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CSA Endodontics > CSA Endodontics 1 > Flashcards

CSA Endodontics 1 Flashcards

1
Q

What is endodontology ?

A
  • 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
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2
Q

What is pulpal disease ?

A

Disease of pulp-dentine complex

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3
Q

How does pulpal disease arise?

A

ongoing caries

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4
Q

What happens to pulp in pulpal disease?

A

non vital and removed

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5
Q

What is order of dentine to pulp

A 
Dentine >
Pre dentine>
Odontoblast layer>
Cell free zone>
Cell rich zone>
Body of pulp >
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6
Q

What is the progression of caries leading to pulp death?

A
  • 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
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7
Q

What is first sign of patient experiencing pain with pulp death ?

A

fluid flow of dentinal fluid

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8
Q

What happens when lesion is irreversible ?

A

caries starting to reach the pulpal horn) , experience pulpal necrosis

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9
Q

What is progession into periapical disease

A

pulp necrotic, (no barrier between bacteria and apical site)

• If no microbial ingress (trauma) no periapical disease

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10
Q

What are the causes of periapical disease?

A

Microorg (Bacteria/Viruses/Fungi /Archea)

  • Host
  • TIME
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11
Q

What is the nature of root canal microflora ?

A
  • Planktonic (free floating)

* Biofilm – difficult to remove & exists In root canal

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12
Q

What is the microbial gradient ?

A
  • 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

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13
Q

What happens when biofilm forms in roots?

A

mature

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14
Q

What is periapical disease ?

A
  • inflammatory , immune system reacting to presence of microbes
  • remove microbes, host response weakened, so less damage occur and repair
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15
Q

What is the state like in APICAL REGION

A
  • lower 02 tension
  • Nutrients from periradicular tissues( glyco/proteins)
  • lower bacterial counts
  • bacteria less accessible to treatment
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16
Q

How does inflammation in periapical disease develop ?

A

as get more bacteria & biofilm matures

• As biofilm matures becomes more virulent

17
Q

What are 4 different zones of Fish?

A
  • Infected zone>Bacteria present here
  • Contaminated >By products present here
  • Irritated >body starts to respond to infection
  • Stimulated >Where getting pre-inflammatory response
18
Q

What is lesion in periapical disease ?

A

• apical granuloma is mass of chronically inflamed granulation tissue that forms at apex of root

19
Q

What does apical granuloma consist of ?

A

infiltrate cells, fibroblasts, osteoclasts, lymphocytes, plasma cells, macrophages

20
Q

What does lesion not contain ?

A

live bacteria –pulp is dead no blood supply to area.

21
Q

What if lesion isn’t infected ?

A

don’t treat patient w/ antibiotics – must be carried by blood & no blood supply to lesion

22
Q

What can epithelial cells at root canal entrance form ?

A

forming plug-like seal at apical foramen

o 45% of granulomas are epithelialized – 10% go on to form cysts

23
Q

What are reversible pulpitis symptoms?

A
  • Sensitive to cold & sweet (OK with hot)
  • Short pain
  • Only with Response to stimulus
  • Well localised
  • Remove cause and pulp will recover
24
Q

What are irreversible pulpitis symptoms?

A 
• 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
25
Q

What fibres innervate pulp ?

A
  • A gamma & A delta

* C fibre

26
Q

Do A fibre die with reversible pulpitis ?

A

yes

27
Q

Why are C fibres last to die ?

A
  • high threshold

- slow pain associated w/ pulp inflamm

28
Q

Why is pulp diagnosis difficult ?

A

can’t see tissue we are diagnosing
• Reliant on patients reported symptoms –
• Poor correlation between symptoms & histology

29
Q

What is clinical diagnosis of pulp disease?

A
  • Listen to the patient
  • Be systematic
  • Ask the right questions
  • Listen out for key words
30
Q

WHAT IS SOCRATES FOR PAIN HISTORY ?

A
  • 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
31
Q

What is clinical examination of pulp disease?

A

•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

32
Q

What are speciality tests?

A
  • 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
33
Q

What does periapical radiograph look for ?

A
  • Look for extent of caries
  • Is there lesion associated w/ area?
  • Does pulp look calcified?
  • Are root canals blocked up?
  • Are roots curved?
34
Q

What other radiographs are there?

A

•Cone beam computerised tomography –3D view

35
Q

What is endodontic diagnosis ?

A

consider both pulpal and periapical condition

• can have pulpitis & apical periodontitis in same multi rooted teeth

36
Q

What is endodontic diagnoses ?

A
  • Dentine hypersensitivity
  • Reversible pulpitis
  • Irreversible pulpiti
37
Q

What is Apical diagnosis?

A
  • Acute apical periodontitis – painful
  • Chronic apical periodontitis - not painful
  • Acute exacerbation of chronic apical periodontitis
  • Chronic periapical periodontitis with suppuration – has sinus
  • Periapical abscess
38
Q

What is differential diagnosis for endodontic pain ?

A
  • 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

CSA Endodontics (7 decks)

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