Sequelae of Dental Caries

PBL
Group B
Date : 10th April, 2016

Sushant Pandey Tutor : Dr. Vinay Marla

Contents:

 Definition of caries
 Changes in enamel and dentin
 Pulpitis
 Periodontitis
 Summary
Dental Caries :
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.”
 Sequelae of Dental Caries

Enamel Caries

Dentine Caries

Pulpitis
Acute Chronic

Acute Apical Peridontitis

Chronic
Periapical Abscess Periapical Granuloma
Acute Chronic
Acute Osteomyelitis Chronic

Periapical cyst
Periosteitis

Cellulitis Abscess
Changes in enamel:

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 dentin:

• 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 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