Transcript Condensing osteitis - University of Minnesota

Pulp and Periapical
Chapter 3
• Also notes from biopsy techniques
Teeth are non-vital
Condensing Osteitis
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Two periapical films showing well defined radiopacity at apex of Mn 1st
molar, exibits root tip absorption and loss of lamina dura and some
widening of the PDL space. Both lesions are present on teeth with
crown or extensive caries
Differential
– Condensing osteitis--look for large carious lesion or crown
(this is correct for previous 2 radiographs)
– Idiopathic osteosclerosis (bone scar) (because the tooth is nonvital you can rule this out--Also note that the PDL space is rarely
obliterated with bone scars
– Osteoma (a smaller lesion)--look for multiple impacted
supernumerary teeth and odontomas--can tip you off to Garnders
– Periapical cemento-osseous dysplasia-- if pt. was female and
african and pulp vital! (so this can be ruled out)
– Cementoblastoma--these can be differentiated by a thin
radiolucent border and they generally show fusion to the root from
which it arose
• Treatment
– Root canal therapy
•Patient reports severe
pain to heat extremes
•Spontaneous pain
•Response to Electric pulp
test is erractic
•Onset has been about a
week
Irreversable Pulpitis
• Occlusal view and periapical radiograph of tooth #14
showing enlarged pulp and occlusal mass protruding
through the dentin
• Differential
– Irreversible pulpitis
– Periapical abcess-remember if you see a cyst at the apex it
means that a cyst was there before the abcess--abcess is
acute--it dosen’t have enough time to wear through the bone
and make a well-defined radiolucency
• Treatment
– Endo
– extraction
•Sensitive to heat
extremes
•Pain goes away when
thermal stimulus
removed
•No spontaneous pain
•Responds at lower
currents to electric
pulp testing
Reversible Pulpitis
• Differential– Reversible pulpitis
– Recurrent caries
• Treatment
– Remove agent that is causing the inflammation
Note the white
arrow
Radiograph of
same tooth
Periapical Abscess
• Tooth #3 has widened PDL on DB root, parulis (a result of
purulent drainage) has collected near the apex of the DB root
tip. No distinct radiolucency noted and pt reports acute onset
• Differential
– Scleroderma (systemic sclerosis) generalized widening of
PDL
– Sarcoma or carcinoma
• Treatment
– Root canal therapy
– If the teeth are VITAL and you see any
radioLUCENCY in the jaw you must biopsy!!
Teeth are vital
Idiopathic (focal) Osteosclerosis
• Differential
– Cemento-osseous dysplasia
– Complex odontoma
• Treatment
– None b/c it’s a radiopacity
African woman, vital teeth
Periapical cemento-osseous dysplasia
• Differential
– Complex odontoma
– Idiopathic osteosclerosis
• Treatment
– None, you don’t worry about a biopsy b/c
african and anterior MN
•Pt has history of
infected MN molar
and/or root
fracture & airway
obstruction
Ludwig’s Angina
• Swelling of the submandibular, submental and
sublingual spaces with resulting airway obstruction
• Differential
– Thyroid gland enlargement, Thyroglossal duct cyst, dermoid
cyst
• Treatment
– Aggressive use of antibiotics, drainage, in some pts may
need to perform tracheostomy
Cavernous Sinus Thrombosis
» Grave concern is raised when the infection
encroaches on the eyelid or affects vision,
because the ophthalmic (angular) veins lack
valves and spread of infection to the brain is
possible
Treatment
drainage, antibiotics, high mortality rate
Teeth are vital
Periapical cyst or Granuloma
• Loss of lamina dura around effected roots
• Differential
– Impossible to tell difference b/w cyst or granuloma from
radiograph alone--need biopsy (cysts are the result of cell
rests of Malassez being in the area of inflammation)
– Periapical scar-radiolucency will persist if scar is formed
– If on the side of root (not at apex) then lateral radicular cyst
• Treatment
– Root canal therapy with follow up to make sure the lesion
has healed
Biopsy techniques
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Get normal tissue with abnormal tissue
If surface lesion--don’t need to go too deep
If swelling or mass--the deeper the better
Don’t biopsy the middle of an ulcer
Lasso technique
Mark with sutures
Punch biopsy--5mm minimum
Include picture and differential with as much clinical
info as possible--this is very important
• Contact the pt right away with results!!
Traumatic (simple) bone cyst
• Not a true cyst; posterior mandible; asymptomatic or painless
swelling
• X-ray: well-defined unilocular radiolucency; “scalloped”
appearance in multiple teeth involvement
• Histo: fibrovascular CT & trabecular bone; cyst may be empty
• Tx: surgical exploration & tissue submission; good prognosis,
rapid new bone formation
• DD: periapical granuloma, periapical cyst, periapical cementoosseous dysplasia, periapical scar, dentin dysplasia type 1
(page 804)
Granular Cell Tumor
-no diff. diagnosis in book
-nodular mass under skin or mucosa
-tongue and buccal muscoa
-schwann cell origin or neuroendocrine cells
tx: local excision
Allergic Stomatitis –Dentifrice Stomatitis
-pseudomembranous candidiasis, morsicatio, sloughing traumatic lesion, mouthwash,
chemical burn
-burning, slight redness to brilliant erythematous lesion, edema possible, superficial
aphthous ulcerations possible, stinging tingling, *superficial epithelial sloughing
-located at site of contact
-dentifrice, medications, lip stick, metals
-tx: remove allergen, antihistamines if necessary
Angioedema
-no diff. Dx listed in book
-diffuse edematous swelling of soft tissue, nontender, solitary or multiple
-face, lips, tongue, pharynx, larynx, hands, arms, legs, genitals, buttocks
-cause: mast cell degranulation which leads to histamine release and typical IgE
hypersensitivity reaction from drugs, foods, plants, dust, heat cold, stress, complement
cascade is common in hereditary andioedema
-tx: oral antihistamines, intramuscular epi,