1. MR. CAPUTO UNIT #2 LESSON #2 Periapical Abscess

2. 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

3. 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

4. Fractured Incisors Leading to Necrotic Pulp

5. 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

6. Signs of an Abscess Elevated temperature General feeling of malaise Throbbing pain in the affected area Possible swollen lymph nodes

7. 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

8. 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

9. 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 prescribed Tooth will later be treated endodontically

10. Tools Used to Obtain an Endodontic Diagnosis Complete dental history and clinical exam of oral cavity Radiographs Percussion test Palpation test Mobility test Periodontal probing Cold and heat tests Electric pulp tester Transillumination test Anesthetic test

11. Purpose of Radiographs Establish length of tooth roots Provide working length for endodontic instruments Confirm 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