CSA Endodontics 1 Flashcards
What is endodontology ?
- practice concerned with form, function & health of injuries to and disease of dental pulp & periardiclar region
- prevention & treatment, principle disease being apical periodontitis caused by infection
- not just RCT but management of pulpal disease & periapical
What is pulpal disease ?
Disease of pulp-dentine complex
How does pulpal disease arise?
ongoing caries
What happens to pulp in pulpal disease?
non vital and removed
What is order of dentine to pulp
Dentine > Pre dentine> Odontoblast layer> Cell free zone> Cell rich zone> Body of pulp >
What is the progression of caries leading to pulp death?
- Pulpal blood flow increases as caries nears dentine
- pulpal tissue inflames, fluid flow of dentinal fluid
- if caries superficial, removal of bacteria followed by healing of pulp
- Beyond threshold of pulpal injury, lesion becomes irreversible >
- tissue inflames ,expands and blood supply strangles itself and dies
What is first sign of patient experiencing pain with pulp death ?
fluid flow of dentinal fluid
What happens when lesion is irreversible ?
caries starting to reach the pulpal horn) , experience pulpal necrosis
What is progession into periapical disease
pulp necrotic, (no barrier between bacteria and apical site)
• If no microbial ingress (trauma) no periapical disease
What are the causes of periapical disease?
Microorg (Bacteria/Viruses/Fungi /Archea)
- Host
- TIME
What is the nature of root canal microflora ?
- Planktonic (free floating)
* Biofilm – difficult to remove & exists In root canal
What is the microbial gradient ?
- bacteria at coronal easier to remove
* apical more difficult to kill as more resistant, cause damage and ones that are most difficult to get to
What happens when biofilm forms in roots?
mature
What is periapical disease ?
- inflammatory , immune system reacting to presence of microbes
- remove microbes, host response weakened, so less damage occur and repair
What is the state like in APICAL REGION
- lower 02 tension
- Nutrients from periradicular tissues( glyco/proteins)
- lower bacterial counts
- bacteria less accessible to treatment
How does inflammation in periapical disease develop ?
as get more bacteria & biofilm matures
• As biofilm matures becomes more virulent
What are 4 different zones of Fish?
- Infected zone>Bacteria present here
- Contaminated >By products present here
- Irritated >body starts to respond to infection
- Stimulated >Where getting pre-inflammatory response
What is lesion in periapical disease ?
• apical granuloma is mass of chronically inflamed granulation tissue that forms at apex of root
What does apical granuloma consist of ?
infiltrate cells, fibroblasts, osteoclasts, lymphocytes, plasma cells, macrophages
What does lesion not contain ?
live bacteria –pulp is dead no blood supply to area.
What if lesion isn’t infected ?
don’t treat patient w/ antibiotics – must be carried by blood & no blood supply to lesion
What can epithelial cells at root canal entrance form ?
forming plug-like seal at apical foramen
o 45% of granulomas are epithelialized – 10% go on to form cysts
What are reversible pulpitis symptoms?
- Sensitive to cold & sweet (OK with hot)
- Short pain
- Only with Response to stimulus
- Well localised
- Remove cause and pulp will recover
What are irreversible pulpitis symptoms?
• Spontaneous • Throbbing pain (Long ) •big response to heat – can be made better by cold o worse by pressure • Remove cause and pulp will not recover
What fibres innervate pulp ?
- A gamma & A delta
* C fibre
Do A fibre die with reversible pulpitis ?
yes
Why are C fibres last to die ?
- high threshold
- slow pain associated w/ pulp inflamm
Why is pulp diagnosis difficult ?
can’t see tissue we are diagnosing
• Reliant on patients reported symptoms –
• Poor correlation between symptoms & histology
What is clinical diagnosis of pulp disease?
- Listen to the patient
- Be systematic
- Ask the right questions
- Listen out for key words
WHAT IS SOCRATES FOR PAIN HISTORY ?
- SITE – local or diffuse
- ONSET – rapid or gradual
- CHARACTER– sharp, throbbing, dull, burning, stabbing, crushing
- RADIATION
- ALLEVIATION– what makes it better?
- TIME
- EXCERBATING FACTORS – things that make it worse?
- SEVERITY
What is clinical examination of pulp disease?
•Extra orally
o Facial swelling
o Discharging spot underneath skin
•Swelling intra orally
o Examine dentition caries/cracked tooth/TSL
o Palpate tissues and percuss suspected teeth
What are speciality tests?
- Electric pulp tester
- Endo-frost – cant feel it, usually means pulp is alive
- EPT and cold test only tests for neural response – not testing blood supply
What does periapical radiograph look for ?
- Look for extent of caries
- Is there lesion associated w/ area?
- Does pulp look calcified?
- Are root canals blocked up?
- Are roots curved?
What other radiographs are there?
•Cone beam computerised tomography –3D view
What is endodontic diagnosis ?
consider both pulpal and periapical condition
• can have pulpitis & apical periodontitis in same multi rooted teeth
What is endodontic diagnoses ?
- Dentine hypersensitivity
- Reversible pulpitis
- Irreversible pulpiti
What is Apical diagnosis?
- Acute apical periodontitis – painful
- Chronic apical periodontitis - not painful
- Acute exacerbation of chronic apical periodontitis
- Chronic periapical periodontitis with suppuration – has sinus
- Periapical abscess
What is differential diagnosis for endodontic pain ?
- Sinus pain – hurt when you move your head?
- Musculoskeletal – is worse in the morning (grinding at night)
- Headache disorder • Systemic – cardiac,
- Neuralgia – burning pain (nerve problems)
- Neuritic, post herpetic neuralgia, neuropathy
- Psychogenic pain
