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 and destory both the __________________ to be successful with a root canal
bacteria and their substrate
We can access only ___% of the complex anatomy & “protected areas” by any instrumentation
60-70%
What are the benefits of using irrigants in a root canal treatment?
- Removal of debris and wetting of the canal walls
- Destruction of organic debris.
- Destruction of microorganisms
- Opening dentinal tubules by removal of the smear layer.
What is the major form of disinfection?
sodium hypoclorite
What are the major weapons in disinfection?
CLEANING AND SHAPING WITH NaOCL and INTRA-CANAL MEDICAMENTS
How does NaOCl work?
- kills micro-organisms on contact
- destroys & dissolves
substrate - 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 NaOCl break down?
- In the bottle
- In the TOOTH
What are the properties of sodium hypochlorite?
- Strong Oxidizer
- Powerful Disinfectant
- Dissolves Necrotic Tissue @ low concentration
- Dissolves Living Tissue @ higher concentration
Why is sodium hypochlorite dangerous?
Extremely TOXIC
- Never forget Eye Protection and never PASS anything over Face
____% NaOCl (Clorox) is 33.2 times STRONGER and MORE TOXIC – also
more effective!
8.3%
NaOCl becomes inactive after ____ min.
3-5
How often does NaOCl need to be replenished?
3-5 minutes
Important to irrigate following each…
active instrument
NaOCl must be in contact with shaped canal a minmum of ______ minutes after canal enlarged to #30 or larger
30 minutes
MUST NOT have tip of syringe beyond ________ constriction
apical
Set the bend at ___ mm short of WL
2 mm
Typical case requires about _____ cc. of NaOCl as irrigant per visit
10-12
Vigorous injection will cause irrigant to express…
apically
What is important about using NaOCl in the mouth considering it is toxic?
- Do NOT let the tip BIND
- Keep tip MOVING & LOOSE in canal
- Tastes Terrible in mouth (Burns throat)
- Dental Dam must NOT leak
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
What are the results if the irrigating needle is allowed to bind in the canal?
- Immediate & Extreme pain for several days
- Ecchymosis
- Swelling
- Temporary disfigurement
How can you undo a NaOCl accident?
There is NO WAY to UNDO a NaOCl accident after it happens
Who needs eye protection while using NaOCl?
*Your Patient
*Your Assistant
*Yourself
How do you protect clothes from NaOCl leaking from the tip?
place your gloved hand under the syringe as you remove it from the tooth
___% EDTA is introduced to the canal system and allowed to work for 60 seconds.
17%
What do you put in the tooth following EDTA?
followed by 8.3 % NaOCl to stop action of Ethylene Diamine Tetra-acetic Acid
What does EDTA stand for?
Ethylene Diamine Tetra-acetic Acid
What is Ethylene Diamine Tetra-acetic Acid (EDTA)?
- Cheleating Agent
- Removes Inorganic Tissue
What is a smear layer?
SMEAR LAYER is produced when we do any mechanical shaping in dentin. It lies on the surface of the dentinal tubules.
Smear layer 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
Some studies will encourage ____________ OR OTHER irrigants as well; we don’t believe this is necessary. No Biofilm removal, precipitate formation.
2% Chlorhexidine
Can we sterilize the root-canal system?
Tt may NOT ALWAYS be possible to eliminate 100% of the micro-organisms, toxins and substrate within the complex canal systems present.
What is an endo activator?
sonic/ultrasonic vibration of NaOCl
- This device agitates irrigation solutions during endodontic treatment. Evidence-based endo has shown that cavitation and acoustic streaming significantly improve debridement and the disruption of the smear layer and biofilm
What are 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.
_______: near universal acceptance as the intracanal medication of choice- pH between 11 and 12
CaOH
What does CaOH do?
- 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 “Ultraca
What is the pH range of CaOH?
11 and 12
Use ______ to dissolve organic tissue and to kill microorganisms
NaOCl
Use a needle that fits loosely ___ mm from WL. Irrigate with an in-and-out gentle movement
2.0 mm
Replenish NaOCl every ______ minutes/after every active instrument
3-5
_________ removes inorganic portion of the “smear layer”
EDTA
CaOH: intracanal medication of choice- pH between _______
11 and 12
