Endodontics - should you treat this case?

Question 1

What questions should you ask yourself before performing endo?

Answer 1

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?

Question 2

What factors are involved in a patient evaluation?

Answer 2

Medical status - recent CV problems? diabetes? Cancer treatment?

Psychological status

Social factors

Question 3

(medical)

At what stage of pregnancy should ONLY emergency treatment be carried out?

Answer 3

1st trimester

Other endo procedures can be carried out 2nd and 3rd.

Question 4

(medical)

In terms of cardiovascular disease, what is a strong contraindicator to endodontic treatment?

Answer 4

MI in the past 6 months

Question 5

(medical)

When carrying out endo treatment on a patient with CV disease what kind of protocol must you adapt?

Answer 5

A stress reducing protocol

i.e.
Shorter appointments
Sedation
Anxiety & pain control

Question 6

(medical)

What must you consider when treating a patient who has underwent/ currently receiving chemotherapy/radiotherapy?

Answer 6

Poor healing

Question 7

(medical)

What kind of endodontic disease can compromise a diabetic - even if well controlled?

Answer 7

Acute endodontic infection

Question 8

(medical)

What must you consider in a patient with diabetes?

Answer 8

Poorer healing/poorer outcomes - must be monitored closely.

Have to minimise stress.

Question 9

(medical)

What kind of patient takes biphosphates?

Answer 9

An individual with osteoporosis

All of these patients are considered a high risk.

Question 10

(medical)

What is the aim(s) in terms of endodontic treatment with patients taking biphosphonates?

Answer 10

Preventative care

Non-surgical tretament

Question 11

(medical)

What must you always be cautious of in a patient taking biphosphonates?

Answer 11

BRONJ

Osteonecrosis of the jaw.

Question 12

(dental)

If a tooth requiring endo treatment has a poor periodontal status what is the appropriate treatment?

Answer 12

Extraction

- endo treatment cannot be performed since the tooth is likely to be mobile.

Question 13

(dental)

If the tooth is unrestorable, should it be endodontically treated?

Answer 13

no - some exceptions

Question 14

(dental)

Can you carry out endodontic treatment without appropriate isolation of the tooth?

Answer 14

No

Question 15

List some factors that would influence the prognosis of endodontic therapy (6)

Answer 15

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

Question 16

What must be covered in consent for endodontic treatment?

Answer 16

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

Question 17

What is the success rate for a tooth with irreversible pulpitis and NO periradicular radiolucency?

Answer 17

90% over 10 years

Question 18

What is the success rate for a tooth with a necrotic pulp?

Answer 18

80% over 10 years

Question 19

What are the possible complications of endodontic treatment?

Answer 19

Perforation

Separated instruments

Post-operative pain

Extrusion of various solutions. (NaOCl etc)

Question 20

Describe the minimal level of difficulty for an endodontic case.

Answer 20

Preop indicates routine complexity - normal
(contributing factors only in the minimal difficulty category)

Likely that a predicatble outcome can be attained

Question 21

Describe the moderate level of difficulty for an endodontic case.

Answer 21

Preop indicates complexity
(1 or more contributing factors in moderate difficulty category)

Predicatble outcome would be challenging for an experienced and competent practitioner

Question 22

Describe the high level of difficulty for an endodontic case.

Answer 22

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