disinfection Flashcards
pulpal system anatomy, implication?
very complex anatomy, instruments fail to reach all parts which can allow bac and substrate to persist
to be successful we must remove/destroy:
Remove & Destroy both the Bacteria and their Substrate to be successful*
what % of pulpal anatomy can we access with instruments
We can access only a percentage of the complex anatomy & “protected areas” by any instrumentation. 60-70%
major cleaning solution
8.3%Sodium Hypochlorite
(NaOCl)
major weapons of disinfection
CLEANING AND SHAPING with NaOCl and INTRA CANAL MEDICAMENTS
ADMINISTRATION OF NaOCl:
use of side vented needle to prevent NaOCl from PA/ keeps you 2mm short WL: TIP OF NEEDLE CANNOT GO PAST APICAL CONSTRICTION
must bend the needle
do not allow tip to bnd to canal, in and out gently
NaOCl functions in pulp system
- NaOCl kills micro-organisms on contact
- NaOCl destroys & dissolves substrate
- Disorganizes Biofilm
- Dilutes Toxins in canal system
- Disinfects RC System & Instruments
- Lubricates Canals
- Floats out Debris
where?
NaOCl breaksdown into?
NaCl and H2O, occurs in tooth
NaOCl replenishment
NaOCl becomes inactive after 3-5
min. in the canal so it must be
replenished every 3-5 min.
what must be done after each active instrument
irrigation
TIME and EFFECT of NaOCl on pulpal tissue
our NaOCl vs normal cleaning solution
Dakin’s solution is often used
for surface disinfection. It is
0.25% NaOCl.
8.3% NaOCl (Clorox) is 33.2
times STRONGER and
MORE TOXIC – also more
effective!
cc NaOCl per visit
Typical case requires about 10-12
cc. of NaOCl
as irrigant per visit
how long must NaOCl contact canal? enlarged to what size?
NaOCl must be in contact with shaped canal a minimum of 30 minutes after canal enlarged to #30 or larger.
patency file used for?
breaking vapor lock and ensuring NaOCl reaches apical portion of canal
NaOCl recapulation
*“Recapitulate” following each active instrument
*“Recapitulation” means:
*Flood canal system with NaOCl
*Do this EVERY 3-5 minutes
*Use a #10 file to WL (as necessary)
*Then move on with next active instrument
*Remember the “30-30 Rule”
NaOCl strengths
Strong Oxidizer
Powerful Disinfectant
Dissolves Necrotic Tissue @low concentration
Dissolves Living Tissue @higher concentration
Med. of CHOICE (Endodontics)
NaOCl cons
Strong Oxidizer
Powerful Disinfectant
DANGEROUS !
Extremely TOXIC
what should we never forget when using NaOCl
No Dam leakage
Never forget Eye Protection and Never PASS anything over Face
even with sde vented tip, vigorous injection can cause:
irrigant to express
apically= extremly toxic, Tastes Terrible in mouth (Burns throat)
how to avoid apical expression of irrigant
do not let tip bind, keep tip moving and loose
no dam leakage
results if tip binds in canal
NaOCl can be easily forced out the end of the tooth into the P/A tissues with disastrous results:
Immediate & Extreme pain for several days
Ecchymosis
Swelling
Temporary disfigurement
Court appearance ?
can NaOCl accicdents be undone
There is NO WAY to UNDO a NaOCl accident after it
happens
PREVENT NaOCl Accidents
eye protection with NaOCl
*Your Patient
*Your Assistant
*Yourself
EYE WASH STATIONS AVAILABLE in BOTH LABS FIND THEM – KNOW HOW TO USE THEM
protective clothing and NaOCl
Protect clothing: The tip of the syringe WILL LEAK as you remove it from the
tooth= rubber gloves
what to do when removing syringe
place your gloved hand under the syringe as you remove it from the tooth.
Sonic/Ultrasonic Vibration of NaOCl
endo activator: will agitates irrigation solutions during endodontic treatment.
Evidence-based endodontics has shown that cavitation and acoustic
streaming significantly improve debridement and the disruption of the
smear layer and biofilm.
may be helpful with difficult and unusual canal systems
can endoactivator decrease tx time?
no
smear layer
The SMEAR LAYER is produced when we do any mechanical shaping in dentin. It lies on the surface of the dentinal tubules.
removal of the smear layer
It is NOT removed by NaOCl and the SMEAR LAYER occludes access to the Dentinal Tubules so must be removed to complete the CLEANING procedure before OBTURATION or when using
various Sealers and Cements.
EDTA removes the layer
technique of remving smear layer
17% EDTA is introduced to the canal
system and allowed to work for 60
seconds. Then followed by 8.3 %
NaOCl to stop action of Ethylene
Diamine Tetra-acetic Acid
why not use chlorohexidine in canal?
we don’t believe this is necessary. No
Biofilm removal, precipitate formation possible
can we sterilize the canal system?
Even with all the latest methods of Cleaning & Shaping, Irrigation and Disinfection, It may NOT ALWAYS be possible to eliminate 100% of the
micro-organisms, toxins and substrate within the complex canal systems present.
intracanal medicatons
Medications placed within the canal system between appointments. Intended to increase local anti-microbial action and to further decrease the microbial challenge within the RC system.
universal intracanal med
CaOH
CaOH preffered why/
pH between 11 and 12
- Discourages most microbial growth- Long lasting (effective over extended periods)- No reported allergic responses- Easy to apply & remove as a paste- Available in clinic as “Ultracal”
sealing portals of entry and exit
All potential “Portals of Entry/Exit” must
therefore be sealed creating a Dense Liquid Tight (Hermetic) Seal “OBTURATION” and FINAL RESTORATION to PREVENT LEAKAGE
