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PERIAPICAL ABSCESS

ORAL PATHOLOGY LECTURE 6. PERIAPICAL ABSCESS. PERIAPICAL ABSCESS. IS A TYPE ON INFLAMMATORY REACTION WHICH USUALLY PRECEDES PULP NECROSIS AN ACUTE EXTENSION OF THE INFLAMMATORY REACTION OF A NECROTIC PULP OPPOSITE TO PERIAPICAL CYST OR GRANULOMA WHICH IS OF CHRONIC CONDITION.

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PERIAPICAL ABSCESS

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  1. ORAL PATHOLOGY LECTURE 6 PERIAPICAL ABSCESS

  2. PERIAPICAL ABSCESS • IS A TYPE ON INFLAMMATORY REACTION WHICH USUALLY PRECEDES PULP NECROSIS • AN ACUTE EXTENSION OF THE INFLAMMATORY REACTION OF A NECROTIC PULP • OPPOSITE TO PERIAPICAL CYST OR GRANULOMA WHICH IS OF CHRONIC CONDITION

  3. PULPITIS PATHWAYS

  4. PATHOGENESIS OF PULPAL INFLAMMATION

  5. CLINICAL FEATURES • SEVERE PAIN ON THE NON VITAL TOOTH BECAUSE OF PRESSURE AND INFLAMMATORY EFFECTS OF CHEMICAL MEDIATORS ON SURROUNDING NERVES. • SLIGHT EXTRUSION OF THE TOOTH OUT OF ITS SOCKET DUE TO PRESENCE OF EXUDATE DUE TO INFLAMMATION • PUS FORMATION MAY SPREAD TO NEARBY STRUCTURES. • AFFECTED JAW MAYBE TENDER TO PALPITATION

  6. SPREAD TO ADJACENT STRUCTURES

  7. SPREAD TO ADJACENT STRUCTURES

  8. SPREAD TO ADJACENT STRUCTURES

  9. CLINICAL FEATURES • HYPERSENSITIVE TOOTH UPON BITING OR PERCUSSION • NEGATIVE RESULTS IN BOTH ELECTRIC OR THERMAL STIMULI • BEING ACUTE IN NATURE, ON RADIOGRAPH THERE IS MILD THICKENING OF THE APICAL PERIODONTAL LIGAMENT SPACE. • IN CASES OF RECURRING CHRONIC EVENTS, PERIAPICAL CHANGES (LUCENCIES) MAYBE SEEN (PERIAPICAL GRANULOMA)

  10. PERIAPICAL GRANULOMA • IN CASES OF LOW GRADE BUT CHRONIC INFLAMMATION AT THE APEX OF A NON VITAL TOOTH GRANULOMA IS USED ON AGAINST THE TERM ABSCESS WHICH IS OF ACUTE IN NATURE.

  11. PULP ABSCESS

  12. COMPOSITION OF PERIAPICAL ABSCESS • PROTEIN RICH EXUDATE • DEAD TISSUES • ACTIVE AND DEAD NEUTROPHILS (PUS) • DILATED BLOOD VESSELS ADJACENT TO AREA OF ABSCESS

  13. COMPOSITION OF PERIAPICAL GRANULOMA • GRANULATION TISSUE AND FIBROUS TISSUES • DIFFERENT KINDS OF WBC PREDOMINANTLY MACROPHAGES AND MULTINUCLEATED GIANT CELLS • IN EPISODES OF ACUTE FLAREUPS NEUTROPHILS MAY INCREASE IN NUMBERS

  14. TREATMENT • DRAINAGE ESTABLISHMENT WITHIN THE TOOTH ITSELF OR ON THE SURROUNDING SOFT TISSUES • ANTIBIOTIC THERAPY • SKILLED AND THOUGHTFUL MANAGEMENT MUST BE EMPLOYED SINCE ANY DELAY MAY CAUSE ANY LETHAL CONSEQUENCE.

  15. COMPLICATIONS • PUS MAY DRAIN ON NATURALLY OCCURING DRAINS TERMED AS FISTULAS OR SINUS TRACTS WHICH MAY BE SEEN ON SKIN OR ON THE PALATE • IF THERE IS NO DRAIN MADE CELLULITIS ENSUES AFTER THE PUS BUILDUP. IT IS AN ACUTE INFLAMMATORY SPREAD ON THE NEARBY SOFT TISSUES • ENZYMES ARE PRODUCED BY HIGHLY VIRULENT MICROORGANISMS PRESENT

  16. COMPLICATIONS • BILATERAL SUBMANDIBULAR AND SUBLINGUAL SPACES ARE KNOWN AS “LUDWIG'S ANGINA” • FATALITIES USUALLY RESULTS FROM BACTEREMIA FROM INFECTION SPREADING INTO THE MAJOR BLOOD VESSELS OR THROUGH A RETROGRADE SPREAD OF INFECTION INTO THE FACIAL EMISSARY VEINS INTO THE CAVERNOUS SINUS, CAVERNOUS SINUS THROMBOSIS

  17. CAVERNOUS SINUS

  18. Severe Ludwig's Angina

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