Endodontics - Add to Overall Flashcards
Can periodontal disease affect the pulp?
Area of fibrosis
Areas of mineralisation
narrower canals
Reparative responses
If blood supply through apical foramen remains intact, pulp can withstand insult from perio disease
Pulpal necrosis only seen when perio disease advanced that microbes reach apical foramen
Can periodontal treatment affect the pulp?
RSI can remove cementum and expose dentinal tubules
Pulpal changes seen adjacent foci of inflamm +/- secondary dentine formation
How can scaling RSI and polishing affect the pulp?
Heat application to intact enamel can increase pulp temp between 5-17C causing irreversible pulpitis
Frictional heat depends on:- speed- torque- amount of force
Cause odontoblast death
How can endodontic pathology to affect the periodontium require?
A patent route to the periodontium
Infected root canal system
Sufficient virulent microbes to provoke a periodontal response
Do lateral canals cause infrabony defects?
Lateral canals in an infected/necrotic pulp may cause lateral periodontal lesions rarely
Can periodontal disease exert an effect on lateral canals?
Where the subgingival biofilm reached a lateral canal, the microcirculation was severed, but inflammation of the adjacent pulpal tissue was minimal
When the subgingival biofilm reached the apical foramen, the whole pulp became necrotic
Can endodontic disease affect the periodontium?
Loss of periodontal attachment directly correlated with the presence of endodontic infection
Patients have deeper pockets, increased CAL, higher freq of vertical/angular defects
Pulpal infections serve as a risk factor in patients prone to periodontitis (other papers say otherwise)
Both endo and perio disease is a microbial infection, microbes associated with a necrotic pulp are fewer than the complex biofilm in a deep periodontal pocket
Host response with be acute abscess or chronic inflamm response
How to drain an endodontic abscess?
Insert a GP cine and radiographCan drain through the PDL space to the sulcus
Can endodontic treatment affect the periodontium?
5-10C elevations in external root temp can produce damage to PDL
Gutta percha increases flow
Tip heated to 250-600C
External root temp between 8.5-22.1Ok to use with care
Name the 8 foreign body reaction in the periodontal and periradicular tissues?
Dentine and cementum chips
Amalgam
Root canal filling material
Intracanal dressing, sealers and obturation materials
Cellulose fibres
Leguminous foods
Calculus
Can cause acute or chronic reaction
Multinuc giant cells surround foreign body
What will influence the treatment options and prognosis?
Timing and amount of remaining perio support
What is the classification system for perio and endo lesions?
2017 World Workshop Periodontitis associated with endodontic lesions
Explain the clinical examination for a possible endo or perio lesion?
Palpation
Percussion pocket probing
Mobility
Sinus or pus draining through PDL
If sinus is present, palpate to see if discharging
If so, insert gutta percha cone and radiograph
Explain the diagnosis procedure for a possible endo or perio lesion?
Special tests
To differentiate between perio and endo
Sensitivity test
Higher false positives in teeth with advanced periodontitis
If perio only tooth will respond to sensitivity testing
Use 2 tests to increase reliability
Test cavities to differentiate between perio and endodontic pathosis
Both perio and endo affecting tooth form a perio-endo lesion
Characterised by CAL, bone loss and periradicular pathology
What symptoms should I suspect with a perio-endo lesion?
Hisotry of symptoms
History of surgery deep pockets (average root lengths)
Furcation
Pus exuding from deep pockets or swellings
