Periapical Abscess:
● Acute inflammatory cells (neutrophils) and purulence at apex of tooth
● infection or trauma
Periapical Granuloma:
● aka chronic apical periodontitis
● Chronically inflamed - Lymphocytes
● Non vital tooth
● Defensive rx
● Cytokines released -> destruction of bone
● 75% of apical inflammatory lesions
Periapical (radicular) Cyst:
● Stimulation of epithelium at apex of nonvital tooth
● 15% of all periapical radiolucencies
● Varants: Lateral radicular cyst, Residual cyst
● Cyst lined by stratified squamous epithelium
Rarefying Osteitis:
● Well-defined and radiolucent
● Collective of Granuloma,cyst, abscess
● Most common lesions of the jaws
● Grow slowly
● asymptomatic unless inflamed
● rarefy: to make thin or less dense.
● Radiolucent cyst -> Vitality test -> non vital -> Rarefying osteitis
Condensing Osteitis:
● Proliferative rx of bone to low grade inflammatory
● Apex of Non-vital tooth
● Bone deposition
● Tooth disease -> rarefying osteitis -> inflamtion -> condensing sclerosis
●
● TX: endo, infection resolution
○ Bone scar -> radiopaque condensed bone
Buccal Bifurcation Cyst
● Buccle of mand. 1st permanent molar
● In children -> average age of 10
● Root tipped toward lingual mandibular cortex
● same histo as DC or Radicular Cyst.
Alveolar Osteitis - inflammation in the alveolar process of the bone.
● aka Dry socket and fibrinolytic alveolitis
● Due to destruction of the initial clot or inappropriate healing
Periapical Abscess sequela:
● Spread of infection to adjacent structures
● Periapical Abscess sequela sinus tract:
○ abscess with purulence
● Periapical abscess sequel intraoral parulis:
○ gum boil
○ Exit of the sinus tract
● Periapical abscess sequela, Cutaneous parulis
○ Typically an enlarged nodular mass
○ Red lesion with other shades of yellow, white, purple
○ Drain through the skin
○
Osteomyelitis:
● acute or chronic inflammation of bone away from initial site
● Diffuse area
● Bone necrosis and sequestra
○ Sequestrum: piece of necrotic bone separating from good bone
● Cause: Tooth-related infection
○ Bacterial infection: Staph and strep
○ Decrease host resistance, decreased vascular supply to bone
● Path:
○ suppurative inflammation
○ interruption of vascular supply
○ Sequestrum and Involucrum (dead bone - sequestrum, srounded by new vital
bone
● Features
○ pain, swelling, fever, lymphadenopathy
○ Chronic: moth eaten
○
Osteomyelitis with proliferative periostitis
● Onionskin pattern
● Dental caries -> periapical inflammation -> Periostuem -> deposition of bone
● Young and mandible common
● Boney swelling but not painfull
●
Periapical Abscess sequela cellulitis:
● Soft tissue spreading
● Purulence unable to drain
● Can lead to Lugwig’s Angina and Cavernous Sinus Thrombosis
Ludwig’s Angina (abscess):
● Cellulitis of the submandibular region
● Rapid swelling that may strangel - cut air ways
● woody tongue - swelling and elevation of tongue
● Bull neck - enlargement and tenderness of the neck
Cavernous sinus Thrombosis (abscess):
● abscess of maxi. Anterior or premolar tooth
● K9 source of infection- most
