Oral Pathology 1, Lecture 12

A mass of chronically inflamed tissue at the tooth root tip (apex), often caused by infection.

Another name for periapical granuloma, emphasizing the chronic inflammation around the tooth root tip.

An infection affecting the tissues around the tooth root tip.

Early stage of periapical inflammatory disease, characterized by neutrophils and no visible radiographic changes.

Infection within the pulp of a tooth; it can spread to the periapical tissues.

Pus-filled pocket/inflammation at the tooth root tip; a possible complication of periapical granuloma.

Changes visible on X-rays; a sign of periapical inflammation; usually seen in advanced cases.

A type of white blood cell that is the major defense mechanism in the early stages of infection.

Death of cells and tissues within the pulp chamber of a tooth.

A channel that forms from a periapical abscess to the surface of the gum, allowing drainage of pus.

Drainage of the abscess, elimination of the infection, and often endodontic therapy or extraction of the affected tooth.

Usually good with appropriate treatment, but can lead to complications like bone loss or spreading infection if not treated.

Symptomatic abscesses cause pain and swelling; asymptomatic ones cause no symptoms until advanced stages.

A secondary inflammatory exacerbation within a periapical granuloma, characterized by recurring pain.

A periapical abscess that is the initial problem, not a worsening of a previous one.

The initial stage of periapical inflammatory disease, causing throbbing pain.

A periapical infection with reduced symptoms after the initial acute stage.

Might show thickening of the periodontal ligament or a poorly defined radiolucency around the root apex, possibly no change at early stages.

A radiographic sign showing thinning of a key bone structure near the tooth root.

Shows the outline of the original chronic lesion, possibly with additional bone loss.

A mass of granulation tissue appearing at the opening of a sinus track (often on the gum).

Sac-like formation near the tooth root that can arise from periapical inflammation.

Breakdown/loss of tooth root structure.

Abscesses spread along the path of least resistance, potentially through bone (osteomyelitis) or soft tissue (cellulitis).

In some cases, a gutta-percha point can help identify the problematic tooth during a radiographic exam when a parulis is present.

Most abscesses drain buccally due to thinner bone, but maxillary incisors, palatal molars, and mandibular molars drain lingually.

A chronic abscess that drains consistently may become asymptomatic due to the lack of purulent material buildup.

Rarely, periapical infections can spread through the bloodstream, causing systemic symptoms like fever, swollen lymph nodes (lymphadenopathy), and malaise.

Abscess biopsies are uncommon as the material is usually liquid. They typically have many white blood cells(polymorphonuclear leukocytes) and other inflammatory material including cellular debris, necrotic matter, bacteria, or histiocytes;.

As irreversible pulpitis progresses, throbbing pain increases, possibly interfering with sleep. Heat worsens the pain, while cold may offer temporary relief. The tooth may respond to electrical pulp testing at higher voltages or not at all.

If drainage of an abscess is blocked, symptoms like pain quickly reappear.

The cyst wall is primarily dense fibrous connective tissue, potentially with inflammatory cells like lymphocytes, neutrophils, and plasma cells.

The cyst cavity (lumen) can have fluid, cellular debris, and various substances including calcification or cholesterol clefts.

Periapical cysts are treated similarly to periapical granulomas. Treatment may include tooth extraction or endodontic therapy (root canal), depending on the tooth's restorability.

Rarely, odontogenic cysts (like periapical) can develop cancerous cells.

Distinguishing between acute apical periodontitis and periapical abscess can be challenging, requiring careful consideration of symptoms.