification of pulpitis is based on symptoms and signs.
Definition
T/F: There is little correlation between symptoms and histological appearance of pulp.
Term
Reversible Pulpitis
Definition
___ ___ is associated with sharp pain of short duration. It is intermittent and non-spontaneous.
Term
Reversible pulpitis (pulpalgia)
Definition
___ ___ presents as dilated/engorged vessels, edema, and some chronic inflammatory cells histologically.
Term
Irreversible pulpitis
Definition
___ ___ is usually sharp, severe pain on stimulation (cold), prolonged and dull with time. Pain is often spontaneous and localized early, becoming more diffuse with time.
Term
Irreversible (cold causes sharp pain in irreversible pulpitis)
Definition
Which pulpitis is similar to partial necrosis with the exception that cold RELIEVES pain?
Term
True! Masses of neutrophils, histiocytes with foci of necrosis, chronic inflammatory cells and fibrosis peripherally
Definition
T/F: Irreversible pulpitis, partial necrosis and necrosis have similar histologic features.
Term
Necrosis
Definition
___ ranges from asymptomatic to severe pain and usually does not respond to pulp vitality tests.
Term
Hyperplastic pulpitis
Definition
___ ___ is also called a pulp polyp.
Term
hyperplastic pulpitis
Definition
___ ___ is chronic pulpitis in children and young adults.
Term
Hyperplastic Pulpitis (pulp polyps)
Definition
___ ___ follows carious pulp exposure with loss of crown and exposure of pulp chamber. Most common in molars due to large pulp chambers in young people.
Term
Remove caries
Definition
How do you treat reversible pulpitis?
Term
Endodontic therapy or extraction
Definition
How do you treat hyperplastic pulpitis, irreversible pulpitis and necrosis?
Term
True! (Pulpitis does not have a good correlation between histology and symptoms.)
Definition
T/F: There is a good correlation between histology and symptoms with periapical inflammation.
Term
periapical inflammation
Definition
Toxic metabolites of degerating cells incite inflammation in ___ ___.
Term
Acute Apical Periodontitis
Definition
___ ___ ___ is the first manifestation of acute inflammation that can result from hyperocclusion. There is pain to pressure, percussion, or may also be spontaneous.
Term
Acute apical periodontitis
Definition
___ ___ ___ has no pus, radiographically presents as slight widening of PDL and is treated with endo or extraction.
Term
acute apical periodontis
Definition
In ___ ___ ___ is not sensitive to thermal since pulp is necrotic, but may have thermal sensitivity due to remaining pulp being vital (multi-rooted tooth).
Term
Acute apical abscess
Definition
___ ___ ___ comes with pus, severe pain to pressure/percussion, but usually not thermal sensitivity since pulp is necrotic.
Term
Parulis
Definition
A ___ is a raised, red mass of gingiva that can appear on skin if tract drains in that area. When pressure is applied to tooth, pus may express through opening.
Term
Acute Apical Abscess
Definition
___ ___ ___ may lead to a parulis.
Term
Cellulitis
Definition
Acute Apical Abscesses may progress to ___ (which is the diffuse spread of acute inflammation through soft tissue and fascial planes) if it is not drained. This is especially likely in immunocompromised patients.
Term
Ludwig Angina
Definition
___ ___ is cellulitis of submandibular, sublingual and submental spaces. It usually arises from necrotic mandibular teeth and can extend to lateral phayrngeal space, retropharyngeal space or mediastinum.
Term
Ludwig Angina
Definition
___ ___ is an elevation, enlargement and protrusion of the tongue (woody tongue).
Term
Ludwig Angina
Definition
Woody tongue and bull neck are clinical manifestations of ___ ___.
Term
True!
Definition
T/F: Bilateral spread of Ludwig Angina is common.
Term
Cavernous Sinus Thrombosis
Definition
___ ___ ___ is when an abscess in upper teeth perforates the buccal cortex and spreads to the maxillary sinue, pterygopalatine fossa or infratemporal fossa. It reaches the orbit through inferior orbital fissure and spreads to cavernous sinus at base of skull.
Term
cavernous sinus thrombosis
Definition
Periorbital edema, proptosis of the orbit and swelling along side of nose are clinical findings in ___ ___ ___.
Term
Phoenix Abscess
Definition
A ___ ___ is an acute exacerbation of chronic apical periodontitis. It can be painful on percussion or pressure. It appears as an abscess within mass of granulation tissue and radiolucent lesion similar to chronic apical peridontitis.
Term
Chronic Apical Periodontitis
Definition
___ ___ ___ is chronic inflammation at the apex of a non-vital tooth. It produces obvious radiographic changes in bone and causes periapical granuloma or periapical (radicular) cyst.
Term
Periapical granuloma
Definition
A ___ ___ can arise de novo as chronic inflammatory lesion. May also be sequella of AAP or AAA and can progress to periapical cyst of phoenix abscess.
Term
periapical granuloma
Definition
___ ___ are mostly asymptomatic, but may be mildly painful to percussion. It is not sensitive to thermal stimuli because pulp is necrotic.
Term
Periapical granulomas
Definition
Widened PDL, resorption of lamina dura and possible root resorption are radiographic findings in ___ ___.
Term
periapical/radicular cyst
Definition
___ ___ arises from pre-existing periapical granuloma. It is the proliferation of epithelial rests of Malassez in PDL. Patient is not sensitive to thermal stimuli since pulp is necrotic.
Term
periapical cyst
Definition
___ ___ appear as hyperplastic stratified squamous epithelial cyst lining, supported by chronically inflamed granulation tissue.
Term
periapical cysts
Definition
Larger periapical lesions (>2cm) more likely to be ___ ___.
Term
chronic apical abscess
Definition
___ ___ ___ is an apical abscess that has drained through a sinus tract. Usually asymptomatic due to release of pressure.
Term
periapical granulmoa, periapical cyst, chronic apical abscess
Definition
Which three pathologies could periapical radiolucency indicate?
Term
residual periapical granumola/cyst
Definition
___ ___ ___ is the most common diagnosis for solitary radiolucencies in alveolar process.
Term
Condensing osteitis
Definition
___ ___ is chronic periapical response to long-term pulpitis or pulpal necrosis. Mild inflammatory reaction stimulates bone formation usually in teens and young adults.
Term
condensing osteitis
Definition
Almost all ___ ___ are asymptomatic, but may present with mild pain to percussion or palpatation. Radiographically = irregular homogeneous radiopacity at apices, dense sclerotic bone, poorly or well defined.
Term
residual condensing osteitis
Definition
___ ___ is the most common diagnosis of solitary radiopacity in alveolar process.
Term
1. widening of apical PDL space, 2. resorption of apical lamina dura, 3. periapical radiolucency or opacity
Definition
What are the 3 radiographic signs of pulpal inflammation or death?
Term
periostitis ossificans
Definition
___ ___ is the proliferation and ossification of periosteum. It is a sequella of periapical inflammation in mandibular molars and premolars. Usually affects children and young adults.
Term
Periostitis ossificans
Definition
___ ___ is usually asymptomatic, presenting as a bony, hard swelling over inferior border or buccal aspect of mandible.
Term
periostitis ossificans
Definition
___ ___ appears radiographically as "onion skin" radiopacities or faintly radiopaque thickening along cortex.
Term
False! Not needed!
Definition
T/F: Cosmetic surgery is an important treatment for periostitis ossificans.
Term
osteomyelitis
Definition
___ is inflammation of bone medullary spaces. It usually arises from odontogenic infection or periodontitis.
Term
False! Osteomyelitis is most common in men and in the mandible
Definition
T/F: Osteomyelitis is most common in women and found largely in the maxilla.
Term
osteomyelitis
Definition
___ occurs in cases of immune dysfunction or bone diseases.
Term
acute osteomyelitis
Definition
___ ___ presents with pain, fever, leukocytosis, lymphadenopathy, paresthesia, neutrophils, pus, necrotic bone, bacteria, thinning of trabecular bone producing radiolucencies with distinct borders.
Term
chronic osteomyelitis
Definition
___ ___ presents as chronically or subacutely inflamed fibrous tissue, sequestra of non-viable bone and bacteria.
Term
chronic osteomyelitis
Definition
___ ___ presents as moth-eaten indistinct radiolucencies.
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