Changes

==Introduction==

==Pulpitis==

Trauma to a [[:Category:Teeth - Anatomy & Physiology|tooth]] (mechanical, chemical, thermal, infective) often results in pulpal inflammation ('''pulpitis'''). <font color="red">(pic E1)</font color>

Trauma to a [[:Category:Teeth - Anatomy & Physiology|tooth]] (mechanical, chemical, thermal, infective) often results in pulpal inflammation ('''pulpitis'''). <font color="red">(pic E1)</font color>

PERIAPICAL LESIONS - Pathology in the area surrounding the apex of a root, i.e. periapical pathology, is most commonly a sequel to chronic pulpitis or pulp necrosis. Initially there is inflammation of the apical periodontal ligament. If untreated, the apical periodontitis progresses to involve the surrounding bone, resulting in destruction of the bone, which is replaced by soft tissue. This is evident as an apical rarefaction on a radiograph. The soft tissue may be granulation tissue (periapical granuloma), cyst (periapical or radicular cyst) or abscess (periapical abscess).  Pic E7

[[Tooth Fractures#Crown Fractures|Crown fracture]] very often involves exposure of the [[Enamel Organ#Pulp|pulp]] in the young and older animal as the pulp chamber follows the contour of the [[Enamel Organ#Crown|crown]]. As the animal gets older there is normally a reduction in the size of the pulp cavity, which is associated with continued deposition of secondary [[Enamel Organ#Dentin|dentine]]. There are conditions that accelerate the rate of deposition of secondary dentine, thus prematurely reducing the size of the pulp cavity. [[Tooth Abrasion and Attrition|Attrition and abrasion]] are two common conditions resulting in a narrow pulp cavity. Injury, orthodontic force and disease can all alter and decrease the pulp chamber and canals. In extreme cases, injury to a [[:Category:Teeth - Anatomy & Physiology|tooth]] will result in the complete obliteration of the pulp chamber and root canals. More unusually, the obliteration is partial, with the pulp chamber retaining the size and shape it had at the time of the injury, and the root canals becoming completely obliterated. On the other hand, injuries that cause inflammation and degeneration/necrosis of the pulp also account for many abnormally large pulp cavities, as dentine production ceases when the pulp is chronically inflamed or necrotic.

Treatment for all three entities is the same, i.e. endodontic therapy or if there are complicating factors, e.g. advanced periodontitis, then extraction.  

 

An untreated periapical abscess can lead to complications such as osteomyelitis and cellulitis through spread of the infection. ( PicE8) A fistulous tract opening on the skin or oral mucosa may develop. Periapical lesions may be entirely asymptomatic or excruciatingly painful. The clinical signs indicative of periapical pathology are often insidious and not noticed by the owner. It is often only after completion of treatment that the owner reports a dramatic improvement in the animal’s general demeanour. Consequently, periapical lesions confirmed by radiography should be treated even if the animal is not showing obvious signs of pain or discomfort. Similarly, discoloured teeth with a necrotic pulp need to be treated before periapical pathology develops.  

 

Pathology in the area surrounding the apex of a root, i.e. periapical pathology, is most commonly a sequel to chronic pulpitis or pulp necrosis. Initially there is inflammation of the apical periodontal ligament. If untreated, the apical periodontitis progresses to involve the surrounding bone, resulting in destruction of the bone, which is replaced by soft tissue. This is evident as an apical rarefaction on a [[Endodontic Disease - Radiographic Interpretation|radiograph]]. The soft tissue may be granulation tissue (periapical granuloma), cyst (periapical or radicular cyst) or abscess (periapical abscess).  <font color="red">Pic E7</font color>

 

 

Treatment for all three entities is the same, i.e. '''endodontic therapy''' or if there are complicating factors, e.g. advanced periodontitis, then extraction.  

 

An untreated periapical abscess can lead to complications such as [[osteomyelitis]] and cellulitis through spread of the infection. <font color="red">( PicE8)</font color> A fistulous tract opening on the skin or oral mucosa may develop. Periapical lesions may be entirely asymptomatic or excruciatingly painful. The clinical signs indicative of periapical pathology are often insidious and not noticed by the owner. It is often only after completion of treatment that the owner reports a dramatic improvement in the animal’s general demeanour. Consequently, periapical lesions confirmed by radiography should be treated even if the animal is not showing obvious signs of pain or discomfort. Similarly, discoloured teeth with a necrotic pulp need to be treated before periapical pathology develops.  

Diagnosis of endodontic disease :

Diagnosis of endodontic disease :

COMBINED PERIODONTIC AND ENDODONTIC LESIONS - There are possible pathways of communication between the pulp and the periodontium. These are denuded dentine tubules, lateral and/or accessory pulp canals, and at the apical foramen. Consequently, a periapical lesion may have a periodontal origin and a periodontal type lesion may originate from the pulp. Another possibility is that a lesion is the result of a combination of endodontic and periodontal pathology. The lesions are classified according to aetiology as follows:

COMBINED PERIODONTIC AND ENDODONTIC LESIONS - There are possible pathways of communication between the pulp and the periodontium. These are denuded dentine tubules, lateral and/or accessory pulp canals, and at the apical foramen. Consequently, a periapical lesion may have a periodontal origin and a periodontal type lesion may originate from the pulp. Another possibility is that a lesion is the result of a combination of endodontic and periodontal pathology. The lesions are classified according to aetiology as follows:

• A Class I lesion, or endodontic–periodontic lesion, is endodontic in origin, i.e. pathology begins in the pulp and progresses to involve the periodontium.

• A Class I lesion, or endodontic–periodontic lesion, is endodontic in origin, i.e. pathology begins in the pulp and progresses to involve the periodontium.

• A Class II lesion, or periodontic–endodontic lesion, is periodontic in origin, i.e. pathology begins in the periodontium and progresses to involve the pulp. (picE10)  

• A Class II lesion, or periodontic–endodontic lesion, is periodontic in origin, i.e. pathology begins in the periodontium and progresses to involve the pulp. <font color="red">(picE10) </font color>

• A Class III lesion, or true combined lesion, is a fusion of independent periodontic and endodontic lesions.

• A Class III lesion, or true combined lesion, is a fusion of independent periodontic and endodontic lesions.