ORAD800: Inflammatory Lesions of the Jaws

Common Sources of Inflammatory Lesion

Infection from pulpal tissue

periodontal disease

tooth extraction wound

compound fractures

hematogenous spread

sterile trauma

What are the two common ways of infection from pulpal tissue?

caries

coronal fracture

Acute

recent onset

Chronic

prolonged course

Osteitis

inflammation in the bone

osteomyelitis

inflammation in the bone or bone marrow

Mediators of inflammation tip the normal bone metabolism to favor either bone ___ or ___

formation

resorption

T/F: there is radiographic evidence for acute inflammation

FALSE - clinical signs and symptoms

T/F: there is widening of the PDL space in acute inflammation

TRUE

T/F: there may be a reduction in bone radiopacity in acute inflammation

TRUE

Chronic inflammation often has increased ___ and ___

radiopacity

radiolucency

Chronic inflammation has the same __ but change in bony pattern

density

Where are inflammatory lesions often seen?

apex of the teeth

What is the periphery of inflammatory lesions?

ill defined

well-defined

long areas of transition

What is the internal structure of inflammatory lesions?

spectrum of appearances

resorption

bone formation

mixed

What are the effects of the inflammatory lesion?

widened PDL

root resorption

periosteum

Apical Periodontitis

minimal inflammatory reaction, non-vital teeth, spontaneous, edema, localized to the apical-PDL

T/F: apical periodontitis is spontaneous and non-vital teeth

TRUE

Radiographic features of apical periodontitis

widened PDL space

Thickening of the lamina dura

Apical Rarefying Osteitis

chronic inflammation, low grade rxn, low virulence, sequela of acute episodes

Rarefying

black

Radiographic features of Apical Rarefying Osteitis

radiolucent lesion

LOSS of lamina dura

margins either ill/well defined

corticated/non corticated

Which periapical Inflammatory Lesion has LOSS of the lamina dura

apical rarefying osteitis

Which periapical inflammatory lesion has THICKENIGN of the lamina dura

apical periodontitis

Sclerosing

white

Apical Sclerosing Osteitis

circumscribed proliferation of periapical bone, exudate of low toxicity, long standing infection, nonvital/degenerating pulp, mandible

Where is Apical Sclerosing Osteitis commonly found?

mandible

Apical Sclerosing Osteitis is also known as

condensing osteitis

focal sclerosing osteitis

Apical Rarefying Osteitis is also known as

chronic apical abscess

apical granuloma

apical cyst

Radiographic features of Apical Sclerosing Osteitis

increased radiopacity

well-defined margins

Osteomyelitis

inflammation of bone or bone marrow

predisposing conditions for osteomyelitis

malnutrition

diabetes

leukemia

anemia

alcoholism

What is a MAJOR predisposing factor for osteomyelitis

Hypovascularity

Which has less blood supply, mandible or maxilla?

mandible

Clinical features of osteomyelitis

pain

swelling

redness

fever

purulent discharge

Acute Osteomyelitis

severe pain

swelling/redness

lymphadenopathy

T/F: there is radiographic manifestation for acute osteomyelitis

FALSE

After 10 days, there is a decrease in __ of the trabeculae, blurred outline for acute osteomyelitis

density

Chronic Osteomyelitis

milder symptoms

low virulent agent

effective host resistance

sinus tract

intermittent exacerbation

Chronic Osteomyelitis has ___ development

sinus tract

Radiographic features of chronic osteomyelitis

radiolucency

mixed radiolucent-radiopaque

sequestration, fistula, fracture

Diffuse Sclerosing Osteomyelitis

older age

proliferation reaction

sub-periosteal bone deposition

slight jaw enlargement

Radiographic Features of Diffuse Sclerosing Osteomyelitis

mixed

ill-defined

increased sclerotic bone

does not cross midline

shortening root

Proliferative Periostitis /Garre's Osteomyelitis

younger patient

female

rare nonsuppurative type

mild infection below periosteum

inferior border of the mandible

hard bony swelling

Radiographic Features of Proliferative Periostitis

thin convex shell of bone

laminated/onion skin appearance

Osteoradionecrosis

mandible

men

history of radiation therapy

hypo vascularity

chronic hypoxia

clinical signs of inflammation

Radiographic Features of Osteoradionecrosis

similar to chronic osteomyelitis

more widespread

Pericoronitis

inflammation around the crown of a partially erupted tooth

Where is pericoronitis commonly found?

third molars

Radiographic features of pericoronitis

underlying osteitis

loss of cortical outline