Sequelae of Dental Caries

PBLGroup B

Date : 10th April, 2016

Sushant Pandey Tutor : Dr. Vinay Marla

Contents:

Definition of caries Changes in enamel and dentin Pulpitis Periodontitis Summary

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 :

Sequelae of Dental Caries

Enamel Caries

Dentine Caries

Pulpitis

Apical Peridontitis

Periapical Abscess Periapical Granuloma

Osteomyelitis

Periosteitis

AbscessCellulitis

Acute Chronic

AcuteChronic

Acute ChronicAcute Chronic

Periapical cyst

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:

• 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:

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.

1.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

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

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

Effects in the periapical tissue

1.APICAL PERIODONTITIS:• Inflammation of the periodontal ligament around the root

apex• Due to spread of infection following pulp necrosis• May be ACUTE or CHRONIC

A. Acute apical periodontitis:• Tenderness on mastication• May cause reabsorption of surrounding bone• Widening of periodontal space

B. 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

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

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.

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

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

Summary

References: Shafer’s textbook of oral pathology, 7th

edition Cawson’s essentials of oral pathology and

oral medicine, 8th edition