Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APD > Emergency endodontics > Flashcards

Emergency endodontics Flashcards

1
Q

What are the different types of endodontic emergency?

A 
pulpitis  - reversible and irreversible 
Periapical infection - symptomatic (acute) apical periodontitis, acute apical abscess 
Cracked tooth 
Mid and post-treatment flare-ups 
Trauma involving the pulp 
Iatrogenic damage involving the pulp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is pulpitis?

A

Inflammation of the pulp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical diagnoses of pulpitis?

A

Irreversible and reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs and symptoms of reversible pulpitis?

A

Pain brought on by hot, cold, sweet
Short duration - does not linger for long after the removal of the stimulus
Can be difficult to localise
Tooth may give an exaggerated response to sensibility testing
Radiographs are generally of normal appearance (no PA radiolucency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment for reversible pulpitis?

A

Removal of the causative factor e.g. caries, failed restoration
Consider placing a temp restoration e.g. ZoE
Monitor response to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the instructions to patient with reversible pulpitis?

A

Pain will gradually decrease
Take analgesics as required
Emphasise need to complete treatment (only temp placed)
Return if the symptoms become more severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs and symptoms for irreversible pulpitis?

A 
Spontaneous pain
Pain persists for hours 
Pain triggered by heat and in the later stages relived by cold (when have hot pulp)
Kept patient awake at night 
Tooth can be TTP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for irreversible pulpitis if have enough time?

A 
Local anaesthetic
Access cavity 
Removal of pulp tissue (barbed broach) - hooks on to the pulp then pull it out
Coronal 2/3 opening 
Determine the WL 
Complete chemico-mechanical debridement 
Copious irrigation 
Dry the canal 
Place CaOH into the canal 
Place bacteria to get tight seal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would it be ideal to do if have time to start treatment and have more time?

A

Ideal to complete the RCT at the same appointment

So after drying the canal; complete the obturation and place a bacteria tight seal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What treatment would you do if pt presents with irreversible pulpitis and time does not permit?

A 
LA
Access cavity 
Removal of pulp tissue (barbed brooch)
Copious irrigation 
Dry the pulp chamber 
Place a sedative dressing (e.g leadermix/Odontopaste)
Place bacterial tight seal 
Complete root canal instrumentation in next few days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the problem with having a hot pulp?

A

When a tooth with pulpitis can be incredibly painful and difficult to anaesthetise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different methods of anaesthetising if have a hot pulp?

A

Regional anaesthesia
Consider additional sources of innervation e.g. long buccal
Multiple anaesthetics (lignocaine and articaine)
Intra-ligamentary anaesthesia
Intra-pulpal anaesthesia - when hit pulp after access, place LA into pulp
Intra-osseous anaesthesia
Consider inhalation sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

if patient presents with irreversible pulpitis and and pain doesnt allow treatment what should you do?

A

Attempt to remove as much pulpal tissue as possible and place a sedative dressing
If this isn’t possible then advise analgesics
No antibiotics for pulpitis
Pt should return to treatment as soon as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the prescribed/advised analgesics to give?

A

Paracetamol 2x500mg up to QDS
Ibuprofen 2x400mg up to RDS
Prescribe co-codamol 2x30/500mg QDs only in very severer pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs and symptoms for symptomatic (acute) apical periodontitis?

A 
TTP
Tender to palpation over the apices
Swelling and reddening of the mucosa
No response to vitality testing
Pain can be severe in function or pressure 
Can be constant and worsening 
Can be present for several hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment for symptomatic apical periodontits if time permits?

A 
LA
Access cavity 
Coronal 2/3 opening 
Determine working length 
Complete chemo-mechanical debridement 
Copious irrigation 
Dry the canal 
Place CaOH into canal 
Place bacteria tight seal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for symptomatic apical periodontitis if time doesn’t permit?

A 
LA
Access cavity 
coronal 2/3 opening 
Copious irrigation 
Dry the canal 
Place CaOH into the canal
Place bacteria tight seal 
Complete root canal instrumentation in next few days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you temporise the RC between appointment’s

A

Intermediate or provisional filling material - IRM, GIC
Either sponge pellet or soft temp material cavit or coltosol
Calcium hydroxide paste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the instructions to patient presenting with symptomatic apical periodontitis?

A 
Pain will gradually decrease 
Take analgesics as required 
Paracetamol 2x500mg up to QDS
Inruprofen 2x400mg up to TDS
Prescribe co-codamol 2x30/500mg QDS - only if in severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the signs and symptoms of acute apical abscess?

A

Swelling
Severe pain especially on pressure
Feeling of the tooth being elevated in the socket
Mobility may be present (bone loss because of apical infection)
The patient may experience fever, malaise and lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for acute apical abscess, if attempting drainage through the tooth?

A 
Attempt drainage through the tooth 
Local anaesthetic  regional block
Access cavity
Drain the pus - if not pus immediately explore the canal/apex with small file to encourage discharge
Copious irrigation 
Dry the canal
Place CaOH into canal 
Place bacteria tight seal 
Complete root canal instrumentation when patient is able
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment for acute apical abscess if there is not drainage through the tooth or drainage is inadequate and fluctuant swelling is present?

A

LA: spray the swelling with ethy chloride or place topical LA for 3 mins (consider regional LA)
Incise the swelling vertically with scalpel
Aspirate the pus
Copious irrigation
Leave to continue to drain and heal
Complete RCT when the patient is able

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When are the only times antibiotics are required if pt presents with acute apical abscess?

A

Signs of spreading infection (diffuse swelling, trismus)
Signs of systemic involvement (fever, malaise, lymphadenopathy)
Certain patients who are severely medically compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the instructions to patient if present with acute apical abscess?

A

Return to dentist or A&E if: the swelling progresses, difficulty opening mouth they start to feel unwell, any difficulty swallowing/breathing, return for completion as soon as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do 20% of patients with odontogenic pain have?

A

Cracked tooth (incomplete fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the causes of a cracked tooth?

A

Masticatory incidents
bruxism
Thermal cycling etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which teeth most commonly are cracked?

A

Second premolars, 1st molars

28
Q

What are the symptoms for a cracked tooth?

A

Pain on chewing, sensitivity to cold and hot fluids, pain which is difficult to locate

29
Q

How do you diagnose a cracked tooth?

A

Ask the patient to bite on a cotton wool roll, stick or fracture detector (tooth slooth)
Pain on release of pressure is most reliable aid and most expressive clincal finiding
Visual detection of crack (fibreoptic, staining)
Radiographs are of little value for detection

30
Q

What is the treatment for a cracked tooth id no signs of pulptitis?

A

Stabilisation of the tooth with adhesive restoration or partial/full coverage down

31
Q

If have a cracked tooth, what may you consider to do to aid diagnosis/provide immediate relief/ protection?

A

Consider using a copper or orthodontic band to stabilise the tooth

32
Q

What is the treatment for a cracked tooth that has signs of irreversible pulptitis?

A

(symptoms when not in function)

Endodontic treatment followed by full crown

33
Q

What is the treatment if tooth has a fracture line that extends below the alveolar crest?

A

Extraction

34
Q

How can a vertical root fracture be identified clinically?

A

There will be a deep but narrow periodontal pocket which follows the path of the root fracture
The fracture may be clinically visible, but often hidden under a restoration and the gingivae
Look for ‘J’ shaped lesion on radiograph

35
Q

What could the sources of pain be in a mid and post-treatment flare up?

A

If had recent restorative treatment

Recent endodontic treatment

36
Q

What could possible recent restorative treatments be that have irritated the pulp?

A

New restoration
Replacement restoration
Preparation of indirect restoration

37
Q

What increases the risk of symptoms to a tooth with mid and post-treatment flare ups?

A

Increased risk in relation to the depth and amount of tooth structure removed and the condition of the pulp

38
Q

What do you need to assess if pt presents with mid and post-treatment flare-ups?

A

Assess the symptoms and make a diagnosis

Assess restoration - leakage, occlusion, exposed dentine

39
Q

How do you treat patient with mid and post treatment flare-ups?

A 
Monitoring
Analgesics 
Adjusting the occlusion,
Placing sedative dressing 
Desensitisation agent
40
Q

When can endo flare-ups happen?

A

Mid or post treatment

41
Q

What are endo flare-ups due to?

What are the different ways this can happen?

A 
baterial contamination/change in bacterial flora:
Poor RD technique 
Unsatisfactory temp restoration 
Inappropriate intra-canal medication 
Incomplete chemo-mechanical prep
Missed canals 
Forcing debris through the apex
Overfill of root material
42
Q

What are the signs and symptoms of an endodontic flare-up

A

Similar to acute apical periodontitis
TTP
Tender to palpation especially over the apices
Swelling and reddening of the mucosa
Pain can be severe in function or pressure
Can be constant and worsening
Can be present for several hours

43
Q

What is a phoenix abscess and what is it due to?

A

When a non-vital tooth flares up when previously been asymptomatic
Probably due to alteration in the internal environment of the RC space during instrumentation
Bacterial flora is altered and causes symptoms

44
Q

What is the first thing you do if the patient complains of having mid-treatment flare-up?

A

Assess the need to re-op the root canal
Is the patient able to tolerate the treatment?
Is there clinical time available?

45
Q

If pt complains of mid-treatment flare-up and want to re-open, what so you do?

A

Follow conventinoal procedure
Try to ascertain the reason for the flare-up
leave the tooth with condensed CaOH in situ

46
Q

What is the advice to patients that have a mid-treatment flare-up?

A

Return if symptoms significantly worsen
The symptoms are unlikely to affect the outcome of the endodontic procedure
Take analgesics as required
Antibiotics not indicated

47
Q

What causes post-treatment flare-ups?

What is the management of post-treatment flare-ups?

A

often due to bacterial contamination at the apex or overfill of material
Difficult to treat as the root filling is in situ and often also the definitive restoration
Best to monitor symptoms and reassure the patient that it should be resolved with time
Advise appropriate analgeics

48
Q

What is a complicated crown fracture?

A

Crown fracture involving pulp
Diagnosis straight forward and based on clinical presentation
A history of trauma with exposed pulp and pain will be present

49
Q

What is the treatment for complicated crown fractures?

A

Open apices - need to preserve vitality by pulp capping or partial pulpotomy - to secure further root development
Also used for adults

50
Q

When should pulp capping be only attempted?

A

When the injury is very recent due to risk of contamination

51
Q

What materials are used for pulp capping or partial pulpotomy?

A

CaOH and MTA

52
Q

What is the treatment of choice if have a complicated crown fracture in older patients with close apices and associated luxation injury with displacement?
Or if injury is old and there are signs of pulpal necrosis?

A

Endodontic

53
Q

What is the procedure for pulp capping?

A

LA
Isolate with RD
Clean with water, saline or chlorhexidine
Disinfect with NaOCl
Apply pulp-capping material - MTA, biodentine or calcium hydroxide over exposed pulp tissue
Seal exposed dentine with GIC or composite
Restore reamaining tooth with composite

54
Q

What is the procedure for partial pulpotomy?

A

LA
RD
Clean with water, saline, or chlorhexidine
Perform pulpotomy to a depth of 2mm with a clean, round diamond bur under water spray
Place a silane mositened cotton pellet over the pulp untill bleeding stops
Apply pulp capping material - biodentint, MTA or CaOH
Seal wit GIC or composite
Restore remaining tooth with composite

55
Q

If have complicated crown fracture partial pulpotomy or pulp cap?

A

PP preferred as better long-term outcomes

56
Q

What is the follow up after partial pulpotomy/pulp cap?

What does the prognosis depend on?

A

Clinical and radiographic 6-8weeks and 1 year prognosis depends on extent of initial injury
Time before intervention and
Stage of root development

57
Q

What is the result of a pulpotomy on a open apex tooth?

A

if the tooth is immature, successful treatment can resilt in completion of root formation - apexogenesis

58
Q

What can iatrogenic exposure of the pulp be divided into?

A

Carious and non-carious exposure

59
Q

What is the most important factor when trying to maintain vitality in pulp exposure?

A

extent of bacterial contamination

60
Q

What is a non-carious pulp exposure mostly caused by?
What is the treatment?
Good prognosis?

A

Over enthusiastic cavity prep or indirect restoration
Best prognosis - provided a bacteria - tight restoration can be provided
Management - pulp capping

61
Q

What do you do if have soft caries over pulp exposure? or patient has symptoms of pulpitis

A

Endo treatment

62
Q

What can be done if have caries and want to prevent exposure/

A

leave affected dentine over the pulp and place a bacteria-tight restoration

63
Q

What so you do if pulp exposure occurs and all infected dentine has been removed and the patient has no symptoms

A

attempt pulp cap or partial pulpotomy

64
Q

Why is partial pulpotomy preferred if have carious exposure?

A

it removed the superficially and potentially infected layer of the pulp
Surrounding dentine is also removed to make space for pulp-capping material to be places

65
Q

If doing a partial pulpotomy and bleeding cant be stopped what do you do?

A

Endo treatment

Means it is irreversibly inflammed

APD (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions