Acute flare-ups of necrotic teeth : a quantitative study

Date
1982
DOI
Authors
Broweleit, David L.
Version
OA Version
Citation
Abstract
The acute alveolar abscess (AAA) as a sequel to pulpal necrosis is a common occurrence. A pre-treatment radiograph will reveal either a normal appearance, a widening of the periodontal ligament space, or a lesion of endodontic origin (LEO). If a lesion is observed the diagnosis has historically been the phoenix or recrudescent abscess. No evidence exists in the literature, however, as to how frequently one might expect to see a lesion. The following investigation was undertaken with the objective of determining in a randomly selected sample of acute alveolar abscesses the percentage of cases that also had a radiographically observable LEO. Two hundred eighty-four pre-treatment periapical radiographs were obtained for study from the Boston University Graduate Endodontic Clinic and from the Boston University Endodontic Alumni Association members. In each case the diagnosis was AAA. The radiographs were divided into three sample groups. Two independent observers, the author and Dr. Herbert Schilder, determined for each radiograph that a lesion of endodontic origin was or was not present. In the total sample of 284 radiographs an average of 46% had radiographically observable lesions of endodontic origin. Stated another way, 46% were the so-called phoenix or recrudescent abscess. This figure is a minimal figure due to radiographic variables. Statistical analysis revealed that correlation was statistically significant at the 0.001 level and variance was not statistically significant at the 0.05 level. The AAA can develop as a direct extension of pulpitis into the periapical tissues. In this case there has not been time for a LEO to develop. The AAA can develop as an acute flare-up following a chronic asymptomatic state. In this case the LEO has had time to develop. Based on the results of this study the two events occur with approximately equal frequency. The terms phoenix or recrudescent abscess are of little value. When a chronic asymptomatic state flares up in an acute episode some triggering mechanism is necessary to bring about the change. The most common triggering mechanism is probably a change in drainage conditions.
Description
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Thesis (M.Sc.D.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1982 (Endodontics)
Bibliography: leaves 107-110.
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This work is protected by copyright. Downloading is restricted to the BU community. If you are the author of this work and would like to make it publicly available, please contact open-help@bu.edu.