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CSA > Clinical endodontics part 1 > Flashcards

Clinical endodontics part 1 Flashcards

1
Q

what is endodontolgy

A

study of form, function and health of injuries and disease of the dental pulp and periradicualr region. the principle disease being apical periodontitis caused by infection

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2
Q

what do plural diseases be caused by (4)

A
  • trauma
  • superficial caires can too
  • tooth surface loss
  • periodontal problems
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3
Q

Label simplified dentine complex

A
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4
Q

How does caires progress and affect pulp dentine complex

A

1- interpoximal caries form
2- develop and extend into dentine
3- inflammatory process seen which starts to progress into pulp chamber
4-the pulp then lays down tertiary dentine to proceed itself
5- the inflammation continues
6- An arteriole venue shunts is developed to relieve pulpal of intrpulpal pressure
7- inflow and outflow of dnetienal fluid resulting from inflammation within pulp and starts to cause pain
8- exposure moevemnt of dentinal fluid within dentinal tubule will affect inflamed pulp

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5
Q

what does the pulp chamber do in repose to caries progression

A

lays down territory dentine and pul chamber starts to calcifiy and shrink away from the lesion
(apparent on radiograph)

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6
Q

Up to this point of caries progression what is prognosis

A

the removal of bacterial insult could result in maintain vitality of the pulp

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7
Q

In this image what can the prognosis be

A

beyond a certain threshold , the pulpal inflammation becomes irreversible and whatever we do, the pulp will die
we don’t know where this might be

  • RCT / extraction
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8
Q

What is bidirectional with caires in pulpal disease

A

as caries continues so does inflammation

inevitably - pull necrosis occur

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9
Q

which nerve cells are the last to die in pulpal necrosis

A

C fibres - Explains severe nature of pain in irreversible pulpitis

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10
Q

what does this image show

A

pulpal necorsis
- no blood supply within root canal
- tooth unable to protect itself

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11
Q

when the pulp becomes necrotic what happens

A
  • no physical or biological barrier to microbial ingress
  • no microbial ingress= no periapicla disease
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12
Q

what are causes of periapical disease (4)

A

bacteria
viruses
fungi
archaea

host response

time for lesion to develop

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13
Q

what is the nature of the root canal microflora

A
  • planktonic
  • biofilm
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14
Q

what is biofilm on root canal microflora

A
  • aggregation for microorganisms growing on a solid substrate
  • complex community interactions
  • extracellular matrix of polymeric substances
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15
Q

what is planktonic

A
  • free floating
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16
Q

describe the apical region fo the root canal mciroflroa

A
  • lower oxygen tension
  • nutrients form periradicualr tissues; proteins and glcyoportiens
  • lower bacterial counts
  • bacterial less accessible to treatment measures
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17
Q

describe the coronal region of the root canal microflora

A
  • higher oxygen tension
  • nutrients from the oral cavity; carbohydrates
  • higher bacterial counts
  • microorgansims more accessible to treatment
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18
Q

Describe periapical disease

A
  • the biofilm forms within the root canal and matures
  • the disease is an inflammatory one, the immune system reacts ti the presence of microbes and their by products apically
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19
Q

describe this image

A

normal periapex

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20
Q

describe developing inflammation

A
  • bacteria and bacteria toxins extrude out through the apical foramen which elicit inflammatory repose in the periodical tissues
  • progress over time to create a lesion
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21
Q

what are the 4 Zones of fish

A
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22
Q

what is found in a lesion (2 things)

A
  • apical granulomas consist of granulomatous tissue with infiltrate cells fibroblasts and well developed fibrous capsule , no real live microbial content
  • epithelium may grow into the entrance of the root canal forming a plug like seal at apical foramen
23
Q

How much of the granulomas found in the lesion epitheliased

A

45%

24
Q

what do extra epithelial tissue consist of

A
  • small blood vessels, lymphocytes, plasma cells and macrophages
25
Q

what is important for clinicians to do with endodontic disease

A
  • prevention should be priortised
  • regenerative techniques and pulp preservation = holy grail
  • save pulp where possible
26
Q

what are symptoms for reversible pulpits

A
  • short duration , sharp pain
  • sensitive to cold and sweet
  • ok with hot
    only in repose to stimulus
  • poorly localised
  • remove cause, pulp will recover
27
Q

what are symptoms fo irreversible pulpits

A
  • long duration , throbbing or aching pain
  • spontaneous
  • excaberated by pressure
  • can be relieved by cold
  • very sensitive to hot
28
Q

what 3 types of neruosn innervate the pulp

A

A beta
A delta
C

29
Q

describe A beta neurone

A

-small diameter , myelinated

respond to touch and pressure
low threshold
Fast

30
Q

describe A delta neurons

A

small diameter, myelinated nueron

  • hot ,cold sensitivity
  • low threshold
    Fast
31
Q

Describe C fibres

A
  • large diameter , unmeylinated neurons
  • high threshold
  • slow, dull pain associated with pulpal inflammation
32
Q

list 3 problems with diagnosis with endodotnics

A
  • you can’t see the tissue you are diagnosing
  • reliant on patient reported symptoms
  • poor correlation between symptoms and histology
33
Q

How do we do a clinal diagnosis for endodotics

A
  • listen to the patient
  • be systematic
  • ask the right questions
  • listen out for key words
  • carry out the right tests
34
Q

what is important to consider when diagnosing any endodotnic disease

A
  • cannot treat without clear diagnosis
  • invites failure of the treatment
  • mixed pain history
  • severity of pain could push to carry out incorrect treatment
  • confidence In patient decreased
35
Q

how do we take the pain history of someone with endodotnic problems

A

Site- local or diffuse
Onset - rapid or gradual
Character- sharp,throbbign,dull,burnign ,stabbing,crushing
Radiation -
Alleviation
Time course
Exaercabting
Severity

36
Q

how do we diagnose endodontic lesions

A
  • SOCRATES
    -radiograph
  • extra oral examination - look for swelling or sinus or facial symmetry
  • abscess potentially
  • dermatological problems - acne - extra drainage sinus
    intramurally - swelling sinus
37
Q

what can this image show

A

problem in this area
- sinus or discharging sinus
- teeth become non vital
- check radiograph where this is coming from

38
Q

describe clinical examination of endodontic lesions

A
  • examine the dentition
  • look for caires, defective restorations, cracked teeth ,tooth surface loss
  • palpate and eprucss suspected teeth (be aware of patients tooth)
39
Q

describe the special tests that can be done in diagnosing endodootnic lesions

A
  • EPT - electric pulp test spray
  • pulp sensitivity test - cold spray
40
Q

what is impotent to remember about special tests

A
  • EPT and cold test for neural response
  • do not test blood supply
  • limited value in trauma case
  • be area of results in multi rooted teeth
41
Q

what type fo radiograph do we use for endodontic tests

A

periapicals - shows full root

42
Q

what do we look for in a periapicla radiograph

A

-caires
- how extensive is caries
- is there a lesion
- does the pulp look calcified
- do the root canals look sclerosis
- do the roots look curved
number of canals
length of canal
-

43
Q

what does this radiograph show

A
  • large access cavity
  • difficult to locate canal
  • sclerosis of root canal
44
Q

what do we do to this tooth

A

unrestorable

45
Q

what does this radiograph show

A
  • ## fracture of UR5
46
Q

what other radiographs are sued in endodontics

A
47
Q

what do we need to consider in an endodotnc diagnosis

A

pulpal and periapicla condition

48
Q

name some example pulpal endodontic diagnsoes

A
49
Q

name some other endodotnic diagnosis

A
50
Q
A
51
Q

what are differential diagnosis for endodontic pain

A
52
Q

how do we know its odontogenic pain and not non odontogenic pain

A

odontogenic
- obvious dental cause
- relieved by LA
- unilateral
tooth derived triggers, biting ,thermal change ,
- REPRODUCIBLE
- often lcoalsiable
- typically willl change for better or worse overtime

NON ODONTOGENIC
- no obvious dental cause
-LA no effect
- can cross midline
- triggers poorly defined
- difficult to reproduce
- poorly localised
- often ongoing without any change
- palpation of musculature causes pain

53
Q
A

CSA (32 decks)

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