Pulpal Diseases Question And Answers

Oral Medicine Pulpal Diseases Important Notes

1. Periapical granuloma

• Many cases are usually asymptomatic
• Some may complain of mild pain on biting/ chewing solid food
• The tooth may be slightly elongated in the socket
• Histologically it mainly composed of macrophages, lymphocytes, and plasma cells
• Less frequently contains mast cells and eosinophils

2. Condensing ostetitis

• It shows radiopacity which is not attached to the tooth
• Lamina dura is intact
• Periodontal space is widened
• The tooth may be vital or nonvital

3. Chronic hyperplastic pulpitis

• It is the excessive, exuberant proliferation of chronically inflamed pulp tissue
• Occurs in children and young adults
• Commonly involves large, open carious lesions
• Teeth commonly involved are deciduous molars and first permanent molars

4. Osteomyelitis

• Acute osteomyelitis do not show any radiographic changes in the early stages
• Later diffuse lytic changes appear in the bone
• Individual trabeculae become fuzzy
• Indistinct and radiolucent areas begin to appear
• Chronic osteomyelitis gives a mottled appearance in the early stages
• Established cases give a moth-eaten appearance due to the enlargement of medullary spaces and widening of Volk- Mann’s canal

Read And Learn More: Oral Medicine Question and Answers

5. Streptococcus

• It is a potent producer of hyaluronidase
• This dissolves hyaluronic acid and helps in the spread of infection
• Staphylococcus are not potent producers of hyaluronidase, thus they remain localized and do not spread infection

Oral Medicine Pulpal Diseases Short Essays

Question 1. Periapical abscess.

Answer:

Periapical abscess

It can be defined as a localized acute or chronic suppurative infection in the periapical region of a tooth.

Periapical abscess Etiology:

• Extension of pulpal infection into periapical tissue
• Fracture of the tooth with pulp exposure
• Accidental perforation of the apical foramen during root canal treatment
• Extension of periodontal infection into the periapical tissues
• Anachoretic infection of the periapical tissues

Periapical abscess Clinical Features:

• Acute abscess produces severe pain in the affected tooth
• There will be localized swelling and an erythematous change in the overlying mucosa
• The pain aggravates during percussion and when pressure is applied
• It causes extrusion of the tooth from its socket
• The associated tooth is non-vital and sometimes it can be mobile also
• The affected area of the jaw may be tendered on palpation
• The application of heat intensifies the pain
• Pus discharging sinus often develops
• A chronic periapical abscess often produces dull pain

Periapical abscess Complications:

• Space infections
• Septicaemia
• Ludwig’s angina
• Cavernous sinus thrombosis
• Osteomyelitis

Periapical abscess Radiographic Features:

• Widening of periodontal ligament space
• There is a loss of lamina dura
• An area of diffuse periapical rarefaction is seen
• Margins vary from well-defined to poor defined
• In advanced cases, the trabeculae are destroyed
• Radiolucency may involve adjacent tooth
• Osteitis can occur at the side of the root
• Maxillary posterior teeth may lead to the destruction of a portion of the antral floor
• Roots of the affected teeth may show resorption

Periapical abscess Management:

• Emergency opening of the pulp chamber through passing file into the periapical region
• Through and through the drain is placed in the abscess and irrigated with a 1:1 mix of 3% H₂O₂ and normal saline solution
• Antibiotics
  • Penicillin 500 mg QID for 5 days
• Endodontic treatment
  • Root canal treatment or extraction of the offending tooth as required, is carried out in 24-48 hours.
• Warm saline mouth rinse

Question 2. Clinical features and management of acute suppurative osteomyelitis.

Answer:

• Acute suppurative osteomyelitis is a serious type of diffusely spreading acute inflammation of the bone characterized by extensive tissue necrosis.

Acute Suppurative Osteomyelitis Clinical Features:

• Age – It occurs after 30 years of age
• Sex – It is common among males
• Site – Mandible is commonly affected
• Presentation
  • It often causes severe pain
  • There is the presence of diffuse, large swelling of the jaw
  • Often there is loosening and soreness of the regional teeth with difficulty in food intake
  • Patients often complain of excessive salivation, difficulty in mouth opening, and bad breath
  • Multiple intraoral or extraoral pus discharging sinuses often develop
  • Regional lymph nodes are enlarged and tendered o Paresthesia of the lip
  • Reddening of the overlying skin or mucosa

Acute Suppurative Osteomyelitis Generalized Features:

• Fever, malaise
• Anorexia,, vomiting
• Metastatic spread of infection
• Pathologic fracture

Acute Suppurative Osteomyelitis Management:

• Incision and drainage
• It is done over the fluctuant areas under antibiotic cover
• Irrigation and debridement of the area
  • Debride any foreign bodies, necrotic tissue or sequestra
  • Irrigate the area with hydrogen peroxide and saline
• Antibiotic therapy
  • Regimen 1- Aqueous penicillin 2 million units 4 4 hourly + oxacillin 1 gm IV 4 hourly
  • Regimen 2 – Penicillin V 500 mg, 6 hourly, Dicloxacil- lin 250 mg, 4 hourly for 2 – 4 weeks
• Extraction – Extraction of the offending tooth
• Sequestrectomy – It is the removal of sequestra which are small pieces of necrotic bone that are avascular and harbor micro-organisms.

Question 3. Periapical Cemental Dysplasia.

Answer:

Periapical Cemental Dysplasia

• It is a reactive fibro-osseous lesion derived from the odontogenic cells in the periodontal ligament

Periapical Cemental Dysplasia Etiology:

• Local factors – trauma, chronic irritation
• Nutritional deficiency
• Metabolic disturbances

Periapical Cemental Dysplasia Pathogenesis:

Periapical Cemental Dysplasia Clinical Features:

• Age and Sex – It is common in women of middle age group
• Site – The mandibular anterior region is commonly affected
• Features
  • The involved tooth is vital
  • It produces pain and paresthesia in the area
  • Hypercementosis is usually associated with it

Periapical Cemental Dysplasia Radiographic Features:

• Site – It usually lies at the apex of the tooth
• Margins – Margins are well defined

Periapical Cemental Dysplasia Management:

• Maintenance phase – The patient is observed periodically
• Enucleation – It is carried out in case of larger lesions

Question 4. Internal Resorption.

Answer:

Internal Resorption

• It is a condition starting in the pulp, in which the pulp chamber or the root canals or both, of the tooth expand by resorption of the surrounding dentin

Internal Resorption Etiology:

• Inflammatory – Pulpal inflammatory hyperplasia
• Iatrogenic-pulpal treatment may stimulate odontoblast formation
• Idiopathic
• Trauma to teeth

Internal Resorption Types:

1. Internal inflammatory resorption – It occurs due to intense inflammatory reaction within the pulp tissue
2. Internal replacement resorption – In this pulpal and dentinal walls are resorbed and replaced by bone or cementum-like bone.

Internal Resorption Clinical Features:

• Age and Sex – Common in the 4th and 5th decade of life in males
• Sites – It may affect any tooth of primary as well as permanent dentition
• Symptoms – It is asymptomatic
  • The affected tooth appears pink called the “pink tooth of mummery”
  • It is due to the filling of the resorbed area by the hyperplastic pulp tissue

Internal Resorption Radiographic Features:

• Site – It is situated entirely on one side of the root
• Radiodensity – Homogenous radiolucency
• Pulp canal – There is an enlargement of the pulpal canal
• Root shape – Round, oval, inverted pear shape or irregular shape
• Margins – well defined

Internal Resorption Management:

• Root canal treatment of offending tooth
• Extraction, if perforation occurs

Oral Medicine Pulpal Diseases Short Answers

Question 1. Condensing Osteitis.

Answer:

Condensing Osteitis Clinical Features:

• Age – It occurs in young persons
• Site – The commonly affected tooth is the mandibular first molar
• Symptoms – Tooth is usually asymptomatic
  • The patient may experience pain or tenderness on percussion in rare cases

Condensing Osteitis Radiographic Features:

• Site – Periapical area of the tooth
• Margins – vary from well-defined to diffuse
• Alveolar bone – The alveolar bone may be sclerosed between two adjacent teeth
• Surrounding structures – Narrowing of the inferior dental canal

Condensing Osteitis Management:

• Root canal treatment is carried out of the affected tooth
• Extraction of the hopeless tooth can be done

Oral Medicine Pulpal Diseases Viva Voce

1. Condensing osteitis causes widening of PDL space
2. Streptococcus is a potent producer of hyaluronidase
3. Foam cells are present in periapical granuloma