Endo OSCE Flashcards
How do you perio probe
Insert probe into sulcus until resistance
* parallel to long axis of tooth
* tip against tooth
* .2-.25N of pressure
What does probing assess?
Gingival Health
Cracked Teeth
BOP=Inflammation
Suppuration=neutrophils/infection
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
What can cause mobility
Loss of Periodontium
Occlusal Trauma
Occlusal trauma
Primary:
* Greater than normal occlusal forces are placed on teeth
Secondary:
* Normal or excessive occlusal forces placed on perio compromised teeth
Signs of occlusal trauma
Fremitus
mobility
Widened PDL
How is occlusion evaluated in endo?
Articulating Paper
What is the most important diagnostic aid
Listening to pt’s chief complaint
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%
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
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
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
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%
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
What is more informative, Cold or EPT?
Cold
* can indicate pulp condition
EPT:
* Only indicate vital or necrotic
What is the rationale for using a control tooth?
Reference
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
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
Abnormal Palpation results, percusion results, or bite tests results in what diagnosis
Symptomatic apical periodontitis
Acute apical abscess=swelling present
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
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?
- Create coordinated efffort across health professionals
- Foundation for learning continuum in interprofessional competency development
- Evaluation & research will strengthen scholarship
- 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
