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BDS3 Endodontics > Case selection and treatment planning in endo > Flashcards

Case selection and treatment planning in endo Flashcards

1
Q

What factors would you evaluate in a patient for a case assessment for endodontic treatment? (3)

A
  • Medical
  • Psychological
  • Social factors
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2
Q

What are some medical findings that might influence our decision to do endodontic treatment or not? (6)

A
  • Pregnancy
  • CVD
  • Cancer
  • Diabetes Mellitus
  • Bisphosphonate therapy
  • Allergies
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3
Q

Is pregnancy a contraindication to endodontic therapy?

A
  • No
  • However, the first trimester is emergency intervention only
  • Pain and infection is managed in collaboration with obstetrician/physician
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4
Q

Is CVD a contraindication to endodontic treatment?

A
  • If patient has had an MI within the past 6 months it is a contraindication
  • Emergency treatment should be provided in consultation with the patient’s cardiologist
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5
Q

Stress reduction protocol for a patient with CVD in relation to endo treatment? (3)

A
  • Short appointments
  • Sedation
  • Pain and anxiety control
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6
Q

What is essential to have with a cancer patient for endodontic treatment?

A
  • A thorough history is essential

- Consult with the oncologist

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7
Q

What could be compromised in a patient who is undergoing chemotherapy or radiotherapy to the head and neck region in endo treatment?

A
  • Healing can be compromised

- Consult with the oncologist

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8
Q

Why might diabetes be a complication for endo treatment?

A
  • An acute endodontic infection can compromise even a well controlled diabetic; so all diabetes patients must be carefully monitored
  • Patients with uncontrolled diabetes should be monitored
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9
Q

How might you accommodate a diabetic who is getting endodontic treatment? (2)

A
  • Appointments should be scheduled so as not to interfere with the patient’s normal insulin and meal schedule
  • Minimise stress
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10
Q

What does BRONJ stand for?

A
  • Bisphosphonate-related osteonecrosis of the jaw
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11
Q

Bisphosphonates slide - can’t think of questions

A
  • BRONJ
  • IV B’s greater risk than oral administra tion - all patients should be considered at some risk
  • Preventive care
  • Non-surgical endodontic treatment of teeth that might otherwise be extracted
  • USe the entire health care team, when developing treatment plans for these patients
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12
Q

If a patient is allergic to latex rubber, what should the dam be made of?

A
  • Vinyl
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13
Q

Is GP a risk of an allergic reaction?

A
  • No as non-cross reactive
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14
Q

What perio considerations do you need to make when doing a dental evaluation? (3)

A
  • Periodontal probing essential - BPE and tooth of interest
  • Poor perio prognosis may necessitate loss
  • Perio-endo or endo-perio lesion
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15
Q

What restorative considerations do you need to make when doing a dental evaluation? (4)

A
  • Sub-osseous caries
  • Poor crown/root ratio
  • Misalignment of pre-existing
  • Presence of pre-existing full coverage restorations (is the tooth already seriously compromised?)
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16
Q

What restorability considerations do you need to make when doing a dental evaluation?

A
  • The restorability of the tooth must be thoughtfully considered first, deconstruct if necessary
  • Remove restoration and decay and have a good look and evaluate the tooth
  • If tooth is unrestorable then RCT should not be happening unless exceptional circumstances
17
Q

What is coaxial illumination?

A
  • Problem with light source that is available on the chair is that because the light and your visual path are not co-incident we get shadow casting
  • If bring light and visual path closer together you are less likely to see shadows
18
Q

Why do we use front surface mirrors for endodontics?

A
  • Most mirrors are rear surface reflecting

- This causes increasing distortion as the angle of the mirror is increased e.g. when looking down canals

19
Q

What are other factors that should be included in your dental evaluation before endodontic treatment? (6)

A
  • Calcifications, dilacerations and resorption
  • Inability to isolate a tooth
  • Unusual anatomy
  • Unusual anatomy
  • Ledges and perforations
  • Posts
  • Separated instruments
20
Q

What calcification considerations do you need to make when doing a dental evaluation? (2)

A
  • Isolated or continuous - can make treatment very difficult even for the most skilled clinician
  • IF orthograde management not possible surgery may be considered
21
Q

What resorption considerations do you need to make when doing a dental evaluation? (2)

A
  • Internal resorption can be differentiated form external resorption by its radiographic appearance
  • External resorption appears to be superimposed on the canal, whereas internal resorption appears to be continuous with the canal
22
Q

What anatomical considerations do you need to make when doing a dental evaluation? (3)

A
  • Does the anatomy look different?
  • Are there extra canals/root structures
  • Is there bifurcations?
  • Even teeth that we think are simple can be a lot more complex than we may think
23
Q

Where does calcification go from and to?

A
  • Goes from coronal and towards apical because it requires vital pulp tissue
24
Q

What is the fast break rule for where we can’t see the canal reaching the apical portion?

A
  • This indicates the division of the canal - divides into 2/3 canals and it becomes harder to discern the individual canal structure
25
Q

It is really important that 2 views of intra-oral radiography are used in an endo assessment. Why is this?

A
  • Allows us to discern canal divisions, multiple roots with a cone shift radiograph
26
Q

Why might we use cone beam CT in an endo assessment?

A
  • CBCT should be considered on a case-by-case basis where lower dose conventional radiography does not provide adequate diagnostic information
27
Q

What are out options for treatment in endodontics? (4)

A
  • No active treatment with review
  • Extraction
  • Orthograde RCT
  • Surgical endodontics
28
Q

What is the decision of type of endo treatment carried out dependent on? (5)

A
  • PAtient assessment
  • Dental assessment
  • Patient motivation
  • Patient time
  • Financial implications
29
Q

When obtaining consent what do you need to include in your discussion? (3)

A
  • Options fo rtreatment
  • Prognosis
  • Risks
30
Q

When talking about options for treatment in the consent process what should you include? (5)

A
  • Follow-up
  • Extraction
  • Orthograde RCT
  • Surgical extractions
  • What do the procedures involve in brief
31
Q

When might perforations be at greater risk?

A
  • If roots are very curved
32
Q

You should assume that pain will be a feature in the post-op of endodontics. To try to minimise this what should you advise the patient?

A
  • Advise patient to take some ibuprofen for a few days before the treatment
33
Q

What should be discussed with the patient to obtain consent for the treatment? (6)

A
  • Procedure
  • Prognosis
  • Alternatives
  • Risks
  • Opportunity to ask questions
  • Agree on a plan - remember endodontics is not all that will be required - restoration and review
34
Q

What risks should you include when obtaining consent form the patient? (4)

A
  • Possibility of failure

individual risks related to the case:

  • Perforations
  • damage to existing restorations
  • Fractures
  • Hypochlorite accidents

BDS3 Endodontics (8 decks)

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