Oral Path - Periapical Disease

Front 1

periapical granuloma

Back 1

a mass of chronically inflamed granulation tissue at the apex of a non-vital tooth

Front 2

what are the components of granulation tissue

Back 2

macrophages, lymphocytes, fibroblasts, collagen, plasma cells, vascular tissue

Front 3

another name for periapical granuloma

Back 3

chronic apical periodontitis

Front 4

describe symptoms of periapical granuloma

Back 4

usually asymptomatic, but pain with acute exacerbation

Front 5

t/f: in periapical granuloma, the affected tooth shows major sensitivity to percussion, with little mobility

Back 5

false - no sensitivity to percussion and no mobility

Front 6

how does a tooth with periapical granuloma respond to pulp testing

Back 6

no reponse - it is a non-vital tooth

Front 7

how are most periapical granulomas discovered

Back 7

routine radiographs

Front 8

describe radiographic appearance of a periapical granuloma

Back 8

- lesion may be circumscribed or an ill-defined radiolucency of variable size
- loss of lamina dura
- possible root absorption

Front 9

what features help you distinguish a periapical granuloma from a periapical cyst radiographically

Back 9

none - you cannot distinguish between them from radiographic appearance

Front 10

what is the proper treatment of a periapical granuloma

Back 10

- if tooth is restorable - root canal therapy
- if tooth is non-restorable - extraction, curettage of all apical soft tissue

Front 11

in cases of periapical granulomas, when should you follow up on endodontically treated teeth

Back 11

1 and 2 year intervals (many suggest 1, 3 and 6 month evaluations)

Front 12

what is the prognosis of a periapical granuloma

Back 12

most are resolved with adequate endodontic treatment

Front 13

how do you treat periapical granuloma lesions that do not resolve

Back 13

periapical surger, biopsy and retrofill

Front 14

what cause failure to heal of a periapical granuloma

Back 14

- cyst formation
- inadequate endo treatment
- root fractures
- foreign material
- periodontal disease and penetration of the sinus

Front 15

what is a cyst

Back 15

pathological cavity, lined with epithelium

Front 16

give 2 other names for a periapical cyst

Back 16

radicular cyst, apical periodontal cyst

Front 17

how is a cyst formed

Back 17

epithelium at the apex is stimulated to form a cyst by inflammation

Front 18

what are the possible sources of epithelium, which leads to a periapical cyst

Back 18

- rests of mallasez
- crevicular epithelium
- sinus lining or epithelium of sinus tract

Front 19

what percentage of periapical radiolucencies are cysts

Back 19

7-54%

Front 20

what is a residual cyst

Back 20

a cyst that forms after a tooth has been extracted, or may occur if an existing periapical lesion is not removed at the time a non-vital tooth is removed

Front 21

describe the symptoms of a periapical cyst

Back 21

lesion is typically atypical unless there is acute exacerbation

Front 22

what may happen as a periapical cyst enlarges

Back 22

- may cause swelling to occur
- may cause movement and mobility of adjacent teeth

Front 23

in a periapical cyst, the associated tooth is _______________

Back 23

non-vital

Front 24

in a lateral periodontal cyst, the associated tooth is _____________

Back 24

vital

Front 25

describe a periapical cyst radiographically

Back 25

- loss of lamina dura
- root resorption is common
- can become quite large

Front 26

describe the treatment for a periapical cyst in a restorable tooth

Back 26

root canal therapy

Front 27

describe the treatment for a periapical cyst in a non-restorable tooth

Back 27

- tooth extracted
- curettage of all apical soft tissue (which is submitted for microscopic examination)

Front 28

rarely, _________________ has been reported developing from a periapical cyst

Back 28

squamous cell carcinoma

Front 29

what is the most common cause of granulomas, cysts and abscesses

Back 29

caries (anything that causes non-vitality - caries is the most common)

Front 30

what is a periapical abscess

Back 30

accumulation of accute inflammatory cells at the apex of a non-vital tooth

Front 31

what gives rise to a periapical abscess

Back 31

- may arise de novo
- an acute exacerbation of a chronic periapical lesion

Front 32

describe a symptomatic periapical abscess

Back 32

pain, sensitivity to percussion, extrusion of the involved tooth, swelling

Front 33

describe the response of the tooth (with periapical abscess) to cold or electrical pulp testing

Back 33

- doesn't respond to either

Front 34

what additional symptoms may a patient with a periapical abscess experience

Back 34

headache, chills, fever, malaise

Front 35

describe radiographic appearance of a periapical abscess

Back 35

- apical periodontal ligament may appear thickened
- ill-defined radiolucency may occur
- or both at the same time
- possibly no alteration may be seen if there is not sufficient bone loss

Front 36

an abscess may progress to ________________

Back 36

- osteomyelitis, cellulitis, development of an intraoral or cutaneous sinus
- a parulis (or gumboil) may develop at the opening of an intraoral sinus tract

Front 37

how is an abscess treated

Back 37

establish drainage, eliminate the focus of infection

Front 38

in an abscess, how do you remove the source of infection

Back 38

- endo therapy, or extraction of non-restorable teeth

Front 39

__________________ are needed in severe cases of periapical abscess

Back 39

analgesics, antibiotics

Front 40

what is a parulis

Back 40

a mass of subacutely inflamed granulation tissue at the opening of an intraoral sinus tract

Front 41

where does a parulis most commonly occur

Back 41

on buccal gingiva of children and young adults

Front 42

describe appearance of a parulis

Back 42

a red tumescence (or yellow if puss-filled)

Front 43

what is the cause of a parulis

Back 43

caused by inflammation arising from a periodontal or periapical abscess

Front 44

what is the treatment of a parulis

Back 44

- they usually go away after endo treatment, but if not they need to be removed surgically

Front 45

what is cellulitis

Back 45

diffuse inflammation of soft tissues which is not circumscribed or confined to one area, but tends to spread to tissue spaces and along facial planes

Front 46

how is cellulitis different from an abscess

Back 46

cellulitis spreads through fascial planes, abscesses are confined to one area

Front 47

name 2 dangerous forms of cellulitis

Back 47

- ludwig's angina
- cavernous sinus thrombosis

Front 48

clinical features of ludwig angina

Back 48

- swelling of floor of mouth, tongue and submandibular region
- sublingual space involvement causes posterior enlargement, elevation and protrusion of the tongue - 'woody tongue'
- submandibular space involvement causes enlargement and tenderness of the neck about the hyoid bone - 'bull neck'

Front 49

name 3 fascial spaces involved in ludwig angina

Back 49

- sublingual
- submandibular
- lateral pharyngeal

Front 50

ludwig angina is initially ___________ but rapidly becomes ______________

Back 50

unilateral, bilateral

Front 51

where might pain occur in ludwig angina

Back 51

floor of mouth and neck

Front 52

name additional symptoms of ludwig angina

Back 52

dysphagia, dysphonia, dysarthria, drooling, sore throat, restricted neck movement, tachypnea, dyspnea, tachycardia, stridor, restlessness, fever, chills, leukocytosis, elevated SED rate

Front 53

in ludwig angina, involvement of lateral pharyngeal space can cause ______________

Back 53

respiratory obstruction

Front 54

describe treatment of ludwig angina

Back 54

1- maintain airway
2- antibiotic therapy
3- surgical drainage

Front 55

describe clinical features of cavernous sinus thrombosis

Back 55

- swelling around the eye, with enlargement of eyelid, conjunctiva
- protrusion and fixation of the eyeball
- induration and swelling of forehead and nose
- lacrimation, photophobia, dilation of the pupil, loss of vision
- pain over the eye and along the opthalmic and maxillary branches of trigeminal nerve

Front 56

name the signs of CNS involvemnt in cavernous sinus thrombosis

Back 56

tachycardia, tachypnea, irregular breathing, stiff neck, stupor, delirium

Front 57

occasionally cavernous sinus thrombosis patients develop a ___________________

Back 57

brain abscess

Front 58

what is the treatment for cavernous sinus thrombosis

Back 58

- removal of offending tooth, establish drainage, antibiotics, corticosteroids (for inflammation)

Front 59

what is osteomyelitis

Back 59

acute or chronic inflammatory process in the medullary spaces or cortical surfaces of bone that extends away from the initial site of involvement

Front 60

in the oral cavity, osteomyelitis is usually a ___________________

Back 60

bacterial infection