Periapical Periodontitis and its Clinical Findings
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Questions and Answers

What is the primary cause of periapical periodontitis?

  • Inflammation of the periodontal ligament
  • Infection following death of the pulp (correct)
  • Spreading of osteomyelitis
  • Extrusion of antiseptics through the apex

    • Which of the following is NOT a common clinical finding for acute periapical periodontitis?

  • Tooth is vital and responsive to vitality tests (correct)
  • Localized pain and infection
  • Tender to touch
  • Escape of exudate into the periodontal ligament

    • What is the radiographic appearance of acute periapical periodontitis?

  • Bone resorption
  • Widening of the periodontal ligament space (correct)
  • Abscess formation
  • Osteomyelitis

    • When is the tooth responsive to vitality tests in acute periapical periodontitis?

    <p>Only when the pulpal necrosis is limited to a single canal in a multirooted tooth</p> Signup and view all the answers

    What is the pathology of acute periapical periodontitis?

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

    Which of the following is a rare complication of acute periapical periodontitis?

    <p>Osteomyelitis</p> Signup and view all the answers

    What is the most common symptom of chronic periapical periodontitis?

    <p>Minimal symptoms</p> Signup and view all the answers

    What is the primary goal of endodontic treatment for acute periapical periodontitis?

    <p>To remove the infected pulp</p> Signup and view all the answers

    What is the radiographic feature of chronic periapical periodontitis?

    <p>Radiolucency</p> Signup and view all the answers

    What is the pathology of chronic periapical periodontitis?

    <p>Chronic inflammation and granulation tissue</p> Signup and view all the answers

    What is the sequelae of chronic periapical periodontitis?

    <p>Periapical granuloma and radicular cyst</p> Signup and view all the answers

    What is the treatment for chronic periapical periodontitis?

    <p>Root canal treatment and radicular cyst enucleation</p> Signup and view all the answers

    What is a periapical granuloma?

    <p>A chronic inflammatory response to infection</p> Signup and view all the answers

    What is the radiographic feature of a periapical granuloma?

    <p>Radiolucency</p> Signup and view all the answers

    What is focal sclerosing osteitis?

    <p>Abnormal bone growth and lesions</p> Signup and view all the answers

    What is the relationship between periapical granulomas and radicular cysts?

    <p>A periapical granuloma can develop into a radicular cyst</p> Signup and view all the answers

    What is a consequence of chronic inflammation in pulpitis?

    <p>Progression to pulp necrosis</p> Signup and view all the answers

    Which of the following is NOT an aetiological factor for pulpitis?

    <p>Mechanical</p> Signup and view all the answers

    What is the primary route of access for bacteria to cause pulpitis?

    <p>Carious cavitation</p> Signup and view all the answers

    What is the classification of pulpitis based on the extent of inflammation?

    <p>Subtotal or generalised</p> Signup and view all the answers

    What is the primary cause of increased pulpal pressure in pulpitis?

    <p>Oedema</p> Signup and view all the answers

    What is the typical outcome of untreated pulpitis?

    <p>Pulp necrosis with periapical periodontitis</p> Signup and view all the answers

    What is the primary factor that determines the duration of pulpitis?

    <p>Pre-existing state of pulp</p> Signup and view all the answers

    What is the characteristic feature of neutrophils in histology?

    <p>Multi-lobed nuclei</p> Signup and view all the answers

    What is the primary difference between reversible and irreversible pulpitis?

    <p>Pain subsides on removal of the stimulus</p> Signup and view all the answers

    What is the treatment for irreversible pulpitis?

    <p>Tooth extraction or root canal treatment</p> Signup and view all the answers

    What is the feature of open pulpitis?

    <p>Pulp survives chronically inflamed beneath a large exposure</p> Signup and view all the answers

    What is chronic hyperplastic pulpitis also known as?

    <p>Pulpal polyp</p> Signup and view all the answers

    What is the characteristic feature of the granulation tissue in pulpal polyp?

    <p>Loose and oedematous with many new blood vessels</p> Signup and view all the answers

    What is the most common feature of acute inflammation in the pulp?

    <p>Initial constriction then dilation of vessels</p> Signup and view all the answers

    What is the primary factor that determines the severity of pulpitis?

    <p>Apical blood flow</p> Signup and view all the answers

    What is the characteristic feature of a necrotic pulp in histology?

    <p>Very blue</p> 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

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    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.

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