Podcast Beta
Questions and Answers
What is the primary cause of periapical periodontitis?
Which of the following is NOT a common clinical finding for acute periapical periodontitis?
What is the radiographic appearance of acute periapical periodontitis?
When is the tooth responsive to vitality tests in acute periapical periodontitis?
Signup and view all the answers
What is the pathology of acute periapical periodontitis?
Signup and view all the answers
Which of the following is a rare complication of acute periapical periodontitis?
Signup and view all the answers
What is the most common symptom of chronic periapical periodontitis?
Signup and view all the answers
What is the primary goal of endodontic treatment for acute periapical periodontitis?
Signup and view all the answers
What is the radiographic feature of chronic periapical periodontitis?
Signup and view all the answers
What is the pathology of chronic periapical periodontitis?
Signup and view all the answers
What is the sequelae of chronic periapical periodontitis?
Signup and view all the answers
What is the treatment for chronic periapical periodontitis?
Signup and view all the answers
What is a periapical granuloma?
Signup and view all the answers
What is the radiographic feature of a periapical granuloma?
Signup and view all the answers
What is focal sclerosing osteitis?
Signup and view all the answers
What is the relationship between periapical granulomas and radicular cysts?
Signup and view all the answers
What is a consequence of chronic inflammation in pulpitis?
Signup and view all the answers
Which of the following is NOT an aetiological factor for pulpitis?
Signup and view all the answers
What is the primary route of access for bacteria to cause pulpitis?
Signup and view all the answers
What is the classification of pulpitis based on the extent of inflammation?
Signup and view all the answers
What is the primary cause of increased pulpal pressure in pulpitis?
Signup and view all the answers
What is the typical outcome of untreated pulpitis?
Signup and view all the answers
What is the primary factor that determines the duration of pulpitis?
Signup and view all the answers
What is the characteristic feature of neutrophils in histology?
Signup and view all the answers
What is the primary difference between reversible and irreversible pulpitis?
Signup and view all the answers
What is the treatment for irreversible pulpitis?
Signup and view all the answers
What is the feature of open pulpitis?
Signup and view all the answers
What is chronic hyperplastic pulpitis also known as?
Signup and view all the answers
What is the characteristic feature of the granulation tissue in pulpal polyp?
Signup and view all the answers
What is the most common feature of acute inflammation in the pulp?
Signup and view all the answers
What is the primary factor that determines the severity of pulpitis?
Signup and view all the answers
What is the characteristic feature of a necrotic pulp in histology?
Signup and view all the answers
Study Notes
Periapical Periodontitis
- Inflammation of the periodontal ligament and surrounding tissues around the tooth apex
- Caused by:
- Spread of infection following pulp death (pulpitis)
- Extrusion of antiseptics during root canal treatment
- High filling or sudden biting on a hard object
Acute Periapical Periodontitis
- Clinical findings:
- History of pulpitis
- Tooth extrusion
- Pain and infection localized to the tooth
- Tooth not vital, unless pulpal necrosis limited to a single canal in a multirooted tooth
- Intense throbbing pain
- Abscess formation
- Spread to facial swelling
- Rarely, local lymphadenopathy or osteomyelitis
- Radiographic appearance:
- Widening of the periodontal ligament space
- No bone resorption
- Pathology:
- Acute inflammation
- Management:
- Endodontic treatment
- Extraction
- Open drainage through skin or mouth if needed
Chronic Periapical Periodontitis
- Clinical features:
- Low-grade infection
- May follow acute periapical periodontitis
- Tooth not vital, unless rare cases of pulpal necrosis in a single canal of a multirooted tooth
- Minimal symptoms
- Tender to percussion
- Radiographic appearance:
- Periapical radiolucency
- Pathology:
- Chronic inflammation (macrophages, lymphocytes, plasma cells)
- Granulation tissue
- Sequelae:
- Periapical granuloma
- Radicular cyst
- Acute exacerbation with suppuration, abscess, cellulitis, and sinus formation
- Rarely, focal sclerosing osteitis
Periapical Granuloma
- Clinical features:
- Most asymptomatic
- May have history of pulpitis
- Can be symptomatic with coexisting pulpitis
- Tooth not vital, unless pulpal necrosis limited to a single canal in a multirooted tooth
- Radiographic features:
- Loss of apical lamina dura
- Bone resorption with radiolucency (circumscribed or ill-defined)
- Size: Small (2cm) or large (may be radicular cysts)
- Root resorption rare
- Not to be confused with:
- Granulomatous inflammation
- Reaction:
- Defensive reaction
- Secondary to bacterial presence in the root canal and spread of toxins into the apical zone
- 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
- Surrounding fibrous wall
- Bone resorption
- Tooth resorption (rare)
- Can result in apical scars:
- Pericapical inflammatory lesions may heal with dense fibrous tissue instead of normal bone
Radicular Cyst
- Definition:
- An epithelial-lined cavity
- Relationship with periapical granuloma:
- Result of reactive proliferation of cell rests of Malassez (epithelial remnants from tooth development) in response to inflammation
- Can develop from periapical granuloma
Focal Sclerosing Osteitis
- Definition:
- Abnormal bone growth and lesions resulting from tooth inflammation or infection
- Can cause harder, denser bones
- Location:
- Most common in lower premolar and molar areas
- Localized pain, usually uniform bone sclerosis
- Radiographic appearance:
- No radiolucent border
- Treatment:
- RCT or tooth extraction (85% of cases resolve)
- Potential residual area of condensing osteitis (bone scar)
Acute Inflammation
- 3 outcomes: complete resolution, healing by connective tissue replacement, or progression to chronic inflammation
Chronic Inflammation
- Occurs due to a prolonged response to persistent stimuli
- Involves 3 cells: lymphocytes, plasma cells, and macrophages
Pulpitis
- Inflammation of the pulp
- 3 aetiological factors: microbial, thermal, and chemical
- Microbial aetiology: bacteria damage the pulp through toxins or direct extension into the pulp chamber
- Access to the pulp chamber is gained through: carious cavitation, attrition/abrasion/erosion, fracture, perio-endo lesion, or iatrogenic means
Classification of Pulpitis
- 5 classifications: acute or chronic, reversible or irreversible, open or closed, subtotal or generalised, and sterile or infected
Pulp Chamber
- Enclosed in dental hard tissue
- Blood supply is through the mature apical foramen
Increased Pulpal Pressure
- Caused by oedema
- 3 stages: venous stasis, ischemia, and necrosis
Outcome of Pulpitis
- Usually results in pulp necrosis with periapical periodontitis
Factors Influencing Healing
- 4 local factors: blood supply, degree of infection, persistent irritation, and mobility
- 3 systemic factors: age, nutrition, and pre-existing medical conditions
- 3 host factors: pulpal anatomy, apical blood flow, and pre-existing state of pulp
Features of Inflammation
- Acute inflammation: initial constriction then dilation of vessels, increased blood flow, formation of exudate, neutrophils, oedema, destruction of odontoblasts, variable necrosis, and variable abscess formation
- Chronic inflammation: presence of lymphocytes, plasma cells, and macrophages, and variable necrosis
Identification in Histology
- Neutrophils: multi-lobed nuclei
- Necrotic pulp: very blue
Symptoms of Pulpitis
- Pain: poorly localised, not provoked by pressure to surface of the tooth, and can be felt in upper or lower jaw and occasionally the ear
Reversible vs. Irreversible Pulpitis
- Reversible: pain subsides on removal of stimulus, hypersensitive to hot and cold, positive response to vitality testing
- Irreversible: persistent and spontaneous pain, reduced or no response to vitality testing
Treatment
- Reversible pulpitis: removal of local irritant
- Irreversible pulpitis: tooth extraction or root canal treatment
Open vs. Closed Pulpitis
- Most pulpitis are closed
- Open pulpitis: pulp survives chronically inflamed beneath a large exposure, despite heavy infection, often associated with open apices in children
Chronic Hyperplastic Pulpitis
- Also known as pulpal polyp
- Caused by large carious exposure of pulp, leading to chronic inflammation and hyperplastic granulation tissue that extrudes from the pulp chamber
- Features of granulation tissue: loose, oedematous, and many new blood vessels, surface may be covered with stratified squamous epithelium
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the causes and symptoms of periapical periodontitis, including inflammation of the periodontal ligament and surrounding tissues around the tooth apex, as well as its clinical findings such as tooth extrusion and pain.
