Periapical granuloma vs Periapical cemental Dysplasia

# Difference between periapical granuloma and periapical cemental dysplasia:
A. Vitality
B. Histologically
C. Radio graphically
D. Culture media

The correct answer is A. Vitality

Periapical granuloma

The tooth in Periapical granuloma is non vital and may be slightly tender to percussion but otherwise symptoms may be minimal.

- Periapical cemento-osseous dysplasia (osseous dysplasia; cemental dysplasia; cementomas).

→ Periapical cemento-osseous dysplasia predominantly involves the periapical region of the anterior mandible.

→ Solitary lesions may occur but multiple foci are present more frequently.

There is a marked predilection for female patients (ranging from 10: 1 to 14: 1) and approximately 70 % of cases affect blacks.

→ Most patients are diagnosed initially between the ages of 30 and 50, with the diagnosis almost never made in individuals under the age of 20 years. 

Teeth associated with the lesions are almost invariably vital and seldom have restorations.

→ Periapical cemento-osseous dysplasia is an asymptomatic condition that is discovered when radiographs are taken for other purposes.

→ Early lesions appear as circumscribed areas of radiolucency involving the apical area of a tooth. At this stage, the lesion cannot be differentiated radiographically from a periapical granuloma or periapical cyst.

With time adjacent lesions often fuse to form a linear pattern of radiolucency that envelopes the apices of several teeth.

Diabetes mellitus symptoms

# History of excessive thirst, hunger, micturition during nights and recent loosening of teeth usually indicate that the patient is suffering from:
A Hypertension
B Hyperthyroidism
C Diabetes mellitus
D Glomerulonephritis

The correct answer is C. Diabetes Mellitus.

Theories of Local Anesthesia

THEORIES OF LOCAL ANAESTHESIA are -
A. Calcium displacement theory:
LA molecules displaces calcium inside the nerve which in turn controls sodium channels.

B. Electrical potential theory: The cations RNH+ of LA align themselves on the nerve membrane and make outside potential more positive, thus the threshold potential is increases.

C. Membrane expansion theory: LA penetrates the membrane, expands it and narrows the sodium channels, thus decreases the permeability to sodium ions.

D. Specific receptor theory: The specific receptors are sodium channels which are bound by LA controls the sodium channels. It is the most acceptable theory which explains the actions of LA.

Cementoblastoma

# A radiograph of the mandibular anterior teeth in a patient reveals radiolucencies above the apices of right lateral and central incisors. No restorations or cavities are present. There is no pain or swelling and the pulps are vital. The diagnosis is:
a) Periapical granuloma
b) Cementoblastoma
c) Radicular cyst
d) Chronic abscess

The correct answer is B. Cementoblastoma

Options A, C, and D are associated with non-vital teeth. Cementoblastoma (periapical osteofibrosis or periapical fibrous dysplasia or periapical cemental fibrous dysplasia) usually involves people of over 20 years of age and women appear to be affected for more than men. The lesion occurs in and near the periodontal ligament around the apex of the tooth, usually a mandibular incisor.  In most cases, the lesions involve the apices of several mandibular anterior teeth or bicuspids.

Note: The codition that is confusing with periapical cemental dysplasia (cementoblastoma) is Benign cementoblastoma, which is a true neoplasm of functional cementoblasts which form a large mass of cementum or cementum like tissue surrounding the tooth root. The Benign cementoblastoma occurs most frequently under the age of 25 years, with no significant gender predilection. The mandibular first permanent molar is the most frequently affected tooth.