Periapical Tissue Diseases Overview

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Questions and Answers

What is the primary cause of an acute periapical abscess?

Genetic predisposition

Dietary factors

Allergic reactions

Infection following pulpitis (correct)

What characteristic is true regarding thermal stimulation in the presence of pulp necrosis?

It does not cause pain (correct)

It causes intense pain

It increases sensitivity

It causes mild discomfort

What clinical feature is associated with periodontitis in acute periapical abscess?

Loss of tooth color

Increased biting force

Persistent dull ache

Slight extrusion of the tooth (correct)

What type of radiographic finding is characteristic of an acute periapical abscess?

Amorphous radiolucent area with faint margins Signup and view all the answers

Which of the following is NOT a complication of an untreated periapical abscess?

Development of gingivitis Signup and view all the answers

What histopathological finding is commonly seen in an acute periapical abscess?

Dense masses of neutrophils Signup and view all the answers

How does a periapical abscess typically present when pus tracks palatally?

As a palatal abscess Signup and view all the answers

Which systemic manifestations may occur with an acute periapical abscess?

Fever and lymphadenitis Signup and view all the answers

What can happen to abscesses related to anterior maxillary teeth?

They may perforate bone above the attachment of the levator anguli oris muscle. Signup and view all the answers

Which space may be involved when abscesses related to mandibular premolars or molars perforate the lingual plate of mandible?

Sublingual space Signup and view all the answers

What is a common treatment for an abscess related to a maxillary tooth?

Administration of antibiotics and drainage Signup and view all the answers

Which statement correctly describes cellulitis?

It is a diffuse inflammation of soft tissues. Signup and view all the answers

What are common symptoms associated with cellulitis?

Trismus, malaise, and elevated temperature Signup and view all the answers

What is a common cause of Ludwig's angina?

Infection from maxillary anterior teeth Signup and view all the answers

What complication can result from the extension of cellulitis associated with maxillary teeth?

Cavernous sinus thrombosis Signup and view all the answers

Which of the following is a characteristic sign of cavernous sinus thrombosis?

Protrusion of the eye Signup and view all the answers

What microorganisms are commonly associated with cellulitis infections?

Veillonella sp., Porphyromonas sp., Streptococcus sp., Fusobacterium sp. Signup and view all the answers

What component does streptokinase work to break down in the body?

Hyaluronic acid Signup and view all the answers

What is the primary treatment for Ludwig's angina?

High dose intravenous antibiotics Signup and view all the answers

What does brawny induration in Ludwig's angina indicate?

Firm, board-like tissue consistency Signup and view all the answers

What type of immune cells are predominantly found in a chronic periapical abscess?

Plasma cells Signup and view all the answers

What is a common symptom of a chronic periapical abscess?

Sinus formation and salty taste Signup and view all the answers

Which of the following describes a key feature of periapical granuloma?

It is the most common type of dental abscess Signup and view all the answers

What indicates the presence of meningeal irritation in cavernous sinus thrombosis?

Severe headache and neck stiffness Signup and view all the answers

What is the primary cause of lateral granuloma?

Presence of lateral or accessory root canal opening Signup and view all the answers

What is the most common cause of osteomyelitis?

Dental infection Signup and view all the answers

Which of the following is NOT considered a cause of lateral granuloma?

Chronic tooth discoloration Signup and view all the answers

Which type of osteomyelitis is marked by the rapid destruction of bone due to a virulent bacterial strain?

Acute Suppurative Osteomyelitis Signup and view all the answers

Which clinical feature is associated with lateral granuloma?

Mild pain when biting or chewing Signup and view all the answers

What is a common early symptom of acute osteomyelitis?

Severe, throbbing, deep-seated pain Signup and view all the answers

What pathology occurs during acute osteomyelitis involving bone marrow?

Spread of exudate along marrow spaces Signup and view all the answers

What is a common radiographical feature of a lateral granuloma?

Well-defined rounded radiolucent area Signup and view all the answers

Which histopathological feature is found in lateral granuloma?

Epithelial rests of Malassez Signup and view all the answers

What demographic is often more affected by acute osteomyelitis?

Adult males Signup and view all the answers

What is a significant predisposing factor for developing osteomyelitis?

Malnutrition Signup and view all the answers

What is an expected complication of a periapical granuloma?

Development of periapical cysts Signup and view all the answers

What is typically seen in the granulation tissue of a periapical granuloma?

Presence of foam cells Signup and view all the answers

What happens to blood vessels in the bone during acute osteomyelitis?

Thrombosis due to compression Signup and view all the answers

Which zone of a periapical granuloma is typically more inflamed?

Central area Signup and view all the answers

What type of treatment is commonly required for lateral granuloma?

Apicectomy with root canal treatment Signup and view all the answers

What is the main feature of diffuse sclerosing osteomyelitis?

Dense mass of sclerotic bone trabeculae Signup and view all the answers

Which age group is primarily affected by focal sclerosing osteomyelitis?

Children and young adults Signup and view all the answers

What type of radiographic appearance is typical for focal sclerosing osteomyelitis?

Localized, uniform radiodensity Signup and view all the answers

Which clinical feature is associated with chronic osteomyelitis with proliferative periostitis?

Hard bony swelling at the jaw periphery Signup and view all the answers

What histological finding is common in the pathology of chronic low-grade osteomyelitis?

Dense fibrotic marrow tissue Signup and view all the answers

What is the primary cause of bone sclerosis in diffuse sclerosing osteomyelitis?

Chronic intra-bony mild bacterial infection Signup and view all the answers

Which of the following is a clinical feature of focal sclerosing osteomyelitis?

Asymptomatic condition Signup and view all the answers

In what anatomical region is chronic osteomyelitis with proliferative periostitis most commonly found?

Mandible Signup and view all the answers

Study Notes

Disease of Periapical Tissue

Periapical area: The area surrounding the apical foramen of a dental root.
Periapical Lesions: Inflammation surrounding the apical foramen of the dental root.
Etiology of Periapical Lesions:
- Pulpitis
- Traumatic Injury
- Deep-seated restorations
- Infection through gingival crevice (periodontal diseases)
- Use of unsterilized instruments during root canal treatment
- Application of strong chemical antiseptics during root canal treatment

Periapical Periodontitis

Inflammation of the periodontal ligament (PDL) around the apical portion of the root.
Types:
- Acute periapical periodontitis
- Chronic periapical periodontitis

Acute Periapical Periodontitis

Painful inflammation of the periodontium due to trauma, irritation, or infection through the root canal.
Also called symptomatic apical periodontitis.
Tenderness on percussion, severe pain causing difficulty closing teeth.

Etiology (Causes)

Vital tooth:
- Occlusal trauma
- Wedging of foreign body
- Blow to the teeth
- Orthodontic pressure
Non-vital tooth:
- Sequelae of pulpitis
- During root canal therapy (forcing irrigating irrigants or medicaments through the apical foramen)
- Extension of obturating material
- Perforation of the root
- Overinstrumentation

Clinical Features (Symptoms)

Hot or cold substances do not cause pain
Slight extrusion of the tooth from its socket
Tenderness on mastication due to inflammatory edema in the PDL
Severe pain due to external pressure forcing edema fluid against sensitized nerve endings
Tender to percussion (preapical test).
Widening of the PDL space (radiographic feature).

Histopathological Features

Acute apical periodontitis characterized by an inflammatory reaction with engorged blood vessels and neutrophil accumulation.
This inflammation is often transient if caused by acute trauma
Progress to bone resorption if irritant not removed.
Abscess formation possible with bacterial infection(acute preapical abscess/alveolar abscess)

Treatment

Selective grinding if inflammation is due to occlusal trauma
Extraction or root canal treatment (RCT) to drain exudate.

Acute Periapical Abscess (Dentoalveolar Abscess)

An acute suppurative process in the dental periapical region.
Accumulation of acute inflammatory cells at the apex of a non-vital tooth.
Etiology:
- Infection (following pulpitis, hematogenous spread)
- Traumatic injury
- Pulp necrosis
- Mechanical/chemical manipulation in RCT
More commonly, exacerbation of a chronic infection (e.g., periapical granuloma, "phoenix abscess").

Clinical Features for Acute Periapical Abscess

History of pain (due to previous pulpitis)
Large carious cavity/filling usually present
Thermal stimulation does not cause pain (due to pulp necrosis)
Tooth extremely painful and sensitive to percussion
Tooth slightly extruded from its socket
Intense throbbing pain as pus forms
Systemic manifestations: Red and tender gingiva around the affected root, no swelling (inflammation confined within bone), lymphadenitis and fever possible

Radiographic Features

Amorphous radiolucent area with irregular faintly margined borders in the periapical area of the dental root.

Histological Features of Acute Periapical Abscess

Dense, almost solid masses of neutrophils (pus cells)
Intermingling with inflammatory exudate, cellular debris, necrotic material, bacterial colonies, or histiocytes
Dilated blood vessels in the PDL and bone marrow space
Inflammatory infiltration of the bone marrow
Resorption and degeneration of osteocytes (bone cells)

Complications of Untreated Periapical Abscess

Pus may discharge directly into the oral cavity (sinus tract).
Pus tracking palatally forming a palatal abscess
Abscesses in molar regions penetrating buccal cortical plate
Inflammatory edema and suppuration spreading into surrounding soft tissues (face, neck, cellulitis)
Abscesses may drain through skin surface.
Perforation of bone above tooth attachments, potentially leading to the eye or upper lip.
Potential discharge into the maxillary sinus
Potential involvement of sublingual, submandibular, and lateral pharyngeal spaces.

Cellulitis

Diffuse inflammation of soft tissues, tending to spread through tissue spaces and fascial spaces .
Clinically: painful, swelling of involved soft tissues, malaise, elevated temperature, trismus (difficulty opening mouth), swelling due to inflammatory edema, suppuration and abscess formation.
Potential eye involvement is a serious concern (potential cavernous sinus thrombosis)
Etiology is often related to spreading infection.

Chronic Periapical Abscess

Features: May be a chronic condition or a sequela of acute infection. No acute symptoms, but tooth is felt high in socket, intraoral sinus formation, possible salty taste.
Microscopically: Pus cavity with chronic inflammatory cells, lymphocytes, plasma cells, macrophages; fibrous tissue and capillaries are present; a fibrous capsule at the periphery

Periapical Granuloma

Localized granulation tissue mass surrounding the apical foramen of a non-vital tooth; most common periapical lesion.
Resulting from pulp death and diffusion of bacterial toxins from root canals into surrounding periradicular tissue (through apical and lateral canals).
Possible presence of lateral/accessory root canals leading to lateral granuloma
Treatment typically involves apicectomy and root canal treatment.

Chronic Periapical Periodontitis

Occurs as a result of pulp death; diffusion of bacterial toxins from the root canals into the surrounding periradicular tissue occurs through apical and lateral canals.
Most common periapical lesion.
Chronic periapical inflammation characterized by granulation tissue.

Osteomyelitis

Acute or chronic inflammatory process in bone marrow spaces or cortical surfaces; usually bacterial infection.
Classification includes acute suppurative, chronic suppurative, chronic low-grade (sclerosing), focal sclerosing, and proliferative periostitis.
Etiology includes dental infection, jaw fracture, or hematogenous spread.
Predisposing factors include radiation damage, Paget's disease, osteoporosis, and systemic diseases (e.g., malnutrition, acute leukemia, uncontrolled diabetes, sickle cell anemia, chronic alcoholism).
Acute osteomyelitis: Rapidly destructive inflammatory process; virulent bacterial strains commonly cause acute spreading of inflammatory process through medullary spaces in bone
Acute osteomyelitis pathogenesis, pathology: inflammation, exudate spread, vascular thrombosis, necrosis, bacterial pus-filled pockets, lifting of periosteum (worsening necrosis) and osteoclastic activity (bone resorption).

Chronic Osteomyelitis

Often a sequella of acute osteomyelitis.
Characterized by a persistent low-grade infection, bone destruction, and granulation tissue formation, with little suppuration.
Local bone sclerosis is more likely than in acute osteomyeliti.s and it is less likely to cause rapid spread of infectious agents
Common sites are posterior mandible, and the disease process is characterized by low-grade pain, bad taste from pus, swelling with increased pain and discharge , along with increased mobility of affected teeth in some cases.

Diffuse Sclerosing Osteomyelitis

Chronic low-grade inflammation of bone
Occurs as a response to a low-grade stimulus
Pathogenesis; bacterial infection causing formation of a mass of chronically inflamed granulation tissue, which then results in sclerosis of surrounding bone with dense bone trabeculae and fibrotic marrow tissue (infiltrated by a small number of lymphocytes and plasma cells).
Clinical features; usually asymptomatic adults, commonly involves the mandible

Focal Sclerosing Osteomyelitis

Focal bony reaction to low-grade periapical infections or pulpal inflammation
Primarily affects children and young adults
Usually asymptomatic
Radiographically, often associated with a narrowed periodontal space or periapical area , which is denser then the surrounding bone
Pathology; characterized by a dense mass of sclerotic bone trabeculae, scanty fibrotic marrow tissue, with an infiltration of a small number of lymphocytes and plasma cells.

Chronic Osteomyelitis with Proliferative Periostitis (Garré's)

Characterized by hard bony swelling around the jaw, often at the periphery
Essentially periosteal osteosclerosis with reactive vital bone expanding the surface of affected bone
Primarily children and young adults
Radiographically shows duplication of the hard cortex - known as onion skin appearance
Histologically, shows a supra-cortical but subperiosteal mass of parallel layers comprised of reactive new bone or osteoid. Connective tissue usually fibrous, with occasional lymphocycte and plasma cells patches.

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Description

This quiz explores diseases affecting the periapical tissues, including definitions and types of periapical lesions and periodontitis. It discusses the etiology behind these conditions and symptoms associated with acute periapical periodontitis. Test your knowledge of dental health and terminology in this specialized area!