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CSA > clinical endodontology part 1 > Flashcards

clinical endodontology part 1 Flashcards

Overview of Endodontology and Endodontics Review how the disease process influences treatment methods Discuss the technicalities of undertaking root canal treatment

1
Q

what is endodontology

A

concerned with the study of the form function and health of injuries to and the disease of the dental pulp and periradicular region their prevention and treatment

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2
Q

how do we get an infected pulp

A
  1. start with a normal tooth and intact pulp
  2. get an interproximal enamel lesion
  3. advances into the dentine
  4. bacteria will travel down the dentinal tubules and produce toxins which causes inflammation in the pulp
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3
Q

what does the pulp do in response to the bacteria entering the pulp chamber

A

the pulp lays down tertiary dentine in an attempt to protect itself and shrinks lower into the apical region

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4
Q

what is laid down naturally in the dentine

A

secondary dentine due to natural ageing and the pulp shrinks away

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5
Q

what can happen in the early stages of a lesion

A

the damage is reversible and we can remove the decay and place a restoration- this is reversible pulpitis

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6
Q

what happens at the dentine pulpal interface

A

the fluid will move back and forward into the tubules and it will create a stimulus causing pain in the tooth

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7
Q

why might the patient experience discomfort

A

as if the pulp suffers from inflammation, it is restricted by hard tissue and therefore there is an increase in pressure

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8
Q

what are the symptoms of irreversible pulpitis

A 
spontaneous 
hot worse than cold 
dull pain
long ache dull throbbing pain 
can be relieved by cold 
exacerbated by pressure
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9
Q

what are the symptoms of reversible pulpitis

A 
not spontaneous 
cold worse than hot 
sharp pain
short duration sharp pain 
sensitive to cold and sweet 
only in response to stimulus
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10
Q

which nerve fibres are the last to die

A

C fibres

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11
Q

what is the ultimate result of pulpitis

A

pulpal necrosis

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12
Q

what is different in multirooted teeth

A

as one of the roots can be necrotic but the other root will still have an active blood supply- the patient can come with symptoms of irreversible and reversible pulpitis

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13
Q

what result would we get if we used a vitality test on a necrotic pulp

A

negative result

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14
Q

what can repair the pulp

A

if we induce bleeding and it allows stem cells to differentiate and rejuvenate the blood supply

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15
Q

what changes can we see in endodontology

A

the study of caries progression which leads to the pulp and then the formation of a perapical abscess

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16
Q

what is early pulpal damage called

A

reversible pulpitis

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17
Q

how can we treat early pulpal damage

A

remove the inter proximal lesion and the bacteria and place a restoration

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18
Q

what must be necessary to have periapical disease

A

bacteria must be present
host response
time

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19
Q

how else can we have bacteria enter the pulp if it not caries

A

trauma

iatrogenic damage

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20
Q

what is the cause of perapical disease

A

bacteria
viruses
fungi
archaea

21
Q

how does periodical disease happen

A
  1. bacteria in the pulp will produce toxins which will leave the tooth via the apical foramen
  2. will start to cause inflammation in the PDL
22
Q

how can we clinically test for inflammation in the PDL

A

TTP test on the tooth in question

23
Q

what are the zones of fish proceeding into the bone

A

infected
contaminated
irritated
stimulated

24
Q

why do we see periapical abscesses as black on an x ray

A

due to the bone being resorbed and there being inflammatory tissue in response to the hosts attempt at defence

25
Q

what mnemonic do we use for pain history

A 
S- site 
O- onset
C- characteristics
R- radiation
A- alleviating factors 
T- time
E- exacerbating factors
S- severity out of 10
26
Q

what should a provisional diagnosis include

A

need to consider both pulpal and periapical condition

27
Q

what issues can we have with multirooted teeth

A

we can have pulpitis and apical periodontitis in the same tooth

28
Q

what are symptoms in the pulp

A

reversible pulpitis
irreversal pulpitis
pulpal necrosis( can be partial or total)
dentine hypersensitivity

29
Q

what symptoms will total pulpal necrosis have

A

none as the pulp is dead

30
Q

what re the symptoms of acute apical periodontitis

A

TTP will be very painful

31
Q

what are the symptoms of chronic apical periodontitis

A

asymptomatic
will see the breakdown of the PDL- possible radiolucency
and the bone and tissue will be destroyed
dull pain but was sharp at the start

32
Q

what are the symptoms of symptomatic apical periodontitis

A

lesion present and the patient experiences acute symptoms TTP and tenderness when palpating tissues might not be swelling
periapical radiolucency

33
Q

what re the symptoms of a periapical abscess

A

swelling
throbbing pain
may have periapical radiolucency

34
Q

what types of periapical abscess can there be

A

chronic- no pain

acute-pain

35
Q

what are the clinical signs and symptoms for dentine hypersensitivity (DH)

A

short sharp pain exposure to cold

gingival recession and exposed dentine

36
Q

what are the special tests for DH

A

acutely sensisitive to cold air and fluids- 3 in 1

37
Q

what is the immediate management to DH

A

OHI and topical desensitising agents- rapid relief sensodyne

38
Q

what is the long term management to DH

A

monitor

restore if necessary

39
Q

what are the clinical signs and symptoms for pulpal necrosis

A

likely symptom free

slight discolouration in the tooth

40
Q

what are the special tests we can do for pulpal necrosis

A

-ve to tests

41
Q

radiographic findings of null necrosis

A

widening of the PDL space may be present

42
Q

what is immediate management of pulpal necrosis

A

not required

43
Q

what is the long term management of pulpal necrosis

A

monitor
RCT
extraction

44
Q

what is the immediate management of acute apical periodontitis

A

adjust occlusion and access tooth and dress with non setting Ca(OH)2

45
Q

what is the long term management of acute apical periodontitis

A

RCT

extraction

46
Q

what do we need to establish before undertaking root canal treatment

A

must get the correct diagnosis and appropriate consent discussion

47
Q

what is mandatory for RCT

A

rubber dam- mandatory
otherwise have no medico legal protection
single tooth isolation- with oraseal

48
Q

why is RCT mandatory

A

protects the airway
prevents contamination by saliva
protects against irritants being swallowed

49
Q

what are the steps for accessing in RCT

A

RUBBER DAM placement etc
estimate where the pulp chamber is with the ruler on the computers
access the cavity with the end Z burs and remove all of the pulp chamber roof until you can see the floor

CSA (51 decks)

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