Oral Pathology Complications of Suppuration

ACUTE APICAL INFLAMMATION

First structure that will be affected is the apical periodontal ligament

ACUTE APICAL ABSCESS

Accumulation of pus in apical periodontal membrane

Tooth is very sore and continuous pulsating pain, slightly extruded from its socket

Apical abscess

Filled with neutrophils: they are the “hallmark” of acute inflammation

Percussion

test for the integrity of the supporting structure

CHRONIC APICAL PERIODONTITIS (CAP)

Chronic conditions are reactions to a long-standing irritation (dental caries, necrosis, pulpitis) with more or less successful attempts to repair

Low Virulence of the Bacteria

High Body Resistance

Presence of Drainage

FACTORS THAT CAN BRING ABOUT CHRONIC CONDITIONS

Dental Granuloma

Radicular Cyst

Chronic Periapical Abscess

TYPES OF CHRONIC APICAL PERIODONTITIS (CAP)

PERIAPICAL GRANULOMA

Localized mass of chronic granulation tissue formed in response to a mild irritation or infection

PERIAPICAL/RADICULAR CYST

Part two of periapical granuloma

Considered as a TRUE CYST because it consists of a pathological cavity lined by epithelium and is often-fluid filled

RCT

Extraction

Enucleation

Marsupialization

Apicoectomy

TREATMENT FOR CAP

Enucleation

Surgical procedure that completely removes the lesion

Marsupialization

Creating a surgical winding keeping it open until the lesion shrinks

Apicoectomy

Cutting the apical third/apex of the tooth

Gumboil

Other term is PARULIS

Accumulation of pus in the gingival tissue. May be periodontal or pulpal

Fistula

The result of an abscess burrowing its way towards the surface in an attempt to drain itself

Follows the path of least resistance through bone (basal bone) and soft tissue

Palatal Abscess

Abscess related to the palatal root of maxillary molars

Sinusitis

Abscess related to posterior maxillary teeth are very close to the floor of the maxillary sinus à pus discharge into the sinus leading to

OSTEOMYELITIS

Inflammation/infection of medullary portion of the bone induced by pyogenic microorganisms

Sequestrum

pieces of dead bone

Involucrum

zone of granulation tissue separating dead bone from normal bone

SUBACUTE OSTEOMYELITIS

Condition somewhat in between acute and chronic osteomyelitis with relatively moderate symptoms

Transitional stage within the time frame of AO corresponding to the 3rd and 4th week after onset of symptoms

Number of Pathogens

Virulence of pathogens

Local and Systemic Host Immunity

Local tissue perfusion

PRIMARY FACTORS IN THE ESTABLISHMENT OF OSTEOMYELITIS

CHRONIC OSTEOMYELITIS

Between the two chunks of bone are many lymphocytes and plasma cells (chronic inflammation)

CHRONIC FOCAL SCLEROSING OSTEOMYELITIS

AKA condensing osteitis

Occurs exclusively in young people

Mandibular 1st molar with large caries

CHRONIC DIFFUSE SCLEROSING OSTEOMYELITIS

Portal of entry is through diffuse periodontal disease

Occurs mostly in older people

GARRE’S OSTEOMYELITIS

Focal overgrowth of the outer surface of the bone cortex

Radiograph: onion-skin appearance

CELLULITIS

Also known as phlegmon

Diffuse inflammation of soft tissue

may become facial abscess with pointing

20-minute warm compress

UNDER CELLULITIS

LUDWIG’S ANGINA

Described by Frederick Wilhelm Von Ludwig (1963)

Topazian: bilateral cellulitis of the submandibular, sublingual, and submental areas

Archer: acute, rapid, septic, diffused inflammation induration, wooden hardness, bilateral swelling of the floor of the mouth and neck

Bilateral swelling of the submandibular, sublingual, and submental spaces

CAVERNOUS SINUS THROMBOSIS

Formation of thrombus in the cavernous sinus or its communicating branches

Usually affects the maxillary canine

Submandibular

Sublingual

Submental

Bilateral swelling, 3 spaces sakop ng Ludwig’s Angina

Doughy to indurated

Texture to palpation of Cellulitis

None

Presence of pus of cellulitis?

Fluctuant

Texture to palpation of Abscess

Yes

Presence of pus of abscess?

Parulis

Other term for GUMBOIL