Endodontics - should you treat this case? Flashcards
What questions should you ask yourself before performing endo?
Is treatment indicated?
Is maintaining the patients tooth in their best interests?
(carry out a patient evaluation)
Should I treat this tooth or should a specialist?
What factors are involved in a patient evaluation?
Medical status - recent CV problems? diabetes? Cancer treatment?
Psychological status
Social factors
(medical)
At what stage of pregnancy should ONLY emergency treatment be carried out?
1st trimester
(Other endo procedures can be carried out 2nd and 3rd.)
(medical)
In terms of cardiovascular disease, what is a strong contraindicator to endodontic treatment?
MI in the past 6 months
(medical)
When carrying out endo treatment on a patient with CV disease what kind of protocol must you adapt?
A stress reducing protocol
i.e.
Shorter appointments
Sedation
Anxiety & pain control
(medical)
What must you consider when treating a patient who has underwent/ currently receiving chemotherapy/radiotherapy?
Poor healing
(medical)
What kind of endodontic disease can compromise a diabetic - even if well controlled?
Acute endodontic infection
(medical)
What must you consider in a patient with diabetes?
Poorer healing/poorer outcomes - must be monitored closely.
Have to minimise stress.
(medical)
What kind of patient takes biphosphates?
An individual with osteoporosis
All of these patients are considered a high risk.
(medical)
What is the aim(s) in terms of endodontic treatment with patients taking biphosphonates?
Preventative care
Non-surgical tretament
(medical)
What must you always be cautious of in a patient taking biphosphonates?
BRONJ
Osteonecrosis of the jaw.
(dental)
If a tooth requiring endo treatment has a poor periodontal status what is the appropriate treatment?
Extraction
- endo treatment cannot be performed since the tooth is likely to be mobile.
(dental)
If the tooth is unrestorable, should it be endodontically treated?
no - some exceptions
(dental)
Can you carry out endodontic treatment without appropriate isolation of the tooth?
No
List some factors that would influence the prognosis of endodontic therapy (6)
Separation of instruments during instrumentation
If a perforation occurs during instrumentation
If there are ledges
Calcification of the pulp chamber - makes it difficult to locate the pulp chamber on a radiograph.
Resorption - Can occur externally or internally
Development anomalies/difficult anatomy
What must be covered in consent for endodontic treatment?
Ensure consent is obtained for each step of the treatment plan.
Options available
The prognosis and why that is the case.
The risks/complications
Ensure they know that they will require a restoration once the endo treatment has been carried out.
Let them ask any questions
What is the success rate for a tooth with irreversible pulpitis and NO periradicular radiolucency?
90% over 10 years
What is the success rate for a tooth with a necrotic pulp?
80% over 10 years
What are the possible complications of endodontic treatment?
Perforation
Separated instruments
Post-operative pain
Extrusion of various solutions. (NaOCl etc)
Describe the minimal level of difficulty for an endodontic case.
Preop indicates routine complexity - normal
(contributing factors only in the minimal difficulty category)
Likely that a predicatble outcome can be attained
Describe the moderate level of difficulty for an endodontic case.
Preop indicates complexity
(1 or more contributing factors in moderate difficulty category)
Predicatble outcome would be challenging for an experienced and competent practitioner
Describe the high level of difficulty for an endodontic case.
Preop indicates exceptional complexity
(several contributing factors in moderate difficulty category and at least 1 in the high difficulty category)
Predicatble outcome would be challenging for an experienced and competent practitioner
