7 - Treatment Planning Flashcards
what are questions we ask during tx planning
- Does the tooth require endodontic therapy or not?
- Does it need emergency treatment?
- Can the tooth be saved or is it better to extract?
- Does it need additional procedures?
- Is it a complicated case?
- How many appointments will it take?
what do you do to determine if tooth needs RCT
- Review Symptoms
- Examine tooth and surrounding tissues
- Perform pulp tests
- Review radiographs
“REPR”
if you have irreversible pulpitis or pulpal necrosis, what is needed?
endodontic therapy (RCT)
if not endo, what could it be?
- pericornitis
- perio
- TMJ
- non odontogenic pain (sinus, heart attack, neuralgia)
- atypical orofacial pain
how do you know if pt needs emergency tx
- depends on symptoms
- assess pain severity
- determine course of action (what procedure needs to be done today)
what is a partial tx designed to provide quick and timely relief for cases of severe pain
emergency tx
is emergency tx definitive?
NO! patient has to be reappointed for treatment completion
what procedures remove coronal pulp only
pulpotomy
what procedure removes coronal AND radicular pulp
pulpectomy
what procedure involves more thorough instrumentation and irrigation requires WL
canal debridement
what are emergency procedures
- pulpotomy
- pulpectomy
- canal debridement
- incision and drainage
- extraction
- referrals
- prescriptions
tx: symptomatic irreversible pulpitis for normal molars and anterior? are these effective?
pulpotomy for molars
pulpectomy for anteriors
usually provides fast effective relief
what is needed post-op for symptomatic irreversible pulpitis tx
NSAID
tx: symptomatic irreversible pulpitis w/ symptomatic apical periodontitis? does the pt get better?
- pulpectomy
- reduce occlusion if practical (don’t reduce occlusion if tooth has crown)
spontaneous pain and temp symptoms usually get better quickly but pain to chewing might persist for a few days
how can you distinguish if it is endo or something else?
do a pulp vitality test. if pulp is vital, then it is not endo
what to prescribe for pt w/ symptomatic irreversible pulpitis w/ symptomatic apical periodontitis
NSAIDS
tx: pulpal necrosis w/ symptomatic apical periodontitis? does it get better?
- canal debridement w/ good NaOCL irrigation
- if practical, reduce occlusion
sensitivity to chewing/pressure could persist for few days
what to prescribe pt w/ pulpal necrosis w/ symptomatic apical periodontitis
NSAIDS
tx: pulpal necrosis w/ acute apical abscess
- establish drainage if possible thru tooth or soft tissue
- canal debridement
prescribe: pulpal necrosis w/ acute apical abscess
- prescribe (Requires) antibiotics
- pain medication - usually NSAID
what does it mean to “reduce occlusion if practical”
- only done on posterior teeth
- do not reduce occlusion on crowns or crown will be ruined
what types of diseases are addressed during non emergencies
progressive disease - pathological and asymptomatic but need tx
(“but doc it doesn’t hurt”
so discus tx w/ pt bc ticking time bomb analogy
what should you considered whether or not tooth should be saved or if extraction is better?
- Is it restorable?
- Periodontal condition?
- Root fractures?
- How does it fit in the overall treatment plan
- Patient desires?
what additional procedures may need be done before RCT
- build up before RCT
- crown lengthening
- root amputations
- PA surgery
- orthodontic extrusion
what are examples of complicated cases
- calcifications
- root curvature
- resorption: internal/external
- unusual anatomy
- previous failed endo
what should you ask to determine if needs to be referred
- Are they routine cases or do they need a special approach?
- Are special instruments and materials required?
- Does it need a multidisciplinary approach?
what is important to do when referring pt
- COMMUNICATION is key!
- share tx problems
- discuss ideas
can tx plan and prognosis CHANGE as diagnosis and tx progress?
YES
what are reasons to have multiple appts
- lack of time
- complexity of case
- pt tolerance
- presence of exudate in canal
- swelling
is there a difference of incidence of post-op pain between one and multiple appts in endo
NO
is there a difference in success rate between one and multiple appt in endo
NO
how far apart should you make endo appts
- generally should be one to two weeks apart
- extenuating circumstances such as pt moving out of town (so come in sooner) or tx has to be completed before surgery (so come in sooner)
better or low success rate if there is pre-existing PA lesion
LOWER
better or low success rate on retreatments
LOWER
better or low success if calcium hydroxide placed between appts
BETTER
prior to __ must explain what kind of restoration the tooth will need afterwards
RCT
should you include the price of restoration when discussion fees
YES
what restoration should you place on anteriors? why?
composite on anterior that are not too damaged do not use amalgam or you will get a horrible esthetic result
what restoration to use on all molars and some anteriors
build-up/crown
when do you place a pulp restoration
if there is not retention for build up
what temporary restoration can be used in between appointments
Cotton and Fuji
can you use temporary crowns on restorations
yes
