Case selection for Endo Flashcards
What are some reasons for claims against dentists with regards to endo treatment?
- unsatisfactory treatment
- failed treatment
- fractured/retained instrument
- post-treatment complications
- no valid consent
- perforation
- failure to refer appropriately
What should be evaluated in the pre-treatment assessment in order to select and deal with cases appropriately?
- Evaluation of patient
- Evaluation of tooth
-Self-evaluation of clinician
What sort of Q’s should we be asking ourselves following examination and diagnosis of an endodontic problem?
- Is treatment indicated?
- Is the P’s oral health needs best met by maintaining the tooth?
- Complete patient evaluation
-Who should treat? (us or refer)
When evaluating a patient in case assessment/selection, what 3 categories of factors should be considered?
- Medical history
- Psychological factors
-Social factors
What medical problems contradict endodontic treatment?
There are no absolute contradictions to endo treatment BUT if in doubt speak with the P’s physician
What are some medical conditions would we consider/think about before endo treatment?
- pregnancy
- CVS disease
- cancer
- diabetes mellitus
- bisphosphonate therapy
- allergies
Describe how pregnancy might affect endo treatment?
- Is NOT a contradiction
- In the first trimester would do emergency intervention only
-pain and infection managed in collaboration with obstetrician/physician
Note: unborn child is at more risk if the infection is not treated
What considerations/changes would you make for someone with a CVS with regards to endo?
- an MI within the past 6 months is a contraindication (delay treatment until this is out of the 6m window)
- Emergency treatment should be provided in consultation with the P’s cardiologist
-Stress reduction protocols should be put in place (short appointments, sedation, pain and anxiety control)
What would you need to do and consider with endo treatment in a cancer patient?
- thorough history essential
- think about cancer treatment as chemotherapy and radiotherapy to the head and neck region can compromise healing
- Consult with the oncologist
- need to try and minimise infection risk with cancer patient
How is an endo infection and diabetes link?
An acute endodontic infection can compromise even a well controlled diabetic; so all diabetes patients must be monitored
P’s with uncontrolled diabetes must be monitors
When should appointments be made for a diabetic?
At times that will not interfere with the patients normal insulin and meal schedule
How might diabetes affect the prognosis for endo treatment?
They have poorer healing so need to consider this and mention it in the discussions about prognosis
For patients on bisphosphates, what are the implications on endo therapy?
- IV greater risk
- Preventative care important
- non-surgical endodontic treatment of teeth that might otherwise be extracted is better
- Use entire health team when developing treatment plans for these patients
What allergies might have an impact/need adjustments made to endo therapy?
Latex allergy = use rubber dam
Gutta Percha not a risk as non-cross-reactive
What periodontal considerations should there be when deciding on endo treatment?
- BPE and 6 point pocket for tooth of interest needed
- if poor prognosis may require extraction
-might want to do perio treatment then assess then endo or opposite way round
What restorative considerations should be made with regards to endo treatment?
Is the tooth restorable?:
- sub-osseous caries
- poor root/crown ratio
- misalignment of teeth (better to extract)
- Presence of pre-existing full coverage restorations (is the tooth already severely compromised?)
What can you do if you are unsure about the tooth’s restorability?
Deconstruct - remove all previous restorations and decay so the extent of healthy tooth structure can be determined
DONT CARRY OUT ENDO if cant restore a tooth with a high degree of certainty
What kind of mirror is used in endo?
front surface mirrors (less distortion)
What are some other factors that can complicate endo treatment?
- calcifications, dilacerations and resorption
- inability to isolate a tooth
- unusual anatomy
- ledges and perforations
- posts
- separated instruments
What are calcifications in the tooth?
Parts of the tooth that have calcified which can mean loss of the pulp chamber (wont be able to find it)
Calcifications of the tooth can make orthograde management very difficult. How might a calcified tooth requiring root treatment be maneged?
Surgical approach may be required
How can you tell if resorption is internal or external?
By its radiographic appearance
External appears to be superimposed on the canal, whereas internal resorption appears to be continuous with the canal
What is the gold standard for intra-oral radiographs when determining the anatomy of a tooth and root structure?
2 views to allow us to assess the root canals and divisions
When might CBCT radiographs be used for endo?
for more complex cases where lower dose radiographs doesn’t provide adequate diagnostic info
What are some anatomical things that radiographs might show that you should consider?
- Large open apices
- C-shaepd anatomy
- developmental anomalies
- ledges on restorations
- previous endo treatment
- previous perforations
- separated instruments
What are the options for treatment in endo?
- No active treatment with review
- Extraction
- Orthograde root canal treatment
- Surgical endodontics
A common reason for claims is ‘poor management, including failure to take radiographs or refer appropriately’. What should you do in order to avoid this?
- Make sure to self-assess yourself. Do you have the skills and experience to carry out this treatment?
- Know when to treat and when to refer
When are you at greater risk of perforating a tooth?
If there is a big root curvature
When are you at greater risk of causing instrument separation?
Curved and narrow canals
Pain is expected after endo treatment. What post op instructions would you give to patients?
Take ibruprofen to delay the onset and decrease the severity of the pain
