Endodontic Disinfection Flashcards
If we chemically
remove the contents
of the pulpal system
& introduce a dye:
A far more
COMPLEX anatomy
is revealed
Instrumentation fails to
contact with a
large
portion of the hidden
spaces which are filled
with bacteria (and
substrate)
WE MUST:
Remove & Destroy both the Bacteria
and their Substrate to be successful*
We can access only a percentage of the
complex anatomy & “protected areas” by any
instrumentation:
60-70%
–%Sodium
Hypochlorite
(NaOCl)
8.3
OUR MAJOR WEAPONS:
CLEANING AND SHAPING with NaOCl and
INTRA-CANAL MEDICAMENTS
ADMINISTRATION OF NaOCl:
Keeps you —. From WL
2mm
MUST NOT have tip of
syringe beyond
apical
constriction ***
(Do NOT allow tip to BIND in
the canal)
NaOCl — micro-organisms on
contact
kills
NaOCl destroys &
dissolves
substrate
NaOCl fxns (5)
Disorganizes Biofilm
Dilutes Toxins in canal system
Disinfects RC System & Instruments
Lubricates Canals
Floats out Debris
When NaOCl
breaks down,
what do we
have?
NaCl & H2O
WHEN
does it
break
down?
(2)
- In the
bottle - In the
TOOTH *
NaOCl becomes inactive after —
min. in the canal so it must be
replenished every — min.
3-5
Important to IRRIGATE
following
each ACTIVE
INSTRUMENT
Dakin’s solution is often used
for
It is —% NaOCl.
surface disinfection.
0.25
8.3% NaOCl (Clorox) is —
times STRONGER and
MORE TOXIC – also more
effective!
33.2
Typical case requires about —
cc. of NaOCl
as irrigant per visit
10-12
NaOCl must be in contact with shaped canal a
minimum of – minutes after canal enlarged
to #– or larger.
30
30
A canal smaller than #30 will seldom if ever
allow any irrigant to reach the apical 1/3 of the cana
“—” following each active instrument
Recapitulate
“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
