Periapical Periodontitis Quiz and Flashcards

Study Notes

Periapical Periodontitis

Inflammation of periodontal ligament and other tissues around the tooth apex
3 main causes:
- Spread of infection following death of the pulp (pulpitis)
- Extrusion of antiseptics through apex during root canal treatment
- High filling or biting suddenly on a hard object

Acute Periapical Periodontitis

Clinical findings:
- History of pulpitis
- Escape of exudate into periodontal ligament causes a small amount of tooth extrusion
- Pain and infection localized, tender to touch
- Tooth not vital, and not responsive to vitality tests, unless pulpal necrosis limited to single canal in multirooted tooth
- Intense throbbing pain
- Abscess can develop
- Can spread in tissue planes causing facial swelling
- Rarely local lymphadenopathy
- Very rarely osteomyelitis or cellulitis
Radiographically:
- No bone resorption, only widening of periodontal ligament space
Pathology (cause): Acute inflammation
Management:
- Endodontic treatment
- Extraction
- Open drainage through skin or mouth if needed due to abscess causing swelling

Chronic Periapical Periodontitis

Clinical features:
- Low-grade infection
- May follow acute periapical periodontitis
- Tooth is not vital, unless very rarely pulpal necrosis is limited to a single canal in a multirooted tooth
- Symptoms may be minimal
- Can be tender to percussion
Radiographically:
- Diagnosed on identification of a periapical radiolucency
Pathology:
- Chronic inflammation (macrophages, lymphocytes, plasma cells)
- Granulation tissue
Sequelae:
- Periapical granuloma
- In some cases, subsequent radicular cyst
- Acute exacerbation with suppuration/abscess, cellulitis, and sinus formation
- Very rarely focal sclerosing osteitis

Periapical Granuloma

Clinical features:
- Most asymptomatic
- May be history of pulpitis
- But can have coexisting pulpitis and therefore be symptomatic
- Tooth is not vital and will not be responsive to vitality tests unless pulpal necrosis is limited to a single canal in a multirooted tooth
Radiographic features:
- Tooth shows loss of apical lamina dura
- Bone resorption appearing as a radiolucency that may be circumscribed or ill-defined
- Size: Small (2cm) or Large
- Root resorption can be seen rarely
Pathological features:
- Granulation tissue
- Neutrophils, lymphocytes, plasma cells, histiocytes, multinucleated giant cells
- Cholesterol clefts and haemosiderin
- Small foci of acute inflammation with focal abscess formation may be seen
- Surrounding fibrous wall
- Bone resorption
- Tooth can be resorbed but generally more resistant than bone

Focal Sclerosing Osteitis

Abnormal bone growth and lesions that may result from tooth inflammation or infections
Can cause harder, denser bones
Most occur in lower premolar and molar areas
Localized pain
Radiographically:
- Does not exhibit a radiolucent border
Treatment:
- RCT or tooth extraction - 85% of cases resolve after this
- Residual area of condensing osteitis known as a bone scar

Description

Learn about what periapical periodontitis is, its main causes, and clinical findings. Explore the inflammation of periodontal ligament and other tissues around the tooth apex, factors leading to this condition, and common signs observed in acute cases.