Endo Flashcards
2 types of fibres which transmit dental pain & sensations they trigger
A delta fibres → sharp, shooting pain
C fibres → dull, aching pain
Special investigations for endodontic examination
- Percussion
- Palpation
- Mobility
- 6PPC of tooth
- Sensibility: EPT, cold
- Radiographs
- Frac finder/ tooth sleuth
- Test cavity
- Selective anaesthesia
Which nerves do EPT typically stimulate?
A-delta
C fibres may not respond
In what cases may EPT readings be unreliable?
Open apices
Recent trauma
2 diagnoses in AAE endodontic diagnosis
Pulpal diagnosis
Periapical diagnosis
AAE pulpal diagnoses (7)
- Normal pulp
- Reversible pulpitis
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Pulpal necrosis
- Previously treated
- Previously initiated treatment
AAE apical diagnoses (6)
- Normal apical tissues
- Symptomatic apical periodontitis
- Asymptomatic apical periodontitis
- Acute apical abscess
- Chronic apical abscess
- Condensing osteitis
Contraindications to endodontic treatment
Myocardial infarction within last 6 months
Considerations for patients with CVD to undergo RCT (3)
- Stress reduction protocol:
- Short appointments
- Sedation
- Pain & anxiety control
Considerations for diabetic patients to undergo RCT
Schedule appt so that does not interfere with patients normal insulin & meal schedule
2 guides for assessing case difficulty and the need for referral for endodontic treatment
AAE endodontic case difficulty assessment form
NHS Restorative Dentistry Index of Treatment need - Complexity Assessment
Discussion points to cover when consenting patient to endodontic therapy
- Procedure
- Prognosis
Irreversible pulpitis: 90%
Pulpal necrosis: 80% - Alternatives to tx
No treatment
Wait for more definitive symptoms to develop
XLA - Risks of tx:
Perforation
Instrument separation
Damage to adjacent restorations
Missed canals
Increased risk of fracture
Failure of endodontic tx - Risks of no tx:
Pain
Infection
Swelling
Loss of teeth
Infection to other areas - Consent
When may sensibility tests yield false positives?
Pulp not totally necrotic
Multirooted teeth (pulp in some canals may still be vital)
3 advantages of CaOH as cavity base/ liners
- High pH & stimulates reparative dentine formation
- Stimulates recalcification of demineralised dentine
- Neutralises low pH of acidic restorative material
3 disadvantages of CaOH as cavity base/ liners
- Cytotoxic
- Weak cement
- Very soluble if not protected
3 design objectives of mechanical preparation
Continuous taper
Maintain original location of apical foramen
Keep apical opening as small as possible
Ideal properties of endodontic disinfection irrigants (14)
- Low cost
- Washing action
- Reduces friction
- Kills planktonic microbes
- Kills biofilm microbes
- Non toxic to periapical tissue
- Non-allergenic
- Enhances cutting of dentine by instruments
- Temperature control
- Dissolves organic & inorganic matter
- Penetrates root canal system
- Does not weaken dentin
- Does not react with negative consequences with other dental materials
4 advantages of NaOCl as endodontic disinfection irrigant
- Potent antimicrobial
- Dissolves pulp remnants & collagen
- Dissolves necrotic & vital tissue
- Disrupts smear layer by acting on organic component
Factors important for NaOCl function (5)
Concentration (0.5% - 6%)
Volume (30ml after instrumentation, final rinse)
Contact (adequate apical preparation + needle size & type)
Exchange
Mechanical agitation (endoactivator, manual dynamic irrigation)
Concentration of NaOCl used for endodontics
0.5% - 6%
3 limitations/ disadvantages of NaOCl
Affects dentine properties: elasticity, flexural strength
Unable to remove smear layer by itself
Effect on organic material
Advantage of EDTA (1)
Capable of removing smear layer when used with NaOCl
Complications of NaOCl use (4)
Discolours fabric
Eye injury (chemical burns)
Extrusion injuries
Allergic reactions
MOA of CHX (3)
Antiseptic
+ charged CHX attracted to - charged phospholipid molecules
Binds to cell wall and causes it to rupture
Cell cytoplasm leaks → lysis → cell death
antiplaque
adsorbs to pellicle, provides bacteriostatic effect lasting 12-14 hours