Infection in the Pulp and Periapical Area

Inflammation

the cellular and vascular response to tissue injury

Infection

the invasion and the proliferation of pathogenic microorganisms in the tissues

___ causes ___

Infection

Inflammation

What is the manifestation of inflammation and infection?

pain

If patient complains about pain, you take an ___ to gauge/determine the cause

x-ray

What are the main pain generating mediators?

histamine, serotonin, bradykinin, prostaglandins

Which of these mediators makes you feel pain via reducing the threshold of the nerve to fire?

prostaglandins

This lecture primarily discusses ___

infection

(instead of/as opposed to inflammation)

What are the cardinal manifestations of infection, clinically?

swelling (and pain)

T/F: swelling and pain always correlate with one another

false... usually, but not always

T/F: you can have swelling without any pain

true

Injury is caused by ___ getting to the cells and destroying them

bacteria

Injury leads to ___

inflammation

Inflammation leads to ___

endodontic infection

Endodontic Infection

the invasion and the proliferation of pathogenic microorganisms in the tissues, pulp, and root canals

Bacteria that can cause caries lesions include:

S. Mutans

Lactobacilli

Bacteria that cause caries lesions do so by disintegrating ___ and invading the ___

enamel

dentin

There are a litany of bacteria found in infected ___

root canals

ex: S. Mutans, lactobacilli, fusobacterium, treponema, propionibacterium, etc.

There are several pathways of bacteria into the dental pulp:

PDL fibers

lateral pulp

thru killing odontoblast cells

5-10 micron cracks within tooth structure

Cracked teeth (do/do not) often come up on x-rays

do not

unless the crack is huge

A crack on a tooth can extend all the way down to the ___

pulp

= easy access route for bacteria

From the pulp, bacteria can head all the way down to the ___

apex

What is pulp?

connective tissue that is specialized in the fact that it can create dentin via its embedded odontoblasts

The invasion of pathogens into the dental pulp and root canal causes ___

infection

Infection causes inflammation with the release of ...

mediators like histamine, serotonin, bradykinin, prostaglandins, nitric oxide

Inflammation is essentially the ___ of cells

breaking down

The release of mediators results in ...

pain, pulp tissue necrosis, bone destruction

If a tooth is infected, the body is going to try to get rid of the infected tooth... if the body cannot do this, the infection can spread ___

systemically

Systemically?

can now affect the entire body and can even be lethal

___ relieve pain by clearing the bacterial cause of it, but they are not implicitly analgesic

Antibiotics

What does LPS endotoxin do to pulp?

destroys it

this was shown by an experiment

What did the experiment prove?

that pulp can be infected through (travel thru) the dentin

Another review, the S. Kakehashi study, proved that ...

bacterial presence/infection causes pulp to become necrotic

germ-free rats had no caries, while normal rats had caries

Periapical Lesion

a lesion that is located around the apex of the tooth

What can accumulate at lesion sites, such as at the periapical?

leukoyctes (and macrophages)

What is accumulation of leukocytes (and macrophages) called?

abscess

T/F: patients with periapical abscess may not feel pain in the periapical region, but may near the cervix of the crown

true

nerves of the periapical region may be dead

Areas of periapical lesion appear red due to ...

increased blood flow to the area

Blood flow is due to the body wanting to ...

bring more cells to the area

Why?

so that infection of the area can be better cleared/treated

Enzymes and mineral-dissolving acid produced by activated ___ will start resorbing bone

osteoclasts

Where may osteoclasts be activated, one he case of infection/inflammation?

near the apex

and elsewhere, too, but this region is highlighted as being particularly bony and correlatively influential for tooth health

Activated osteoclasts will begin synthesizing bone digesting ___ and mineral dissolving ___

enzymes

acid

Bacteria themselves produce ... that may cause damage

proteolytic enzymes

organic acids

LPS (and other endotoxins)

The periapical area is the ___ of bone that shows up as ___ area on an X-ray

resorption

radiolucent

As aforementioned, root canal infections involve bacteria on the ___

canal surfaces

Disinfection of the internal contaminated surface of the root canal can be done in two ways:

mechanical

chemical

Mechanical

via endodontic files

Chemical

via sodium hypochlorite

or

via EDTA

When disinfecting internal contaminated surface of the root canal, you need to clean ___ all the way to the ___

dentinal tubules

pulp

These chemical means are bacterial ___, but you need to be careful not to insert the associated needle too deep... why?

killers

these can kill systemic cells, too... you need to get rid of the first layer of tooth that is infected, not the rest of the tooth/beyond

Obturation

process of filling/sealing a root canal

How do you pack sealant into a root canaled tooth?

condensation

Two types of condensation:

lateral

vertical

Why is sealing the root canal system necessary?

to prevent recontamination

Why is a root canal, in general, necessary?

to remove infected pulp tissue and infected dentin

this is necessary for healing

What can happen if there is no healing?

pathogenic microorganisms can spread from the pulp, killing the nerves of the tooth, into the periapical area and beyond (to rest of system)

primary (chronic) periradicular disease agents

• Pseudoramibacter

• Treponema

• Dialister

• Prevotella

• Porphyromonas

• Fusobacterium

• Peptostreptococcus

• Campylobacter

• Filifactor alocis

primary (acute) periradicular disease agents

• Treponema

• Porphyromonas

• Prevotella

• Dialister

• Fusobacterium

• Propionibacterium

• Streptococus

• Peptostreptococcus

secondary/persistent infection agents

• Enterococcus

• Pseudoramibacter

• Propionibacterium

• Dialister

• Streptococcus

• Treponema

• Candida