Endodontic Disinfection Flashcards by sophie rosen

If we chemically
remove the contents
of the pulpal system
& introduce a dye:

A far more
COMPLEX anatomy
is revealed

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Instrumentation fails to
contact with a

large
portion of the hidden
spaces which are filled
with bacteria (and
substrate)

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WE MUST:

Remove & Destroy both the Bacteria
and their Substrate to be successful*

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We can access only a percentage of the
complex anatomy & “protected areas” by any
instrumentation:

60-70%

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–%Sodium
Hypochlorite
(NaOCl)

8.3

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OUR MAJOR WEAPONS:

CLEANING AND SHAPING with NaOCl and
INTRA-CANAL MEDICAMENTS

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ADMINISTRATION OF NaOCl:
Keeps you —. From WL

2mm

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MUST NOT have tip of
syringe beyond

apical
constriction ***
(Do NOT allow tip to BIND in
the canal)

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NaOCl — micro-organisms on
contact

kills

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NaOCl destroys &
dissolves

substrate

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NaOCl fxns (5)

Disorganizes Biofilm
Dilutes Toxins in canal system
Disinfects RC System & Instruments
Lubricates Canals
Floats out Debris

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When NaOCl
breaks down,
what do we
have?

NaCl & H2O

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WHEN
does it
break
down?
(2)

In the
bottle
In the
TOOTH *

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NaOCl becomes inactive after —
min. in the canal so it must be
replenished every — min.

3-5

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Important to IRRIGATE
following

each ACTIVE
INSTRUMENT

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Dakin’s solution is often used
for
It is —% NaOCl.

surface disinfection.
0.25

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8.3% NaOCl (Clorox) is —
times STRONGER and
MORE TOXIC – also more
effective!

33.2

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Typical case requires about —
cc. of NaOCl
as irrigant per visit

10-12

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NaOCl must be in contact with shaped canal a
minimum of – minutes after canal enlarged
to #– or larger.

30
30

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A canal smaller than #30 will seldom if ever

allow any irrigant to reach the apical 1/3 of the cana

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“—” following each active instrument

Recapitulate

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“Recapitulation” means:
(4)

*Flood canal system with NaOCl
*Do this EVERY 3-5 minutes
*Use a #10 file to WL (as necessary)
*Then move on with next active instrument

You were given a 12 cc.
syringe for a reason:

You should Use it ALL @ each
appointment

Sodium Hypochlorite:
(4)

Strong Oxidizer
Powerful Disinfectant
Dissolves Necrotic Tissue
@low concentration
Dissolves Living Tissue
@higher concentration
Med. of CHOICE (Endodontics)

Sodium Hypochlorite: Strong Oxidizer Powerful Disinfectant DANGEROUS ! Extremely TOXIC If Swallowed:

Call Poison Center 1-800-222-1222 KU Med. Dental Dam must NOT Leak EYES: Flush w/ water 15 min. Never forget Eye Protection and Never PASS anything over Face

NaOCl is EXTREMELY ---

TOXIC

Even WITH special tip: *Vigorous injection will cause irrigant to express ---*

apically

*Vigorous injection will cause irrigant to express apically* (5)

* Be Careful * Do NOT let the tip BIND * Keep tip MOVING & LOOSE in canal * Tastes Terrible in mouth (Burns throat) * Dental Dam must NOT leak

NaOCl Incidents: Use extreme care with NaOCl If the irrigating needle is allowed to bind in the canal,

NaOCl can be easily forced out the end of the tooth into the P/A tissues with disastrous results:

f the irrigating needle is allowed to bind in the canal, NaOCl can be easily forced out the end of the tooth into the P/A tissues with disastrous results: (5)

Immediate & Extreme pain for several days Ecchymosis Swelling Temporary disfigurement Court appearance ?

NaOCl accidents

There is NO WAY to UNDO a NaOCl accident after it happens PREVENT NaOCl Accidents

EYE PROTECTION at ALL TIMES:

*Your Patient *Your Assistant *Yourself

eyewash stations

EYE WASH STATIONS AVAILABLE in BOTH LABS FIND THEM – KNOW HOW TO USE THEM

Protect clothing:

The tip of the syringe WILL LEAK as you remove it from the tooth.

Dr. Robert Edwards suggests that you

place your gloved hand under the syringe as you remove it from the tooth.

sonic/Ultrasonic Vibration of NaOCl : Endo Activator

*This device agitates irrigation solutions during endodontic treatment. Evidence-based endodontics has shown that cavitation and acoustic streaming significantly improve debridement and the disruption of the smear layer and biofilm.

Sonic/Ultrasonic Vibration of NaOCl May be helpful:

Especially in difficult and unusual canal systems. Does not diminish time of use for NaOCl

Endo Activator doesn’t reduce the

overall time required for effective irrigation of the canals

The SMEAR LAYER is produced when

we do any mechanical shaping in dentin. It lies on the surface of the dentinal tubules.

It is NOT removed by NaOCl and the SMEAR LAYER occludes access to the Dentinal Tubules so must be removed to complete the CLEANING procedure before OBTURATION or when using various Sealers and Cements. with??

EDTA

---% EDTA is introduced to the canal system and allowed to work for --- seconds. Then followed by --- % NaOCl to stop action of ---

17 60 8.3 Ethylene Diamine Tetra-acetic Acid (EDTA)

Some studies will encourage --- OR OTHER irrigants as well; we don’t believe this is necessary. why?

2% Chlorhexidine No Biofilm removal, precipitate formation

Can we sterilize the root-canal system?

Even with all the latest methods of Cleaning & Shaping, Irrigation and Disinfection, It may NOT ALWAYS be possible to eliminate 100% of the micro-organisms, toxins and substrate within the complex canal systems present.

Intracanal Medications:

Medications placed within the canal system between appointments. Intended to increase local anti- microbial action and to further decrease the microbial challenge within the RC system.

CaOH:

near universal acceptance as the intracanal medication of choice

CaOH pH

pH between 11 and 12

skipped CaOH (5)

- Discourages most microbial growth - Long lasting (effective over extended periods) - No reported allergic responses - Easy to apply & remove as a paste - Available in clinic as “Ultracal”

Therefore: All potential “Portals of Entry/Exit” must therefore be

sealed creating a Dense Liquid Tight (Hermetic) Seal “OBTURATION” and FINAL RESTORATION to PREVENT LEAKAGE

Use NaOCl to

dissolve organic tissue and to kill microorganisms

Use a needle that fits loosely

2 mm from WL. Irrigate with an in-and-out gentle movement

Replenish NaOCl every ---minutes/after every active instrument

3-5

EDTA removes

inorganic portion of the “smear layer”

CaOH:

intracanal medication of choice- pH between 11 and 12