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Pulpal & periapical diseases

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Pulpal & periapical diseases

  1. 1. Vivek Narayan Oral Medicine and Radiology
  2. 2.  It is a microbial disease of the calcified tissues of the tooth (enamel & dentin), characterized by the demineralization of the inorganic components and the dissolution of the organic components of the tooth. Dental caries
  3. 3.  Pulpitis is defined as the inflammation of the dental pulp Pulpitis ??? PULPITIS ACUTE REVERSIBLE IRREVERSIBLE CHRONIC CHRONIC HYPERPLASTIC PULPITIS
  4. 4. PULPITIS Mechanical Thermal Chemical Microbial Etiology
  5. 5.  Clinical features  Shorter duration.  Sensitivity to cold temperatures.  Mild or moderate pain.  Pain is relieved on removal of the stimulus.  Tests positive for EPT at low current.  Minimal inflammation. Treatment  Removal of the irritant.  Removal of caries and restoration of the tooth.  Replacement of any defective fillings.  Analgesics and anti-inflammatories for the pain. Acute pulpitis – Reversible pulpitis
  6. 6.  Clinical features  Shorter duration.  Pain is severe & spontaneous sometimes.  Pain aggravated by extremes of temperature.  Pain is not relieved even after removal of the stimulus.  Radiating pain.  Pain is also aggravated in supine position – ‘nocturnal pain’.  Severe inflammation. Treatment  Same as reversible pulpitis. Acute pulpitis – Irreversible pulpitis
  7. 7.  Clinical features  Symptoms are milder than the acute form.  Pain is dull & continuous in nature.  EPT threshold is increased.  Presence of a large carious lesion majority of the time. Treatment  Root canal therapy.  Extraction. Chronic pulpitis
  8. 8.  Excessive & exuberant proliferation of the dental pulp as a result of chronic inflammation. Clinical features  Occurs mostly in children & young adults.  Large carious lesions.  Appears as pinkish red mass protruding out of the carious tooth.  May or may not bleed when probed.  Deciduous & first permanent molars are frequently affected. Treatment  Extraction of the affected teeth. Chronic hyperplastic pulpitis (pulp polyp)
  9. 9.  Spread of infection to the apical periodontal ligament region. Clinical features  Acute or chronic.  Mild pain while chewing.  Pain on percussion and on periapical palpation.  Tooth feels slightly elevated due to inflammation & edema in the apical region. Radiographic features  Loss of lamina dura in the periapical region.  Widened periodontal ligament space. Treatment  Endodontic treatment. Periapical periodontitis
  10. 10. It is a localized mass of granulation tissue formed at the apex. Clinical features  Asymptomatic.  Mild pain present.  Pain present while chewing.  Tooth is elevated from the socket. Radiographic features  Radiolucent area present attached to the tooth apex.  Well circumscribed & demarcated from the surrounding bone. Treatment  Extraction of the affected tooth.  Apicectomy in some cases. Periapical granuloma
  11. 11. Acute or chronic suppurative process of the periapical region of the tooth. Clinical features  Carious or a discolored tooth.  Tooth is very painful & is extruded from the socket.  Regional lymphadenitis & fever.  Chronic form generally presents with no features.  Sinus tract openings. Radiographic features  Ill defined periapical radiolucency. Treatment  Drainage of pus.  Extraction of the affected tooth.  Endodontic treatment done sometimes. Periapical abscess
  12. 12. ABSCESS Organism - staphylococcus Coagulase secretion Fibrinogen (from exudate) Fibrin Fibrin barrier Localization of pus SPREADING INFECTION Organism - streptococcus Streptokinase & hyaluronidase secretion Breakdown of hyaluronic acid (cement substance) Streptococci consumes local O₂ creates anaerobic environment Growth of anaerobes - collagenase Perforation of bone Spread of infection
  13. 13.  Infection gone beyond the alveolar bone & involves the neighbouring soft tissues as a localized form.  Pain is continuous and may be described as extreme, growing, sharp, shooting, or throbbing in nature.  Acute onset.  Localized intraoral & extraoral swelling.  Trismus.  Lymphadenitis.  Pyrexia. Dentoalveolar abscess
  14. 14.  Cellulitis Spread of infection diffusely into fascial planes of soft tissues. Cellulitis Ludwig’s angina Cavernous sinus thrombosis
  15. 15.  Clinical features  Edematous periorbital enlargement.  Canine space is infected.  Ptosis.  Induration of the swelling.  Fever, headache, nausea.  CNS spread leads to meningitis. Treatment  Surgical drainage.  High dose antibiotics.  Extraction of affected tooth.  Anticoagulants. Continued…
  16. 16. Clinical features  Chronic in nature & asymptomatic.  Mostly associated with a non vital tooth.  Swelling is present if the cyst expands by destroying bone.  Initially swelling is bony hard but later exhibits ‘egg shell’ crackling.  Due to acute exacerbation, the cyst can turn into an abscess. Radiographic features  Well circumscribed radiolucency in the periapical region.  Radiolucency surrounded by sclerotic border.  Radiolucency is bigger than that of a periapical granuloma.  Root resorption. Treatment  Extraction of the affected tooth.  Endodontic therapy.  Marsupialization. Periapical cyst (radicular cyst)
  17. 17. Caries in enamel Caries in dentin Caries in pulp - pulpitis Acute pulpitis Chronic pulpitis Acute periapical periodontitis Chronic periapical periodontitis Chronic periapical abscess Acute periapical abscess Dentoalveolar abscess Periapical granuloma Radicular cystCellulitis Sequel Of Pulpitis

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