1-30. ACUTE APICAL ABSCESS
The inflammation in the periapical tissues is very severe, resulting in swelling,
fever, and sharp pain. An incision and drainage may be necessary to relieve the pain
and drain the pus. There is generally no pathology seen in the bone on a radiograph.
(This abscess is nearly always the result of a change from an existing chronic infection).
The symptoms and treatment are the same as those for the acute apical
abscess. However, pathology can be seen in the surrounding bone on the radiograph.
a. Periapical Granuloma. Periapical (or radicular) granuloma is a common
result of pulpitis. It is a mass of granulation tissue that forms at the apical/lateral
foramen in response to chronic inflammation caused by necrosis of the pulp tissue. It
is composed of capillaries, inflammatory cells, fibroblasts, collagen, and macrophages.
It is this type of tissue that fills the bony defect seen on radiographs.
b. Periapical Cyst (Radicular Cyst). A periapical cyst (or radicular cyst) often
forms from proliferation of islands of odontogenic (tooth origin) epithelium present within
a radicular granuloma. The cystic lesion consists of a fluid-filled cavity that is lined with
epithelium. The cyst generally develops from a long-standing periapical granuloma.
See figures 1-2 and 1-3.
1-33. SIGNIFICANT CLINICAL INFECTIONS LUDWIG'S ANGINA
Ludwig's angina is a profound infection clinically characterized by a firm swelling
of the floor of the mouth and elevation of the tongue. Swelling may spread into the
tissues of the neck that can cause swelling of the tissues and airway obstruction that
can cause death. This condition is relatively rare, but very dangerous. It is commonly
accompanied by fever, pain, and serious interference with breathing. Extensions of
infection from carious teeth, extraction sites, or tonsils may cause this disease.
Treatment includes establishing an airway, administering antibiotics to control infection,
and establishing drainage through incision. Referral to an oral and maxillofacial
surgeon is usually required.