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
what is endodontology
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
how do we get an infected pulp
- start with a normal tooth and intact pulp
- get an interproximal enamel lesion
- advances into the dentine
- bacteria will travel down the dentinal tubules and produce toxins which causes inflammation in the pulp
what does the pulp do in response to the bacteria entering the pulp chamber
the pulp lays down tertiary dentine in an attempt to protect itself and shrinks lower into the apical region
what is laid down naturally in the dentine
secondary dentine due to natural ageing and the pulp shrinks away
what can happen in the early stages of a lesion
the damage is reversible and we can remove the decay and place a restoration- this is reversible pulpitis
what happens at the dentine pulpal interface
the fluid will move back and forward into the tubules and it will create a stimulus causing pain in the tooth
why might the patient experience discomfort
as if the pulp suffers from inflammation, it is restricted by hard tissue and therefore there is an increase in pressure
what are the symptoms of irreversible pulpitis
spontaneous hot worse than cold dull pain long ache dull throbbing pain can be relieved by cold exacerbated by pressure
what are the symptoms of reversible pulpitis
not spontaneous cold worse than hot sharp pain short duration sharp pain sensitive to cold and sweet only in response to stimulus
which nerve fibres are the last to die
C fibres
what is the ultimate result of pulpitis
pulpal necrosis
what is different in multirooted teeth
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
what result would we get if we used a vitality test on a necrotic pulp
negative result
what can repair the pulp
if we induce bleeding and it allows stem cells to differentiate and rejuvenate the blood supply
what changes can we see in endodontology
the study of caries progression which leads to the pulp and then the formation of a perapical abscess
what is early pulpal damage called
reversible pulpitis
how can we treat early pulpal damage
remove the inter proximal lesion and the bacteria and place a restoration
what must be necessary to have periapical disease
bacteria must be present
host response
time
how else can we have bacteria enter the pulp if it not caries
trauma
iatrogenic damage
what is the cause of perapical disease
bacteria
viruses
fungi
archaea
how does periodical disease happen
- bacteria in the pulp will produce toxins which will leave the tooth via the apical foramen
- will start to cause inflammation in the PDL
how can we clinically test for inflammation in the PDL
TTP test on the tooth in question
what are the zones of fish proceeding into the bone
infected
contaminated
irritated
stimulated
why do we see periapical abscesses as black on an x ray
due to the bone being resorbed and there being inflammatory tissue in response to the hosts attempt at defence
what mnemonic do we use for pain history
S- site O- onset C- characteristics R- radiation A- alleviating factors T- time E- exacerbating factors S- severity out of 10
what should a provisional diagnosis include
need to consider both pulpal and periapical condition
what issues can we have with multirooted teeth
we can have pulpitis and apical periodontitis in the same tooth
what are symptoms in the pulp
reversible pulpitis
irreversal pulpitis
pulpal necrosis( can be partial or total)
dentine hypersensitivity
what symptoms will total pulpal necrosis have
none as the pulp is dead
what re the symptoms of acute apical periodontitis
TTP will be very painful
what are the symptoms of chronic apical periodontitis
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
what are the symptoms of symptomatic apical periodontitis
lesion present and the patient experiences acute symptoms TTP and tenderness when palpating tissues might not be swelling
periapical radiolucency
what re the symptoms of a periapical abscess
swelling
throbbing pain
may have periapical radiolucency
what types of periapical abscess can there be
chronic- no pain
acute-pain
what are the clinical signs and symptoms for dentine hypersensitivity (DH)
short sharp pain exposure to cold
gingival recession and exposed dentine
what are the special tests for DH
acutely sensisitive to cold air and fluids- 3 in 1
what is the immediate management to DH
OHI and topical desensitising agents- rapid relief sensodyne
what is the long term management to DH
monitor
restore if necessary
what are the clinical signs and symptoms for pulpal necrosis
likely symptom free
slight discolouration in the tooth
what are the special tests we can do for pulpal necrosis
-ve to tests
radiographic findings of null necrosis
widening of the PDL space may be present
what is immediate management of pulpal necrosis
not required
what is the long term management of pulpal necrosis
monitor
RCT
extraction
what is the immediate management of acute apical periodontitis
adjust occlusion and access tooth and dress with non setting Ca(OH)2
what is the long term management of acute apical periodontitis
RCT
extraction
what do we need to establish before undertaking root canal treatment
must get the correct diagnosis and appropriate consent discussion
what is mandatory for RCT
rubber dam- mandatory
otherwise have no medico legal protection
single tooth isolation- with oraseal
why is RCT mandatory
protects the airway
prevents contamination by saliva
protects against irritants being swallowed
what are the steps for accessing in RCT
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
