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Pulp and Periapical Disease (view source)
Revision as of 16:12, 19 September 2013
, 16:12, 19 September 2013no edit summary
:[[Dental Caries|Caries]]
:[[Dental Caries|Caries]]
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==Pulpal Reactions==
==Pulpal Reactions==
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>
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>
==Clinical Signs==
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==
It is important to determine whether the pulp is exposed or not. If there is an obvious pulp exposure this can be diagnosed clinically by visual inspection of the tooth. Occasionally it may not be obvious and [[Oral Examination Under General Anaesthesia|examination under general anaesthesia]] using a [[Dental Explorer|dental explorer probe]] or path finder needs to be performed. This should NEVER be done in the conscious animal as an exposed pulp will be very sensitive.
A red or black spot usually indicates that the pulp is exposed. <font color="red">(pic E9)</font color>The red spot indicates a fresh/vital/inflamed pulp, whilst a black spot usually indicates that the pulp has started to become necrotic and the black colour results from degradation of haemoglobin. Whether the pulp is vital or not, the tooth will still require treatment.
In cases of caries decay, a brown discolouration is seen on the occlusal surface. Due to the demineralization of the enamel and dentine, this brown discolouration is soft and the explorer probe sticks in the carious dentine.
[[Intra-Oral Radiography|Radiography]] may help determine whether a [[Fractured Teeth#Root Fracture|root fracture]] is present, the nature of the fracture (crown-root/vertical fracture) and whether perapical pathology is present. Radiographs also help determine whether teeth with uncomplicated crown fractures need treatment or not. Radiographs do not confirm that the pulp itself is exposed. See [[Endodontic Disease - Radiographic Interpretation|radiographic interpretation of endodontic disease]].
==Treatment==
==Treatment==
Treatment for all three entities is the same, i.e. '''endodontic therapy''' or if there are complicating factors, e.g. advanced periodontitis, then extraction.
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.
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.
==Combined [[Periodontal Conditions|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 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.