Sequelae of dental caries

this presentation talks about Sequelae of dental caries

1. Sequelae of Dental Caries PBL Group B Date : 10 th April, 2016 Sushant Pandey Tutor : Dr. Vinay Marla

2. Contents: Definition of caries Changes in enamel and dentin Pulpitis Periodontitis Summary

3. It is defined as “a progressive, irreversible microbial disease of multifactorial nature affecting the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic portion of the tooth.” Dental Caries :

4. Sequelae of Dental Caries Enamel Caries Dentine Caries Pulpitis Apical Peridontitis Periapical Abscess Periapical Granuloma Osteomyelitis Periosteitis Abscess Cellulitis Acute Chronic Acute Chronic Acute Chronic Acute Chronic Periapical cyst

5. Initially, caries presents as a painless white spot ( decalcification of the enamel, which may be reversible ) , followed by cavitations and the appearance of brownish discoloration . Changes in enamel:

6. Tubular sclerosis = Formed at halfway between pulp and DEJ. Heavily mineralized. Reactionary dentine = Forms at pulp dentine interface. Dead tracts = Formed when odontoblasts die and their tubules become sealed off. Changes in dentin:

7. Changes in pulp: Most common cause of dental pain. Most cases of pulpitis are primarily a result of dental caries in which bacteria or their products invade the dentin and pulp tissue. Within the rigid confines of the pulp chamber this produces severe persistant pain and the pulp eventually undergoes necrosis.

8. FOCAL REVERSIBLE PULPITIS : due to dentinal and pulpal irritation pulp hyperemia C/F: Tooth sensitive to thermal changes Responds to low current in EPT Application of ice results in pain but disappears on removal

9. 2. ACUTE PULPITIS: extensive acute inflammation of pulp frequent sequel of focal reversible pulpitis Pain is due to pressure built up due to lack of exudate escape C/F: pain persists even after removal of thermal stimuli Lacinating or throbbing type pain Responds to low current in EPT

10. 3. CHRONIC PULPITIS: Due to quiescence of a previous acute pulpitis or may be chronic from onset Reduced pain and reaction to thermal change due to degeneration of nerves Granulation tissue formation Response to high current in EPT

11. Effects in the periapical tissue APICAL PERIODONTITIS: Inflammation of the periodontal ligament around the root apex Due to spread of infection following pulp necrosis May be ACUTE or CHRONIC Acute apical periodontitis: Tenderness on mastication May cause reabsorption of surrounding bone Widening of periodontal space

12. Chronic apical periodontitis (periapical granuloma): Common sequelae of pulpitis Localized mass of chronic granulation tissue at the apex of non vital tissue Thickening of ligament at the root apex

13. 2. APICAL PERIODONTAL CYST (PERIAPICAL CYST): Due to bacterial infection and necrosis of pulp Usual sequela of the periapical granuloma Lined by epithelium and fluid filled Lining epithelium is derived from epithelial rests of Malassez

14. 3. PERIAPICAL ABSCESS (ALVEOLAR ABSCESS): Acute or chronic suppurative process of the periapical region. May develop from acute periapical periodontitis or from periapical granuloma. Localized collection of pus in the alveolar bone at the root apex following death of the pulp.

15. Osteomyelitis: Inflammation of bone and bone marrow Sequela of periapical infection resulting in diffuse spread of infection throughout the medullary space Necrosis of jaw bone

16. Cellulitis: Inflammation of soft tissues which tends to spread through tissue spaces and facial planes Caused by organisms producing hyaluronidase and fibrinolysins Cellulitis of face and neck occurs as sequela of an apical abscess or osteomyelitis

17. Summary

18. References: Shafer’s textbook of oral pathology, 7 th edition Cawson’s essentials of oral pathology and oral medicine, 8 th edition