Endodontics treatment on the clinic Flashcards
Before starting any treatment what must you have taken
A thorough history and examination
What should the history include?
- Complaint of
- History of presenting complaint
- Previous dental history
- Social history
- Medical history
What does the examination include
- Extra oral exam
- Intra oral exam
- Special tests
Give examples of some special tests
- Radiographs
- Sensitivity/ vitality tests
- Study models
After taking a good history and exam what should you be able to form
A diagnosis
Give examples of some Endodontics related diagnoses we can come to
- Reversible pulpitis
- Irreversible pulpitis
- Acute periodical inflammation
- Chronic periapical inflammation
- Chronic suppurative periapical inflammation
- Acute periapical abscess/celulitis
Which fibres are often affected in reversible pulpitis
A delta fibres
Which fibres are affected by irreversible pulpits
C fibres
What questions about the pulp should you ask yourself before making a treatment plan
Can the pulp be saved?
What is periapical inflammation
When infection spreads beyond the apex of the tooth into the periradicular tissues
What are the symptoms of acute periapaical inflammation
Short sharp pain with a spontaneous onset but short duration
What are the symptoms of chronic periapaical inflammation
Usually asymptotic
What can happen when you treat chronic periapical inflammation
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
What is a phoenix abscess?
It is acute exacerbation of a chronic periapical lesion. It can occur immediately following root canal treatment if bacteria is left in the canal
What is the difference between cellulitis and an abscess
Cellulitis is a diffuse inflammatory process characterised by oedema, redness pain and interference of function
An abscess is a localised collection of pus
Gove examples of vital Endodontics treatment
Pulp capping
Direct pulp cap
Pulpotomy
Pulpectamy
How do we cap a pulp
We leave a small layer of dentine over the pulp and avoid exposing it to bacteria
How do we place a direct pulp cap
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
What is the first thing you aim to treat with any patient
Treat any pain they have come in with
What is the aim of emergency treatment
To relieve symptoms
Give examples of emergency treatment we can carry out to help Endo patients
- Seal dentinal tubules if they have reversible pulpitis
- Access clean and drain if they have symptomatic irreversible pulpitis
- Prescribe antibiotics if they have SYSTEMIC symptoms and spreading infection
Where does Endodontics treatment fall in a full treatment place
After placing definitive restorations but before the designing of fixed or removable dentures
Before starting any treatment what must you gain from the patient
Consent (also let patient know of cost and prognosis in general practice)
Give some tooth factor you must consider before starting Endodontics treatment
- 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
- Also consider if you can get a rubber dam onto and around the tooth
How must we assess the restorability of a tooth
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
What can happen if you down remove any restorations on the tooth and just start accessing through the restoration
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
List the equipment needed for Endodontics treatment
- Patient protection
- La and topical
- Rubber dam kit
- Oro seal
- floss and wedgets
- Cons kit with hand pieces
- Endo kit
- Irrigant and syringe
- Hand files
- Protaper golds and k files
- Apex locater
- Paper points, GP
- Non setting calcium hydroxide
- Finger spreader
- Tubiseal and mixing pad
- Any restoration material needed
Talk through the standard timeline for an Endodontics treatment plan
- History, examination, diagnosis and emergency treatment
- Confirm restorability, place provision restoration and finalise treatment plan
- Prevention, period and caries management before treatment
- Access and working length determination
- Prepare the canals
- Obturate the canals
Talk through the stages we follow when preparing a canal
- Access
- Coronal flare using gates gladdens or SX
- Determine working length
- Prepare using pro tapers of k files
How do we create a corona flare
Can either use:
SX (more conservative)
OR
Gates gliddens (removes more tooth tissue)
When do we obturate the canals
- No symptoms
- No odour
- When we have thoroughly cleaned the canal
Name the 4 radiographs we usually take during RCT
- Pre op
- Working length
- Master point
- Post op
List the main complaints defence bodies receive from patients undergoing RCT
- Poor communication
- Unsatisfactory treatment
- Failure to make appropriate diagnosis
- Incorrect/ unnecessary treatment
- Fee dispute
- Post treatment complication
How can you reduce the risk of being sued
- Provide treatment to the best of your ability
- Explain the treatment to your patient
- Keep carful records
What must your records include
- Patients complaint, symptoms and history
- Clinical signs and special tests
- Diagnosis and treatment plan
- LA type and amount used
- Working length and reference points
- Instrumentation and preparation
- Type of root filling material and sealer used
- Number of radiographs
- Type of restoration material used
- Any complications
State the claim that if a patient makes is usually indefensible
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
