Clinical endodontics part 1 Flashcards
what is endodontolgy
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
what do plural diseases be caused by (4)
- trauma
- superficial caires can too
- tooth surface loss
- periodontal problems
Label simplified dentine complex
How does caires progress and affect pulp dentine complex
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
what does the pulp chamber do in repose to caries progression
lays down territory dentine and pul chamber starts to calcifiy and shrink away from the lesion
(apparent on radiograph)
Up to this point of caries progression what is prognosis
the removal of bacterial insult could result in maintain vitality of the pulp
In this image what can the prognosis be
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
What is bidirectional with caires in pulpal disease
as caries continues so does inflammation
inevitably - pull necrosis occur
which nerve cells are the last to die in pulpal necrosis
C fibres - Explains severe nature of pain in irreversible pulpitis
what does this image show
pulpal necorsis
- no blood supply within root canal
- tooth unable to protect itself
when the pulp becomes necrotic what happens
- no physical or biological barrier to microbial ingress
- no microbial ingress= no periapicla disease
what are causes of periapical disease (4)
bacteria
viruses
fungi
archaea
host response
time for lesion to develop
what is the nature of the root canal microflora
- planktonic
- biofilm
what is biofilm on root canal microflora
- aggregation for microorganisms growing on a solid substrate
- complex community interactions
- extracellular matrix of polymeric substances
what is planktonic
- free floating
describe the apical region fo the root canal mciroflroa
- lower oxygen tension
- nutrients form periradicualr tissues; proteins and glcyoportiens
- lower bacterial counts
- bacterial less accessible to treatment measures
describe the coronal region of the root canal microflora
- higher oxygen tension
- nutrients from the oral cavity; carbohydrates
- higher bacterial counts
- microorgansims more accessible to treatment
Describe periapical disease
- 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
describe this image
normal periapex
describe developing inflammation
- 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
what are the 4 Zones of fish
what is found in a lesion (2 things)
- 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
How much of the granulomas found in the lesion epitheliased
45%
what do extra epithelial tissue consist of
- small blood vessels, lymphocytes, plasma cells and macrophages
what is important for clinicians to do with endodontic disease
- prevention should be priortised
- regenerative techniques and pulp preservation = holy grail
- save pulp where possible
what are symptoms for reversible pulpits
- short duration , sharp pain
- sensitive to cold and sweet
- ok with hot
only in repose to stimulus - poorly localised
- remove cause, pulp will recover
what are symptoms fo irreversible pulpits
- long duration , throbbing or aching pain
- spontaneous
- excaberated by pressure
- can be relieved by cold
- very sensitive to hot
what 3 types of neruosn innervate the pulp
A beta
A delta
C
describe A beta neurone
-small diameter , myelinated
respond to touch and pressure
low threshold
Fast
describe A delta neurons
small diameter, myelinated nueron
- hot ,cold sensitivity
- low threshold
Fast
Describe C fibres
- large diameter , unmeylinated neurons
- high threshold
- slow, dull pain associated with pulpal inflammation
list 3 problems with diagnosis with endodotnics
- you can’t see the tissue you are diagnosing
- reliant on patient reported symptoms
- poor correlation between symptoms and histology
How do we do a clinal diagnosis for endodotics
- listen to the patient
- be systematic
- ask the right questions
- listen out for key words
- carry out the right tests
what is important to consider when diagnosing any endodotnic disease
- 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
how do we take the pain history of someone with endodotnic problems
Site- local or diffuse
Onset - rapid or gradual
Character- sharp,throbbign,dull,burnign ,stabbing,crushing
Radiation -
Alleviation
Time course
Exaercabting
Severity
how do we diagnose endodontic lesions
- SOCRATES
-radiograph - extra oral examination - look for swelling or sinus or facial symmetry
- abscess potentially
- dermatological problems - acne - extra drainage sinus
intramurally - swelling sinus
what can this image show
problem in this area
- sinus or discharging sinus
- teeth become non vital
- check radiograph where this is coming from
describe clinical examination of endodontic lesions
- examine the dentition
- look for caires, defective restorations, cracked teeth ,tooth surface loss
- palpate and eprucss suspected teeth (be aware of patients tooth)
describe the special tests that can be done in diagnosing endodootnic lesions
- EPT - electric pulp test spray
- pulp sensitivity test - cold spray
what is impotent to remember about special tests
- 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
what type fo radiograph do we use for endodontic tests
periapicals - shows full root
what do we look for in a periapicla radiograph
-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
-
what does this radiograph show
- large access cavity
- difficult to locate canal
- sclerosis of root canal
what do we do to this tooth
unrestorable
what does this radiograph show
- ## fracture of UR5
what other radiographs are sued in endodontics
what do we need to consider in an endodotnc diagnosis
pulpal and periapicla condition
name some example pulpal endodontic diagnsoes
name some other endodotnic diagnosis
what are differential diagnosis for endodontic pain
how do we know its odontogenic pain and not non odontogenic pain
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
