endodontic decision making Flashcards
diagnosis
1) patient can localize tooth 73.3% of the time
2) periradicular pain (swelling)
- localize 89% of the time
clinical diagnosis
1) facial asymmetry, swelling
2) look for oozing in vestibule
radiographic diagnosis
1) radiograph of periradicular area
2) inserted sinus tract with GP >= size 40
weird pimples
1) can trace GP into a very large, strange pimple to a tooth
diagnoses in painful teeth
1) hypersensitivity
2) reversible pulpitis
3) etc. etc.
hypersensitivity
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
reversible pulpitis
1) acute, stabbing, localized
2) exacerbated by cold
3) carious lesion
4) tooth fracture
5) leaking restorations, new restorations
6) cracks
7) exposed dentin
clinical findings of reversible pulpitis
1) sensitivity positie
2) pain lasts little longer
3) cold stimulus
4) etc
radiograph of reversible pulpitis
1) caries lesion or trauma lesion
2) no periapical radiolucency
therapy of reversible pulpitis
1) restore or RCT
irreversible pulpitis
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
clinical findings of irreversible pulpitis
1) extensive carious lesion or recurrent
2) large, deep restorations, cast restorations
3) coronal tooth fracture
irreversible pulpitis radiograph
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
emergency
1) 2 appointments
- effective treatment in minimal time, completion at next appointment
2) perception of pain
- influenced by anesthesia
- reaction to pain
pulpotomy
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
pulpectomt
1) caOH2 in RC
2) come back for RCT
irrreversible pulpitis
1) therapy
- coronal flaring
- instrumentation
- NaOCl irrigation
- electronic working length
- afterwards, radiographic length determination >= 90% accurate
- preparation to apical size
dressing
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
Ca(OH)2 application
1) syringeable or powder
- not recommended to inject
2) use lentulo
pulp necrosis
1) symptomatic apical periodontitis
2) symptomatic apical abscess
necrosis
1) spontaneous pain, dull throbbing
2) radiating paint
clinical findings of necrosis
1) darkened tooth
2) sensitivity testing negative
3) palpate apex
necrosis radiograph
1) narrow roots
2) mineralization in pulp chamber
3) widened PDL in acute apical periodontitis
4) deep carious lesion, tooth fracture
necrosis therapy
1) root canal is usually infected, antimicrobial strategy
sodium hypochlorite accidents
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
aspiration and ingestion of foreign bodies
1) MUST LIGATE RUBBER DAM CLAMPS
acute apical abscess
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
root filled tooth
1) cannot be retreated in an emergency visit
2) therapy: extraction or prescription of antibiotic
trauma
1) ex root fracture
- poor prognosis unless practure located apically
2) extraction therapy
fracture or not
1) cervical and middle root fractures have worst prognosis
resorption associated with orthodontic tooth movement
1) trauma
2) orthodontic tooth movement
- crushing blood vessels
radiograph exam must have
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
endo perio diagnosis
1) dental history of pain
2) sensitivity
3) mobility
pain symptoms of non dental origin
1) cyclical with day or seaseon
2) paresthesia without a source
3) travels around midline of the face
