PERIAPICAL ABSCESS Webs

							PERIAPICAL ABSCESS




ORAL PATHOLOGY LECTURE 6
        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
PULPITIS PATHWAYS
PATHOGENESIS OF PULPAL
    INFLAMMATION
         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
SPREAD TO ADJACENT
   STRUCTURES
SPREAD TO ADJACENT
   STRUCTURES
SPREAD TO ADJACENT
   STRUCTURES
          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)
      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.
PULP ABSCESS
    COMPOSITION OF PERIAPICAL
            ABSCESS
   PROTEIN RICH EXUDATE
   DEAD TISSUES
   ACTIVE AND DEAD NEUTROPHILS (PUS)
   DILATED BLOOD VESSELS ADJACENT TO
    AREA OF ABSCESS
    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
             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.
           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
           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
CAVERNOUS SINUS
Severe Ludwig's Angina