Endodontics treatment on the clinic

Question 1

Before starting any treatment what must you have taken

Answer 1

A thorough history and examination

Question 2

What should the history include?

Answer 2

1. Complaint of
2. History of presenting complaint
3. Previous dental history
4. Social history
5. Medical history

Question 3

What does the examination include

Answer 3

1. Extra oral exam
2. Intra oral exam
3. Special tests

Question 4

Give examples of some special tests

Answer 4

1. Radiographs
2. Sensitivity/ vitality tests
3. Study models

Question 5

After taking a good history and exam what should you be able to form

Answer 5

A diagnosis

Question 6

Give examples of some Endodontics related diagnoses we can come to

Answer 6

1. Reversible pulpitis
2. Irreversible pulpitis
3. Acute periodical inflammation
4. Chronic periapical inflammation
5. Chronic suppurative periapical inflammation
6. Acute periapical abscess/celulitis

Question 7

Which fibres are often affected in reversible pulpitis

Answer 7

A delta fibres

Question 8

Which fibres are affected by irreversible pulpits

Answer 8

C fibres

Question 9

What questions about the pulp should you ask yourself before making a treatment plan

Answer 9

Can the pulp be saved?

Question 10

What is periapical inflammation

Answer 10

When infection spreads beyond the apex of the tooth into the periradicular tissues

Question 11

What are the symptoms of acute periapaical inflammation

Answer 11

Short sharp pain with a spontaneous onset but short duration

Question 12

What are the symptoms of chronic periapaical inflammation

Answer 12

Usually asymptotic

Question 13

What can happen when you treat chronic periapical inflammation

Answer 13

Sometimes treatment may allow an increased level of oxygen to enter the previously closed tooth
The bacteria may then become aerobic causing the tooth to flare (phoenix abscess)
Patient will not be happy as tooth is now symptomatic when it wasn’t before

Question 14

What is a phoenix abscess?

Answer 14

It is acute exacerbation of a chronic periapical lesion. It can occur immediately following root canal treatment if bacteria is left in the canal

Question 15

What is the difference between cellulitis and an abscess

Answer 15

Cellulitis is a diffuse inflammatory process characterised by oedema, redness pain and interference of function
An abscess is a localised collection of pus

Question 16

Gove examples of vital Endodontics treatment

Answer 16

Pulp capping
Direct pulp cap
Pulpotomy
Pulpectamy

Question 17

How do we cap a pulp

Answer 17

We leave a small layer of dentine over the pulp and avoid exposing it to bacteria

Question 18

How do we place a direct pulp cap

Answer 18

In a clean environment under rubber dam we place a layer of material (non setting calcium hydroxide or RMGIC) over the pulp before placing our restoration on top

Question 19

What is the first thing you aim to treat with any patient

Answer 19

Treat any pain they have come in with

Question 20

What is the aim of emergency treatment

Answer 20

To relieve symptoms

Question 21

Give examples of emergency treatment we can carry out to help Endo patients

Answer 21

1. Seal dentinal tubules if they have reversible pulpitis
2. Access clean and drain if they have symptomatic irreversible pulpitis
3. Prescribe antibiotics if they have SYSTEMIC symptoms and spreading infection

Question 22

Where does Endodontics treatment fall in a full treatment place

Answer 22

After placing definitive restorations but before the designing of fixed or removable dentures

Question 23

Before starting any treatment what must you gain from the patient

Answer 23

Consent (also let patient know of cost and prognosis in general practice)

Question 24

Give some tooth factor you must consider before starting Endodontics treatment

Answer 24

1. Confirm if the tooth is restorable. If it is not restorable there is no point trying to save it when a crown can not be placed on top
2. Also consider if you can get a rubber dam onto and around the tooth

Question 25

How must we assess the restorability of a tooth

Answer 25

You CAN NOT rely solely on clinical and radiographic exam so you must remove any restorations on the tooth to be able to accurately assess restorability

Question 26

What can happen if you down remove any restorations on the tooth and just start accessing through the restoration

Answer 26

You will not know the status of the tooth tissue under the restoration (it may be infected with secondary caries) This means there could be a bacteria reservoir under the restoration that could lead to Endodontics failure

Question 27

List the equipment needed for Endodontics treatment

Answer 27

1. Patient protection 2. La and topical 3. Rubber dam kit 4. Oro seal 5. floss and wedgets 6. Cons kit with hand pieces 7. Endo kit 8. Irrigant and syringe 9. Hand files 10. Protaper golds and k files 11. Apex locater 12. Paper points, GP 13. Non setting calcium hydroxide 14. Finger spreader 15. Tubiseal and mixing pad 16. Any restoration material needed

Question 28

Talk through the standard timeline for an Endodontics treatment plan

Answer 28

1. History, examination, diagnosis and emergency treatment 2. Confirm restorability, place provision restoration and finalise treatment plan 3. Prevention, period and caries management before treatment 4. Access and working length determination 5. Prepare the canals 6. Obturate the canals

Question 29

Talk through the stages we follow when preparing a canal

Answer 29

1. Access 2. Coronal flare using gates gladdens or SX 3. Determine working length 4. Prepare using pro tapers of k files

Question 30

How do we create a corona flare

Answer 30

Can either use: SX (more conservative) OR Gates gliddens (removes more tooth tissue)

Question 31

When do we obturate the canals

Answer 31

1. No symptoms 2. No odour 3. When we have thoroughly cleaned the canal

Question 32

Name the 4 radiographs we usually take during RCT

Answer 32

1. Pre op 2. Working length 3. Master point 4. Post op

Question 33

List the main complaints defence bodies receive from patients undergoing RCT

Answer 33

1. Poor communication 2. Unsatisfactory treatment 3. Failure to make appropriate diagnosis 4. Incorrect/ unnecessary treatment 5. Fee dispute 6. Post treatment complication

Question 34

How can you reduce the risk of being sued

Answer 34

1. Provide treatment to the best of your ability 2. Explain the treatment to your patient 3. Keep carful records

Question 35

What must your records include

Answer 35

1. Patients complaint, symptoms and history 2. Clinical signs and special tests 3. Diagnosis and treatment plan 4. LA type and amount used 5. Working length and reference points 6. Instrumentation and preparation 7. Type of root filling material and sealer used 8. Number of radiographs 9. Type of restoration material used 10. Any complications

Question 36

State the claim that if a patient makes is usually indefensible

Answer 36

If the dentist fails to protect the oropharynx from ingestion of foreign bodies such as inhalation or swallowing of an Endodontics instrument it is likely that any resultant claim with be indefensible