2 | Periapical Inflammatory Lesions and Bone Conditions

Comprehensive practice flashcards covering periapical inflammatory lesions, pericoronitis, osteomyelitis, and necrotic bone conditions based on lecture notes.

Periapical inflammatory lesion

A local response of the bone around the apex of a tooth arising from necrosis of the pulp or destruction of periapical tissues by extensive periodontal disease.

Apical periodontitis

An inflammatory reaction in the periapical periodontal ligament and surrounding bone caused by toxic metabolites exiting the root apex.

Periapical Rarefying osteitis

A radiolucent presentation of a periapical inflammatory lesion characterized by bone resorption.

Periapical Sclerosing osteitis

A radiopaque presentation of a periapical inflammatory lesion characterized by increased bone formation.

Condensing osteitis

A synonym for radiopaque presentations of periapical inflammatory lesions, such as focal sclerosing osteitis.

Parulis

A fistula in the oral cavity through which a periapical abscess may spontaneously drain to relieve acute pain.

Lytic changes

Radiolucent findings in bone that indicate the destruction of mineralized tissue.

Epicenter

The central point of a lesion; for periapical inflammatory lesions, it typically remains in the vicinity of the tooth apex.

Accessory pulpal canals

Variations in root anatomy that may cause a periapical inflammatory lesion to be centered away from the tooth apex.

Widening of the periodontal ligament space

The earliest detectable radiographic change in a periapical inflammatory lesion, resulting from the loss of bone density at the apex.

Pericoronitis

Inflammation of the tissues surrounding the crown of a partially erupted tooth, most common in mandibular third molars.

Operculitis

A synonym for pericoronitis.

Trismus

A common clinical presentation of pericoronitis in lower third molars characterized by a restricted ability to open the mouth.

Ulcerated operculum

The soft tissue flap over a partially erupted tooth that is usually the primary source of pain in pericoronitis.

Follicular space in mandibular third molar region

The area centered on the crown of an embedded tooth where radiographic changes of pericoronitis typically originate.

Osteomyelitis

An inflammation of bone that can spread to involve the marrow, cortex, cancellous portion, and periosteum.

Sequestrum / sequestra

A segment of bone that has become necrotic due to ischemic injury caused by an inflammatory process; considered the hallmark of osteomyelitis.

Garré’s osteomyelitis

A form of osteomyelitis characterized by an exuberant periosteal response to inflammation, also known as proliferative periostitis.

Diffuse sclerosing osteomyelitis

A chronic form of osteomyelitis characterized by a pronounced sclerotic response and increased bone formation.

Periostitis ossificans

A synonym for Garré’s osteomyelitis or proliferative periostitis.

Acute suppurative osteomyelitis

A synonym for the acute phase of osteomyelitis, often caused by pyogenic organisms.

Medullary spaces

The internal bone cavities that contain inflammatory infiltrates, such as neutrophils, during the acute phase of osteomyelitis.

Hematogenous spread

The spread of infection through the bloodstream, identified as one potential source of acute osteomyelitis.

Paresthesia of the lower lip

A clinical sign of acute osteomyelitis involving the third division of the fifth cranial nerve distribution.

Technetium bone scan

A nuclear medicine study where a positive result indicates increased bone metabolic activity.

Gallium citrate scan

A nuclear medicine study where a positive result indicates an inflammatory cell infiltrate.

Chronic Recurrent Multifocal Osteomyelitis (CRMO)

A nonpurulent osteomyelitis condition commonly affecting children, characterized by bone pain and negative microbiologic cultures.

SAPHO syndrome

A clinical acronym for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis.

Synovitis

The term for inflammatory arthritis represented by the ‘S’ in the SAPHO syndrome acronym.

Hyperostosis

A clinical feature of SAPHO syndrome referring to acquired bone overgrowth.

Onion skin

A radiographic appearance of periosteal new bone forming in layers, often seen in chronic osteomyelitis.

Fibrous dysplasia

A benign bone disorder where normal bone is replaced by fibrous tissue, which may be confused radiographically with sclerotic chronic osteomyelitis.

Paget’s disease

A skeletal disorder affecting the entire mandate that lacks the periosteal new bone formation and sequestra seen in osteomyelitis.

Osteosarcoma

A malignant tumor that may show a spiculated ‘sunray-like’ periosteal response, used as a differential diagnosis for chronic osteomyelitis.

Sequestrectomy

A surgical procedure involving the removal of a sequestrum to manage chronic osteomyelitis.

Decortication

A surgical management option for chronic osteomyelitis that involves removing the outer layer of the bone.

Osteoradionecrosis

An inflammatory bone condition developing after therapeutic radiation exposure, diagnosed when exposed bone persists for at least three months.

Therapeutic radiation threshold

Radiation doses exceeding $50\,\text{Gy}$ are usually required to cause the irreversible damage seen in osteoradionecrosis.

Hypocelluar and hypovascular

The state of irradiated bone that lacks sufficient cells and blood supply, creating a hypoxic environment that impairs healing.

Hypoxic environment

A low-oxygen state in irradiated bone that is a primary factor in the development of osteoradionecrosis.

Bisphosphonates

Synthetic pyrophosphate analogs that inhibit osteoclasts and reduce bone metabolism.

Pyrophosphate analogs

The chemical classification of bisphosphonates used to treat conditions like osteoporosis and metastatic bone tumors.

Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ)

A complication of bisphosphonate therapy resulting in exposed necrotic bone, typically following invasive dental procedures.

Aminobisphosphonates

Intravenous medications that are most commonly associated with the development of BRONJ.

Multiple myeloma

A bone marrow malignancy treated with bisphosphonates that can increase the risk of BRONJ.

Hypercalcemia of malignancy

An elective condition involving high blood calcium due to cancer, frequently treated with bisphosphonates.

Mandibular predilection in BRONJ

BRONJ affects the posterior mandible in approximately $60\%$ of cases.

Maxillary involvement in BRONJ

BRONJ affects the maxilla in approximately $40\%$ of cases.

Bisphosphonate persistence

The duration these drugs remain in the bone, which can be up to $12\,\text{years}$.

Sclerotic radiographic appearance

A bone pattern showing increased radiopacity, often found in chronic forms of osteomyelitis and BRONJ.