MR. CAPUTOUNIT #2 LESSON #2

Periapical Abscess

Today’s Class

Driving Question: How can a fractured tooth lead damage a tooth’s pulp?

Learning Intentions: We will be able to list the different symptoms of pulpal damage.

Anchor: Explain pulpal necrosis

Pulpal Necrosis

Necrotic pulp is nonvital pulp that is infected and dead

Necrotic pulp has been deprived of its blood and nerve supply and is no longer composed of living tissue

Nonvital tooth will not respond to heat, cold, or electrical stimulation

Nonvital pulp may range from being asymptomatic to being very sensitive

Fractured Incisors Leading to Necrotic Pulp

Periapical Abscess

Results from an infection of pulpal tissue causing pulp to die

Pus and fluid accumulate and form in the bone surrounding tooth

Fistulous tract is formed

Image courtesy Instructional Materials for the Dental Team, Lex. KY

Signs of an Abscess

Elevated temperatureGeneral feeling of malaiseThrobbing pain in the affected areaPossible swollen lymph nodes

Cellulitis

Inflammation that can occur from the abscess and spreads out into connective tissue of the face

Serious bacterial infection that may become life threatening

Appears as a swollen, red area of the skin that feels hot and tender and may spread rapidly

Incision and drainage of abscess with prescribed antibiotics may occur

Treatment indicated when swelling and infections are localized in alveolar bone with a clearly defined area on mucosa

Several visits may be required

Local anesthesia may not be as effective

Incision and Drainage (I & D)

Image courtesy Instructional Materials for the Dental Team, Lex. KY

I & D Procedure

Involves incising, or lancing, of area to express exudate (pus)

DA needs to keep high-volume evacuator or a 2 x 2 gauze square close to incision site to absorb exudate

Drain may be placed Antibiotics may be prescribedTooth will later be treated endodontically

Tools Used to Obtain an Endodontic Diagnosis

Complete dental history and clinical exam of oral cavity

RadiographsPercussion test Palpation test Mobility testPeriodontal probing

Cold and heat testsElectric pulp testerTransillumination

testAnesthetic test

Purpose of Radiographs

Establish length of tooth rootsProvide working length for endodontic

instrumentsConfirm that root canal filling material is

located properly 1 to 2 millimeters from tooth apex

Provide final film as record of finished procedure

Used to process dental insurance claims or pre-authorization