Dental Sclerosis Overview

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Questions and Answers

What is typically the first radiographic feature observed in acute apical periodontitis?

  • Complete loss of bone density
  • The formation of an abscess
  • A significantly widened periodontal space
  • A hazy appearance of the lamina dura (correct)

Which of the following is characteristic of the histopathology of acute apical periodontitis?

  • Engorged blood vessels and neutrophil packing (correct)
  • Presence of lymphocytes and plasma cells
  • Chronic inflammatory response
  • Absence of inflammatory cells

What is the appropriate management for irreversible pulpitis?

  • Root canal treatment (correct)
  • Just remove the irritant
  • Extraction of the affected tooth
  • Antibiotic therapy followed by monitoring

In cases of acute periodontitis, why are antibiotics not typically administered?

<p>Immediate dental treatment is sufficient (C)</p> Signup and view all the answers

What is the characteristic presentation of facial oedema in acute apical periodontitis?

<p>No facial oedema develops (B)</p> Signup and view all the answers

Which statement accurately describes the periodontal space in acute apical periodontitis?

<p>It may appear slightly widened (C)</p> Signup and view all the answers

Which of the following conditions requires the removal of irritants only?

<p>Reversible pulpitis (B)</p> Signup and view all the answers

What is the result of untreated pulp necrosis?

<p>It necessitates root canal treatment (D)</p> Signup and view all the answers

What happens to bone changes during acute apical periodontitis?

<p>They require time to develop (D)</p> Signup and view all the answers

What typically indicates that acute inflammatory reaction is localized to the apex?

<p>Localized accumulation of neutrophils (A)</p> Signup and view all the answers

What characterizes condensing osteitis as a dental condition?

<p>It results in a localized sclerotic reaction to a dental infection. (B)</p> Signup and view all the answers

Which type of tooth condition can sometimes be associated with condensing osteitis?

<p>A vital tooth in rare cases. (C)</p> Signup and view all the answers

What is the primary form of treatment for condensing osteitis?

<p>Removal of the underlying cause. (C)</p> Signup and view all the answers

What is a common characteristic of the radiographic appearance of condensing osteitis?

<p>It blends with the surrounding bone in the periapical area. (A)</p> Signup and view all the answers

Which condition is characterized by acute inflammatory changes of the periodontium?

<p>Acute apical periodontitis. (A)</p> Signup and view all the answers

Which symptom is commonly associated with acute apical periodontitis?

<p>Severe localized pain triggered by touch. (D)</p> Signup and view all the answers

Which of the following is not a cause of acute apical periodontitis?

<p>Chronic periodontal disease. (A)</p> Signup and view all the answers

What distinguishes the pain response in acute apical periodontitis from other dental conditions?

<p>Pain is localized and severe to touch. (A)</p> Signup and view all the answers

What is a common feature of the affected tooth in acute apical periodontitis?

<p>It may be discolored due to pulp death. (A)</p> Signup and view all the answers

Which symptom is typically not associated with condensing osteitis?

<p>Presence of pus. (A), Swelling. (B)</p> Signup and view all the answers

Condensing osteitis typically results in a sclerotic reaction in the periodontal ligament space.

<p>False (B)</p> Signup and view all the answers

Apical periodontitis is characterized by severe pain that can occur with the slightest touch.

<p>True (A)</p> Signup and view all the answers

Condensing osteitis only occurs in non-vital teeth.

<p>False (B)</p> Signup and view all the answers

Mild pain can be a symptom of condensing osteitis despite it being largely asymptomatic.

<p>True (A)</p> Signup and view all the answers

The primary treatment for apical periodontitis involves surgical intervention.

<p>False (B)</p> Signup and view all the answers

Condensing osteitis can be discovered through routine dental visit X-rays.

<p>True (A)</p> Signup and view all the answers

Acute apical periodontitis may result from traumatic occlusion caused by high spot restoration.

<p>True (A)</p> Signup and view all the answers

In condensing osteitis, the affected area appears as a radiolucency on X-rays.

<p>False (B)</p> Signup and view all the answers

Patients with acute apical periodontitis will respond to hot or cold stimuli with pain.

<p>False (B)</p> Signup and view all the answers

Bone lesions associated with condensing osteitis can resolve over time after treatment.

<p>True (A)</p> Signup and view all the answers

Facial oedema is commonly observed in acute apical periodontitis.

<p>False (B)</p> Signup and view all the answers

The lamina dura may appear hazy during the early radiographic evaluation of acute apical periodontitis.

<p>True (A)</p> Signup and view all the answers

Acute apical periodontitis typically shows evidence of chronic inflammation in histopathological analysis.

<p>False (B)</p> Signup and view all the answers

Root canal treatment is indicated for cases of reversible pulpitis.

<p>False (B)</p> Signup and view all the answers

The periodontal space may be slightly widened in cases of acute apical periodontitis.

<p>True (A)</p> Signup and view all the answers

Antibiotics are commonly prescribed for acute apical periodontitis.

<p>False (B)</p> Signup and view all the answers

Engorged blood vessels and neutrophil packing are consistent findings in the histopathology of acute apical periodontitis.

<p>True (A)</p> Signup and view all the answers

No changes are seen in radiographic features during the first stages of acute apical periodontitis.

<p>True (A)</p> Signup and view all the answers

Immediate dental treatment is sufficient to address acute apical periodontitis.

<p>True (A)</p> Signup and view all the answers

Patients with acute apical periodontitis will likely experience facial swelling as a primary symptom.

<p>False (B)</p> Signup and view all the answers

What characterizes the histopathological structure of a periapical abscess?

<p>A central area containing pus and a thick fibrous wall (D)</p> Signup and view all the answers

Which condition represents an acute exacerbation of a chronic periapical lesion?

<p>Phoenix abscess (B)</p> Signup and view all the answers

What is a common management approach for a phoenix abscess?

<p>Repeat endodontic treatment or tooth extraction (B)</p> Signup and view all the answers

What is primarily responsible for the sudden worsening of symptoms in a phoenix abscess?

<p>Inadequate debridement during endodontic procedures (B)</p> Signup and view all the answers

Which inflammatory cells primarily surround the central area of a periapical abscess?

<p>Neutrophils (A)</p> Signup and view all the answers

Which of the following suggests a diagnosis of chronic apical periodontitis?

<p>Large ill-defined periapical radiolucency (B)</p> Signup and view all the answers

What is the function of the thick fibrous wall surrounding a periapical abscess?

<p>To isolate the infection from surrounding tissues (B)</p> Signup and view all the answers

What is a potential outcome of inadequately treated necrotic pulp related to chronic apical periodontitis?

<p>Formation of a phoenix abscess (A)</p> Signup and view all the answers

In which condition might antibiotics be administered as a management strategy?

<p>Phoenix abscess (D)</p> Signup and view all the answers

What is the primary histological feature of the area surrounding a periapical abscess?

<p>Presence of dilated blood vessels (D)</p> Signup and view all the answers

What is the primary cause of a periapical abscess?

<p>Infection extension from pulp tissue (C)</p> Signup and view all the answers

Which of the following is a systemic manifestation of an acute periapical abscess?

<p>Lymphadenitis (C)</p> Signup and view all the answers

What typically characterizes the pain experienced in an acute periapical abscess?

<p>Localized and intense (D)</p> Signup and view all the answers

What radiographic feature is associated with a chronic periapical abscess?

<p>Large ill-defined periapical radiolucent area (C)</p> Signup and view all the answers

Which type of inflammation is primarily associated with pus formation in a periapical abscess?

<p>Acute inflammation (B)</p> Signup and view all the answers

What is a possible effect of pus formation in an acute periapical abscess on the surrounding bone?

<p>Bone resorption activation by osteoclasts (D)</p> Signup and view all the answers

During the early stages of a periapical abscess, what typical radiographic changes are expected?

<p>Widening of the periodontal membrane space (D)</p> Signup and view all the answers

What sensation may a patient experience as a result of a chronic periapical abscess?

<p>Salty taste (C)</p> Signup and view all the answers

What clinical feature is NOT associated with a periapical abscess?

<p>Response to cold stimuli (D)</p> Signup and view all the answers

What is a common result of chronic irritation from a periapical abscess?

<p>Pus drainage through a sinus tract (A)</p> Signup and view all the answers

Flashcards

Apical Periodontitis

A localized inflammation at the tip of the root of a tooth, usually caused by bacteria.

Acute Apical Periodontitis

An early stage of apical periodontitis characterized by rapid onset and minimal bone changes.

Lamina Dura

The bony wall surrounding the tooth root, which may appear hazy or slightly widened in acute apical periodontitis.

Periodontal Space

The space between the tooth root and the surrounding bone, which may become slightly wider in acute apical periodontitis.

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Acute Inflammatory Reaction

The characteristic feature of acute apical periodontitis, involving an accumulation of neutrophils and engorged blood vessels.

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Neutrophils

The most common type of white blood cell involved in the initial inflammatory response in acute apical periodontitis.

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Remove Irritant Only

When removing the irritant to treat acute apical periodontitis, this is done if pulp is normal or reversible.

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Root Canal Treatment

When pulp is irreversibly diseased or dead, this treatment is required for acute apical periodontitis.

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Antibiotics Not Needed

Antibiotics are generally not needed for acute apical periodontitis because immediate dental treatment is sufficient.

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Draining Exudate

The process of draining the infected exudate from the tooth, which can be achieved through immediate dental treatment.

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Condensing Osteitis

A localized inflammatory condition caused by a sclerotic reaction to a dental infection. The bone becomes harder and denser.

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Etiology of Condensing Osteitis

The main cause of condensing osteitis is a dental infection that triggers a hardening response in the bone.

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Clinical Features of Condensing Osteitis

Condensing osteitis is often asymptomatic, but may cause mild pain. It usually occurs in the jaw area around the roots of molars. X-rays reveal a denser, opaque appearance compared to surrounding bone

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Treatment for Condensing Osteitis

The treatment for condensing osteitis involves addressing the underlying dental infection. The associated tooth may be treated or extracted.

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Causes of Acute Apical Periodontitis

Acute apical periodontitis can result from traumatic bite, rapid orthodontic treatment, bruxism, acute pulpitis, or pulp necrosis.

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Clinical History of Acute Apical Periodontitis

The patient may report a recent dental visit, pain due to previous pulp inflammation, and the affected tooth might be discolored or have visible decay.

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Pain in Acute Apical Periodontitis

Acute Apical Periodontitis feels intensely painful, even to the slightest touch. The pain is localized to the affected tooth due to inflammation in the periodontal ligament.

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Response to Stimuli in Acute Apical Periodontitis

Hot or cold stimuli typically do not cause pain in Acute Apical Periodontitis.

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Pulp Test Results in Acute Apical Periodontitis

The affected tooth may respond to a pulp tester, indicating that the nerve is still alive. In other cases, the nerve may be dead (pulp necrosis) and the tooth won't respond.

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What causes Condensing Osteitis?

Condensing osteitis often occurs in a tooth that's either decayed or has a large filling and may even be non-vital due to infection.

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How is Condensing Osteitis discovered?

The condition is usually discovered during routine dental x-rays, showing a denser, opaque area at the tooth's root.

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How is Condensing Osteitis treated?

Removing the source of the dental infection, often by treating or extracting the affected tooth.

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What are the causes of Acute Apical Periodontitis?

This condition can be caused by a traumatic bite, rapid orthodontic adjustment, excessive grinding (bruxism), tooth inflammation, or tooth nerve death.

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What are the symptoms of Acute Apical Periodontitis?

Patients may report a recent dental visit, pain related to previous tooth inflammation, and the affected tooth might be discolored or decayed.

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How does Acute Apical Periodontitis feel?

The defining characteristic is severe pain, even with light touch, localized to the affected tooth.

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How does Acute Apical Periodontitis respond to stimuli?

Hot and cold sensations typically don't cause pain in this condition, and a pulp test may show that the nerve is still alive or dead.

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How is Acute Apical Periodontitis treated?

Treating the underlying cause, which might involve removing the irritant, root canal treatment, or surgical intervention, based on the status of the pulp.

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What is acute apical periodontitis?

An early stage of apical periodontitis characterized by rapid onset and minimal bone changes, often with no visible symptoms.

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What are the earliest radiographic signs of acute apical periodontitis?

The bone surrounding the tooth root may appear slightly fuzzy or the space between the tooth and bone may be slightly wider in acute apical periodontitis due to inflammation.

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What is the histopathology of acute apical periodontitis?

Acute apical periodontitis is a localized inflammatory reaction at the tip of the tooth root with engorged blood vessels and an influx of neutrophils.

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What is the treatment for acute apical periodontitis if the pulp is normal or reversible?

If the pulp is healthy or reversible, the irritation causing acute apical periodontitis should be removed.

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What is the treatment for acute apical periodontitis if the pulp is irreversibly diseased or dead?

If the pulp is irreversibly diseased or dead, root canal treatment is necessary to address acute apical periodontitis.

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Are antibiotics needed for acute apical periodontitis?

Antibiotics are not usually necessary for acute apical periodontitis as immediate dental treatment is enough to eliminate the infection or drain the pus.

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What is the typical pain presentation in acute apical periodontitis?

In acute apical periodontitis, the pain is localized to the affected tooth due to inflammation of the periodontal ligament.

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What is the response to hot or cold stimuli in acute apical periodontitis?

Hot or cold stimuli do not usually cause pain in acute apical periodontitis.

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What are the pulp test results in acute apical periodontitis?

The tooth affected by acute apical periodontitis may respond to a pulp tester, indicating a live nerve. In other cases, the nerve may be dead (pulp necrosis) and the tooth won't respond.

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What are some causes of acute apical periodontitis?

Acute apical periodontitis can be caused by a traumatic bite, rapid orthodontic treatment, bruxism, acute pulpitis, or pulp necrosis.

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Phoenix abscess

An acute exacerbation of a chronic periapical lesion, like a granuloma or cyst, that occurs after root canal treatment or inadequate debridement.

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Shift in balance (Phoenix abscess)

A condition where the balance between the body's defenses and the virulence of microorganisms shifts, leading to increased microbial activity in the root canal.

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Central area (periapical abscess)

The pus-filled central area of a periapical abscess, containing necrotic tissue and inflammatory cells.

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Surrounding area (periapical abscess)

The surrounding area of a periapical abscess containing dilated blood vessels and inflammatory cells, primarily neutrophils.

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Fibrous wall (periapical abscess)

A thick fibrous wall that forms around the central area of a periapical abscess, encapsulating the infection.

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Draining the periapical abscess

Opening the root canal to drain pus and provide access for endodontic treatment.

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Endodontic treatment

Treating the infected tooth's root canals to remove the source of the infection.

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Repeat endodontic treatment

A re-treatment of the root canals, often after inadequate initial treatment or when an abscess returns.

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Antibiotics

Medications used to control the spread of infection, often prescribed alongside endodontic procedures.

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Tooth extraction

Surgical removal of the tooth, often used as a last resort when endodontic treatment cannot salvage it.

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What is a periapical abscess?

It's a painful condition in the area around the root of a non-vital tooth, caused by a pus-forming infection.

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How does a periapical abscess develop?

It can arise from the tooth's pulp tissue becoming infected, or from an existing inflammation around the root becoming worse.

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What are some signs you might have a periapical abscess?

A tooth with deep decay or a large filling is a clue. The pain is sharp and localized to the affected tooth.

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What happens if the periapical abscess is draining?

If the abscess is draining through a pathway, the pain is often less severe, and you might notice a salty taste.

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What is the lamina dura, and how does it look on an X-ray?

It refers to the layer of hard bone that surrounds the tooth root. In a periapical abscess, this area may become hazy or show a hole on an X-ray.

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What is a chronic periapical abscess?

It's a chronic infection around the tooth root that's usually mild and slow-growing. It can cause discomfort when chewing, but not severe pain.

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What is a radiolucent area on an X-ray?

It's a sign of bone loss caused by the infection. You might see a dark area on an X-ray around the tooth root.

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What is the typical treatment for a periapical abscess?

It involves removing the infected pulp (the inner part of the tooth), cleaning and sealing the tooth root to prevent reinfection.

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What happens to the nerve in a tooth with a periapical abscess?

A tooth with a periapical abscess is often dead, meaning the nerve inside is no longer alive.

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How does a periapical abscess appear on an X-ray?

In the early stages, there might be no visible changes on an X-ray. As the abscess progresses, you might see a widening of the space between the tooth root and the bone.

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Study Notes

Dental Sclerosis (Condensing Osteitis)

  • A periapical inflammatory condition caused by a localized sclerotic bone reaction to a dental infection.
  • Often linked to a carious or heavily restored, non-vital tooth (sometimes, a vital tooth).
  • Results from infection of periapical tissues in a patient with good immunity and a low-grade inflammatory stimulus.
  • Mostly asymptomatic, with possible mild pain; typically near molar root apices.
  • Affects young to older adults; usually discovered during routine dental X-rays.
  • Radiographic feature: a radiopacity within the periapical area, blending with the surrounding bone, but separated from the periodontal ligament space.
  • Treatment: Removal of the underlying cause (e.g., treatment of the affected tooth); bone lesions often resolve or partially heal.

Apical Periodontitis

  • A localized acute inflammatory change in the tissues surrounding the tooth's apex, the periodontium.
  • Caused by traumatic occlusion (high spot restorations, rapid orthodontics, bruxism) in a normal pulp or reversible pulpitis, acute pulpitis or pulp necrosis.
  • May present with a history of recent dental work, pain from prior pulpitis, a carious, restored, or discolored tooth.
  • Tooth may be slightly extruded with heavier bite pressure due to inflammatory exudate in the periodontal ligament.
  • Severe, localized pain (even to touch) due to acute nature and triggered periodontal ligament proprioceptors.
  • Pain not elicited by hot or cold stimuli.
  • Pulp tester response varies; no facial edema, alveolar tenderness, or other systemic reactions.
  • Radiographic changes may initially be absent, appearing later as a slightly hazy lamina dura and slight widening of the periodontal space around the apex.
  • Histopathology: a typical acute inflammatory reaction localized to the apex, with engorged blood vessels and an abundance of neutrophils.
  • Treatment:
    • Normal pulp/reversible pulpitis: Remove the irritant.
    • Irreversible pulpitis/pulp necrosis: Root canal treatment.
    • Antibiotics not typically used for acute periodontitis, as direct dental treatment is preferred.

Periapical Abscess

  • A suppurative condition (pus formation) of the periapical area of a non-vital tooth.
  • Can be acute or chronic.
  • Etiology: Extension of infection from pulp tissue or an acute exacerbation of a periapical granuloma.
  • Pathogenesis: Decayed tooth infection following pulpitis, traumatic injury, or pulp necrosis allows bacterial ingress, causing vasodilation and inflammatory fluid infiltration into the periodontal ligament and alveolar bone.
  • Severe, persisting irritants lead to acute inflammation, neutrophil infiltration, cell necrosis, and pus formation.
  • Acute periapical abscess: Pus stimulates osteoclastic activity and bone resorption, causing submucosal pus extension and swelling.
  • Chronic periapical abscess: Low-intensity irritant or draining pus through a sinus tract; may cause mild pain, discomfort, or a salty taste.
  • Clinical features (acute):
    • Systemic: Acute onset pain, redness, hotness, fever, malaise, lymphadenitis, leukocytosis.
    • Local: Intense, localized pain (periodontal ligament proprioceptors); feeling of fullness, tooth elongation; pain on percussion, non-response to pulp tester (non-vital).
    • Swelling (bone resorption and submucosal pus); possible intraoral or extraoral pointing. Draining leads to chronic stage & pain reduction.
  • Radiographic features:
    • Early: No changes.
    • Progressing: Widening of the periodontal ligament space.
    • Later: Hazy or ill-defined periapical radiolucent area.
    • Chronic: Large, ill-defined periapical radiolucent area.
  • Histopathology:
    • Central pus (necrotic tissue, dead/living neutrophils).
    • Surrounding: Vasodilated blood vessels, dense inflammatory cells (mostly neutrophils), thick fibrous wall.
  • Management:
    • Open access to drain pus through root canal
    • Endodontic treatment.

Recrudescent (Phoenix) Abscess

  • An acute exacerbation of a chronic periapical lesion (chronic apical periodontitis, chronic abscess, granuloma, or cyst).
  • Etiology/Pathogenesis:
    • Commonly follows root canal treatment; inadequate debridement, untreated necrotic pulp, shift in balance between microorganism virulence and host resistance (high virulence microorganism stimulation or lowered host defense).
    • Sudden worsening of chronic periapical lesion symptoms.
  • Clinical/Radiographic Features: Similar to periapical abscess, except for a large, ill-defined periapical radiolucency.
  • Management:
    • Repeat endodontic treatment or tooth extraction.
    • Antibiotics to control infection spread.

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