Endo OSCE Flashcards by Connor Schmidt

How do you perio probe

Insert probe into sulcus until resistance
* parallel to long axis of tooth
* tip against tooth
* .2-.25N of pressure

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What does probing assess?

Gingival Health
Cracked Teeth
BOP=Inflammation
Suppuration=neutrophils/infection

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How do you test and classify mobility?

Miller Classification: Mobility
1. Grade 1: 0.5-1.0 mm (more than normal)
2. Grade 2: 1.0-2.0 mm
3. Grade 3: >2.0 mm Or depressible

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What can cause mobility

Loss of Periodontium
Occlusal Trauma

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Occlusal trauma

Primary:
* Greater than normal occlusal forces are placed on teeth

Secondary:
* Normal or excessive occlusal forces placed on perio compromised teeth

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Signs of occlusal trauma

Fremitus
mobility
Widened PDL

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How is occlusion evaluated in endo?

Articulating Paper

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What is the most important diagnostic aid

Listening to pt’s chief complaint

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How do you perform vitality testing

Cold or EPT

PFM crown
* Can’t be tested accurately
* access prep w/o anesthesia, Vital pulp- surface of restoration or enamel can be penetrated w/o too much discomfort–>if vital=sudden pain w/dentin is reached; Necrotic if no discomfort or pain w/dentin

Cold Test
* Carbon Dioxide snow or refrigerant
* sensitivity=75% (ability to detect pulp necrosis that is verified clinically)
* Specificity=92% (ability to detect normal pulp)

EPT:
* Sensitivty: 92%
* Specificty: 75%

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How to perform percussion testing? What does it assess?

Tap on tooth either parallel or perpendicular to crown
* painful=periapical iinflammation-might be sharp pain
* Percuss neighboring teeth and contralateral
* Neighboring teeth often show some tenderness-spread of cytokine and neuropeptides=lower pain threshold

If pain on chewing
* Bite test-bite down on cotton swab

Sharp, Brief pain on biting
* Tooth slooth or cotton swab
* reproduce symptom
* apply to different cusps until pt recongnized same type of pain=CRACK
* might be hidden under large occlusal restoration

Normal to occlusal percussion but sensitive to lateral percussion
* cause=occlusal prematurity or wear pattern in lateral excursion

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How do you perform palpation? What does it assess?

Firm pressure on mucosa over the apex
* how far inflammatory process has extended periapically
* Painful response=Periapical inflammation

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What does heat indicate and how is it performed? What are the possible results?

Performed:
* Warm gutta percha
* Warm water
* Burlew wheel
* Polishing Point

Not as accurate as cold or EPT

Exaggerated and lingering after hold or cold=Irreversible pulpitis
* No response w/other tests=Pulp Necrosis

Stimulate C fibers

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What does cold indicate and how is it performed? What are the possible results?

Endo Ice: Tetrafluoethane (- 26 C)
Carbon Dioxide Snow (-98C)

Stimulates A delta fibers

False Negative Response
* happens w/calcific metamorphosis

False Positive:
* cold contacts gingive or transferred to adjacent teeth w/positive pulps

Exaggerated & LIngering reponse=irreversible pulpitis
No response=Pulp Necrosis

CO2 Snow: (-98C)
* Sensitivity=75% (detect pulp necrosis & verified clinically)
* Specificity: 92% (Detect normal pulp)

EPT:
* Sensitivity: 92%
* Specificity: 75%

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What does EPT indicated and how is it performed? What are the possible results? What do the numbers mean?

Directly stimulate nerve fibers w/a gradually increasing current
* Does not cause tubule fluid movement

Advantage: Calcified canals
Disadvantage: only detects vital or non-vital

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What is more informative, Cold or EPT?

Cold
* can indicate pulp condition

EPT:
* Only indicate vital or necrotic

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What is the rationale for using a control tooth?

Reference

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What is transillumination? What does it test? What is a positive transillumination? What instrument is used to perform this test?

Identifies longitudinal crown fractures
* Fracture does not transmit light

Mandibular 2nd molar=most commonly cracked tooth

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What is the tooth slooth and what is it used for?

Bite test

When pt presents with sharp, brief pain on biting
* Tooth slooth or cotton swab to reproduce
* =Crack

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Abnormal Palpation results, percusion results, or bite tests results in what diagnosis

Symptomatic apical periodontitis

Acute apical abscess=swelling present

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What is Vista Blue and what is it used for?

Vista Blue
* Detect fractures and hard to find root canal orifices
* unit dose packaging-limit risk of staining
* individual brush tip-used for 1 pt and no sterilization/Throw away

Methylene blue due
* superior pooling and visibility
* preferred over caries indicator dyes for identifying extra and intra-coronal cracks
* Apply w/disposable applicator tip
* Will stain clothing and countertops

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Describe the indication for antibiotic use

Pt has:
1. systemic involvement
* fever, malaise, cellulitis, trismus, dysphagia, lymphadenopathy, immunocompromised

Acute apical abscess w/no drainage
* can also do I&D

Strategies for post-op pain control

Penicillin:
* 1g loading
* 500 mg q6h 3-7 days

Amoxicillin:
* 1g loading
* 500 mg q8h 3-7 days

Clindamycin (for endo)
* 600 mg loading
* 300 mg q6h x7 days

MILD PAIN
Ibuprofen
* up to 800 mg q6h

MODERATE PAIN:
Tylenol 500 mg q6h

SEVERE PAIN (impacted teeth, perio surgery, complex implant placement)
Hydrocodone q6h

What are pulpal diagnosis

Normal
* Inflamed
* Reversible Pulpitis
* Symptomatic Irreversible pulpitis
* Asympatomatic Irreversible Pulpitis
* Necrotic
* Previously initiated tx
* Previously treated

Normal Pulp

No Symptoms
normal response to pulp testing
* mild or transient response to cold test
* does not last more than 1 or 2 secs

Reversible Pulpitis

inflammed vital Pulp-> Can heal to NORMAL Discomfort w/cold or sweet * goes away w/in a couple of seconds Causes: * Exposed dentin * careis or deep restorations No spontaneous pain

Symptomatic Irreversible Pulpitis

Vital inflammed pulp=can't heal TX=RCT Characteristics: * Sharp pain to thermal stimulus * Lingering pain (30 secs or longer) * Spontaneous-wakes patient up at night * Sometimes sensitive to heat * Referred pain * Postural changes-analgesics don't work Causes: * Deep caries * extensive restorations * fractures exposing pulp

Asymptomatic Irreversible pulpitis

Vital inflamed pulp can NOT heal TX=RCT No symptoms: * respond normal to thermal causes: * trauma * Deep caries--> pulp exposure

Pulp Necrosis

Pulp Death * No response to thermal testing-> can be due to calcified canal, recent hx of trauma, or just not responding * asymptomatic Does not cause apical periodontitist by itself unless canal is infected

Previously Treated Pulp

Endo treated tooth * Canals are obturated but not intracanal medicaments * no response to cold or EPT

Previously Initiated Pulp therapy

partial endo treated tooth * Pulpotomy or pulpectomy * may not repsond to endo testing Might still have symptoms

Normal Apical Tissue

Not sensitive to Percussion/Palpation * Radiographically-intact PDL/Lamina dura * Normal Bone

Symptomatic Apical Periodontitis

Periapical Inflammation * painful to biting, percusion or palpation Radiographic: * Normal * Widened PDL * Periapical Radiolucency

Asymptomatic Apical Periodontitist

Inflammation & Destruction of apical periodontium * Origin: Pulp Periapical Radiolucency * No discomfort to percussion, palpation, biting

Chronic Apical Abscess

Gradual Onset-little to no discomfort Asymptomatic * Sinus tract present-pus * Periapical Radiolucency * No discomfort to palpation, percusion, or biting

Acute apical abscess

Rapid onset * spontaneous pain * extreme tenderness to palpation/percussion * swelling Might have fever, malaise, lymphadenopathy Usually has apical radiolucency

Condensing Osteitis

Diffuse radiopaque lesion at apex * Long standing apical inflammation rare

Local Anesthesia Strategies

If there is a periapical lesion of endo origin, the pulp dx is?

Necrotic

Distinguish b/w various post-op complications (and strategies to prevent them from happening)

Pre-op pain decreased by * 50% after 24 hr * 90% after 1 week Sinust tract heals b/w 1-2 weeks Apical Radiolucency * 88% show signs of healing b/w 3-12 months post-op

What are the 6 specialities represented in IPEC

Dentistry Nursing Medicine Osteopathic Medicine Pharmacy Public Health

What are the 4 topics of interest for competencies

Values & Ethics Roles & Responsibilities Interprofessional communication Teams and teamwork

Triple Aim

Improve pt experience of care Improve population health Reduce per capita cost of health care Implemented in Patient Protection & Affordable Care Act in 2010

What other fields should health professional be competent in?

Law Business Architecture Urban Planning Teaching Engineering

Most important outcome of IPEC's expanded competency model?

Providing an enabling framework for * clinical care providers * public health practitioners * professionals from other fields To collaberate more effectively * optimize health care across multiple disciplines * Advance population health

How many dental schols required IPE in 2012? 2015?

2012: 34% 2015: 69%

Commission on Dental Accreditation (CODA) is member of what related to IPE

Health Professions Accreditors Collaborative (HPAC)

What are the modules & topics of IPEC

Modules: * range from case-based resources, evaluation tooths, & multimedia resources Primary Topics: * Communication skills * curriculum development or evaluation * health education * clinical performance evaluation

What are the 8 reasons why it is important to agree on a set of core competencies across professions?

1. Create coordinated efffort across health professionals 2. Foundation for learning continuum in interprofessional competency development 3. Evaluation & research will strengthen scholarship 4. Inform professional liscencing of potential testing content for interprofesional collaberative practice

Sub-competencies for values & ethics

Pt's & Populations interests at the center of interprofessional health care delivery Promote health & health equity across life span Respect the privacy of pts by maintaining confidentiality during team based care

Subcompetencies of Roles & Responsibilities

Recognize limits in skills, knowledge & abilities communicate clearly role & responsibility to pts, families, etcs

Sub-competencies of interprofessional communication

give instructive feedback to others on team * respond respectfully to feedback from others use respectful language during difficult situations

Sub-competencies: Team & Teamwork

Use available evidence to inform effective teamwork and team-based practices Peform effectively on teams & in different roles