MOD 1 PT 2

Suppurative process of the periapical region of a tooth, which is a relatively common disorder of dogs and cats.

PERIAPICAL Abscess

Synonyms: Periradicular abscess, tooth root abscess

PERIAPICAL Abscess

PERIAPICAL Abscess - RISK FACTORS

• Dental Trauma (Infective, Mechanical,
  Thermal, Chemical)

• Endodontic and periapical disease

• Periodontal disease

PERIAPICAL Abscess - PERIAPICAL Abscess

PERIAPICAL Abscess

PERIAPICAL Abscess - DISEASE FORMS

1. acute

2. chronic

• Visible swelling due to the physical
  presence of the abscess

• Owner notices discolored or fractured
  tooth

• With acute abscess, Owner may notice
  anorexia or a reluctance to eat

PERIAPICAL Abscess

presents no clinical signs

Chronic periapical abscess

• Fractures and/or discolored tooth
  crowns

• Severe Periodontal disease

• Draining Tracts

PERIAPICAL Abscess

• The primary cause is ____
  resulting in irreversible pulpitis and
  pulp necrosis

PERIAPICAL ABSCESS

dental trauma

PERIAPICAL Abscess - DIFFERENTIAL DIAGNOSIS

• Periapical granuloma

• Periapical bone lysis

• Periapical Cyst

• Osteomyelitis

PERIAPICAL Abscess - INITIAL DATABASE

• CBC, Serum Biochemistry, Urinalysis:
  Unremarkable; Used for preoperation

• Meticulous oral examination under
  general anesthesia to identify teeth
  with pulpal lesions (Fractured teeth,
  often with pulp exposure; discolored
  teeth, caries, drainage tracts)

PERIAPICAL Abscess

CONFIRMATORY TESTING

• Dental Radiography

  • Acute Abscess may show only mild
    widening of apical periodontal
    space

  • Chronic Abscess is associated with
    bone destruction around the apex
    of the tooth; resorption of the most
    apical portion of the tooth root may
    be present

PERIAPICAL Abscess - tx

• Extraction or Endodontic therapy (Total
  pulpectomy and root canal filling)

• Endodontic therapy may need to be
  staged (performed in several sessions)

• Concurrent systemic antibiotic
  treatment; Use alone is NOT
  appropriate treatment

• Analgesic Treatment

• Monitor teeth at risk for pulpal disease

prognosis - PERIAPICAL Abscess

• Excellent if therapeutic goals are
  achieved

nonspecific clinical descriptive term referring to a local, exophytic
growth on the gingiva.

EPULIDES

EPULIDES - distribution

Mostly Peripheral
Odontogenic Fibroma (POF)

EPULIDES - breeds

Acanthomatous ameloblastoma
more commonly diagnosed in Shetland
sheepdogs

Peripheral
Odontogenic Fibroma (POF)

> 5 yrs old

Acanthomatous ameloblastoma

> 7 yrs old

EPULIDES

DISEASE FORMS/SUBTYPES

• PERIPHERAL ODONTOGENIC FIBROMA

• GIANT CELL GRANULOMA

• ACANTHOMATOUS AMELOBLASTOMA

• Slow growth: gingiva-like

• Fibroblast main component in mass

• Recurrence can happen but takes time

PERIPHERAL ODONTOGENIC FIBROMA

• Rapid Growth: Inflammatory and
  ulcerative changes

• Multinuclead giant cell is main
  component in mass

• Rapid Recurrence after incomplete
  excision

GIANT CELL GRANULOMA

• Soft, Reddish Purple

• Ulcerated and inflamed

GIANT CELL GRANULOMA

• Rapid growth; Cauliflower-like

• Basal cell is main component in mass

ACANTHOMATOUS AMELOBLASTOMA

• Mixed or Mesenchymal odontogenic
  tumor

• Arising from cells in the periodontal
  ligament

PERIPHERAL ODONTOGENIC FIBROMA

• Variant of the peripheral odontogenic
  fibroma; Origin remains unknown

GIANT CELL GRANULOMA

• Epithelial odontogenic tumor

• Debatable wheteher arising from
  epithelial rests of Malassez in
  periodontal ligament or epithelial rests
  of Serres in gingival connective tissue

ACANTHOMATOUS AMELOBLASTOMA

Not invasive; changes in alveolar
bone is unlikely

PERIPHERAL ODONTOGENIC FIBROMA

Invasive; changes to alveolar
bone is visible on dental radiographs

ACANTHOMATOUS AMELOBLASTOMA

ACANTHOMATOUS AMELOBLASTOMA

ACANTHOMATOUS AMELOBLASTOMA

Gingival excision with
conservative margins; extraction of
associated tooth, and curettage if
the alveolar socket

PERIPHERAL ODONTOGENIC FIBROMA

Considered for
nonresectable mass, incomplete
resections, and recurrent tumors

Radiation Therapy

causes cellular death after
controlled freezing and thawing of
tumor

Cryosurgery

Acute or chronic inflammation of the esophagus, classically secondary to gastric acid (often
due to reflux or persistent vomiting), foreign bodies, or medications

ESOPHAGITIS

• ___dogs may be prone to
  hiatal hernia, which can cause reflux
  esophagitis

brachycephalic