endodontic decision making

Question 1

diagnosis

Answer 1

1) patient can localize tooth 73.3% of the time
2) periradicular pain (swelling)
- localize 89% of the time

Question 2

clinical diagnosis

Answer 2

1) facial asymmetry, swelling
2) look for oozing in vestibule

Question 3

radiographic diagnosis

Answer 3

1) radiograph of periradicular area
2) inserted sinus tract with GP >= size 40

Question 4

weird pimples

Answer 4

1) can trace GP into a very large, strange pimple to a tooth

Question 5

diagnoses in painful teeth

Answer 5

1) hypersensitivity
2) reversible pulpitis
3) etc. etc.

Question 6

hypersensitivity

Answer 6

1) fast onset, short, piercing, localized pain
2) mainly to cold
3) treatment of cervical area with precipitating agents
4) or mechanical blockage of tubules
5) replacement of leaking temp fillings

Question 7

reversible pulpitis

Answer 7

1) acute, stabbing, localized
2) exacerbated by cold
3) carious lesion
4) tooth fracture
5) leaking restorations, new restorations
6) cracks
7) exposed dentin

Question 8

clinical findings of reversible pulpitis

Answer 8

1) sensitivity positie
2) pain lasts little longer
3) cold stimulus
4) etc

Question 9

radiograph of reversible pulpitis

Answer 9

1) caries lesion or trauma lesion
2) no periapical radiolucency

Question 10

therapy of reversible pulpitis

Answer 10

1) restore or RCT

Question 11

irreversible pulpitis

Answer 11

1) sharp pain, difficult to localize
2) heat and cold sensitivity
3) lingers pain >= 30 secs
4) referred or radiating pain
5) visible duration and intensity

Question 12

clinical findings of irreversible pulpitis

Answer 12

1) extensive carious lesion or recurrent
2) large, deep restorations, cast restorations
3) coronal tooth fracture

Question 13

irreversible pulpitis radiograph

Answer 13

1) carious lesion or trauma lesion
2) no PA radiolucency
3) 60-79% of RCTs caused by carious pulp exposure
- 18,5% related to restoration

Question 14

emergency

Answer 14

1) 2 appointments
- effective treatment in minimal time, completion at next appointment
2) perception of pain
- influenced by anesthesia
- reaction to pain

Question 15

pulpotomy

Answer 15

1) sterile cotton pellet and temporary filling relieves pain in 96% of cases
2) for irreversible pulpitis
3) eugenol or corticosteroid base
- bring them back to do RCT if older
- younger might not need RCT

Question 16

pulpectomt

Answer 16

1) caOH2 in RC
2) come back for RCT

Question 17

irrreversible pulpitis

Answer 17

1) therapy
- coronal flaring
- instrumentation
- NaOCl irrigation
- electronic working length
- afterwards, radiographic length determination >= 90% accurate
- preparation to apical size

Question 18

dressing

Answer 18

1) Ca(OH)2 only after complete extirpation
2) antimicrobial placed with paper point
3) rotate into canal wiht lentulo spiral
4) seal cavity
5) patient may have pain or discomfort for 48 hours - NSAID

Question 19

Ca(OH)2 application

Answer 19

1) syringeable or powder
- not recommended to inject
2) use lentulo

Question 20

pulp necrosis

Answer 20

1) symptomatic apical periodontitis
2) symptomatic apical abscess

Question 21

necrosis

Answer 21

1) spontaneous pain, dull throbbing
2) radiating paint

Question 22

clinical findings of necrosis

Answer 22

1) darkened tooth
2) sensitivity testing negative
3) palpate apex

Question 23

necrosis radiograph

Answer 23

1) narrow roots
2) mineralization in pulp chamber
3) widened PDL in acute apical periodontitis
4) deep carious lesion, tooth fracture

Question 24

necrosis therapy

Answer 24

1) root canal is usually infected, antimicrobial strategy

Question 25

sodium hypochlorite accidents

Answer 25

1) tissue dissolving incidents
2) can be locked into roots
3) cooling packs, afterwards hot packs
3) antibiotics against secondary infection
4) oral surgeon may have to see them

Question 26

aspiration and ingestion of foreign bodies

Answer 26

1) MUST LIGATE RUBBER DAM CLAMPS

Question 27

acute apical abscess

Answer 27

1) drainage via pointed scalpel
2) drain access through debridement via root canal
3) incise and drain abscess if possible
4) never leave tooth open to oral cavity
5) antibiotics if you did not completely drain

Question 28

root filled tooth

Answer 28

1) cannot be retreated in an emergency visit
2) therapy: extraction or prescription of antibiotic

Question 29

trauma

Answer 29

1) ex root fracture
- poor prognosis unless practure located apically
2) extraction therapy

Question 30

fracture or not

Answer 30

1) cervical and middle root fractures have worst prognosis

Question 31

resorption associated with orthodontic tooth movement

Answer 31

1) trauma
2) orthodontic tooth movement
- crushing blood vessels

Question 32

radiograph exam must have

Answer 32

1) PA must include whole tooth
2) must include normal and abnormal structures
3) two angulations may be needed to confirm findings
4) if abnormal structure is too large for a PA radiograph, use panorex
5) CBCT may be indicated

Question 33

endo perio diagnosis

Answer 33

1) dental history of pain
2) sensitivity
3) mobility

Question 34

pain symptoms of non dental origin

Answer 34

1) cyclical with day or seaseon
2) paresthesia without a source
3) travels around midline of the face