Endodontic BDS4 Summary Flashcards
What is the main aim of root canal treatment? 2
To eliminate INFECTION
remove root canal contents
What do we assess for endodontics?
Tooth colour
Soft tissue - any swellings
Palpate the soft tissue
sinus presence
TTP?
Sensibility testing
Radiographs
Prev restoration?
How is pain transmitted?
Via CNV and its three branches
What are A delta fibres?
The A-delta fibers are somatic, myelinated fibers that have primary connections to the cortical regions of the brain. These fibers convey sharp, lancinating, easily localized pain signals; this pain sensation usually quickly passes
What are C fibres?
C fibers respond to stimuli which have stronger intensities and are the ones to account for the slow, lasting and spread out second pain. These fibers are virtually unmyelinated and their conduction velocity is, as a result, much slower which is why they presumably conduct a slower sensation of pain
What are the types of sensibility tests?
Ethyl chloride
EPT
test adjacent sound teeth first so pt knows what to expect
What do sensibility tests assume?
That tooth having a nerve supply correlates to mean it has a vital blood supply
What does EPT do?
This is where we apply conducting medium such as toothpaste to tooth and pt holds to complete circuit and it generates AP in A delta fibres (short sharp pain) and when pt feels pain breaks circuit
What does Ethyl chloride do?
Cold stimulus applied that stimulates A delta fibres
SIs for endo?
Sensibility testing
Radiographs
Tooth sleuth
Selective anaesthetisa
What are the types of pulpal diagnosis?
Normal pulp
Reversible pulpitis
Asymptomatic Irreversible pulpitis
Symptomatic irreversible pulpitis
Pulpal necrosis
What is a normal pulp?
This is where the pulp is symptom free, normal response to testing
Mild/transient response to cold testing which lasts 1/2 seconds following removal
What is reversible pulpits?
Inflammation of the pulp that is capable of healing following management of cause
Tooth experiences discomfort to cold stimulus/sweet stimulus when applied but assess after few seconds of removal
not spontaneous
common in carious or prev restored tooth
What is symptomatic Irreversible pulpitis?
This is where pulp is inflamed and incapable of healing and RCT is indicated
Radiogaphuically - may be winding of PDL or loss of LD and only if chronic will be PA radiolucency
spontaneous, lingering pain, hard to localise, hot and cold, awake at night, OTC analgesia not effective
What is asymptomatic irreversible pulpitis?
This is where pulp inflamed, not capable of healing but tooth is asymptomatic - hard to dx
may have widened PDL or loss of LD
What is pulpal necrosis?
This is where pulp is no longer vital - has died
may prev have been symptomaitic but now asymptomatic and pulp has liquefied
if long standing can get PA radiolucency
What are the PA diasnoses?
Symptomatic apical periodontitis
Asymptomatic apical periodontitis
Chronic apical abscess
Acute apical Abscess
Condensing osteitis
What is Symptomatic apical periodontitis?
This is where there is inflammation of the apical periodontium, widening of the PDL, loss of LD, tooth is TTP, sporadic pain, RCT indicated
What is asymptomatic apical periodontitis?
This is where there is inflammation of apical periodontium, widening of PDL, loss of LD but tooth is not symptomatic - often small bony swelling present
What is an acute apical abscess?
This is where there is an inflammatory rxn to pulpal infection and necrosis - rapid onset, spontaneous pain, TTP, pus, swelling, often no radiographic changes
systemic malaise
What is a chronic apical abscess
Longstanding response to pulpal infection/necrosis
pt often has bad taste and may have sinus tract with discharging pus nbut little to no symptoms
PA radiolucneyc
What is condensing osteitis?
This is where there is a diffuse radiopaque lesion as a result of low grade inflammatory response (infection)
What are the tx options in Endo?
No intervention with review
Orthograde RCT
Re-RCT
Retrograde surgical RCT
How do we carry out endo?
Front surface mirror
Good light
Magnification
If pulp is NV and cause is endo what is tx?
RCT
If pulp is NV and cause is perio and endo what is tx
RCT then 7-10 days later perio tx
If pulp is vital and cause is endo what is tx?
RCT
or if pulpitis reversible then caries removal
What causes endodontic infection?
It is causes by microorganisms which invade the root canal space and proliferate and develop biofilms which adhere to dentine and make eradication difficult