Intro to endodontic dental techniques

Question 1

What is endodontics?

Answer 1

The branch of dental science that deals with the aetiolgy, diagnosis, prevention and management of diseases of the dental pulp and their sequelae (encompasses much more than root canal therapy!)

Question 2

What are the 4 principles of endodontics?

Answer 2

• Respect the integrity of the pulp and periodontal tissues by avoiding mechanical and chemical trauma
• Protect the vital pulp (pulp capping)
• Provide root canal therapy for traumatised or infected teeth
• Carefully follow up all treatments

Question 3

What is pulp capping?

Answer 3

We use a calcium hydroxide lining = stimulates production of secondary dentine in pulp

Question 4

Which treatments does endodontics encompass?

Answer 4

• Care in pupal preservation (i.e. water coolant and not desiccating the cavity)
• Pulp capping (with fine exposure)
• Pulpotomy (deciduous teeth n.b. this is difficult because the root resorb = try to remove infected pulpal material from coronal pulp chamber)
• Pulpectomy and RCT
• Surgical endodontics (turning gum back and cutting into the root of the tooth to fill)

Question 5

What are the problems with surgical endodontics?

Answer 5

Quite damaging (often have to remove quite a lot of bone to reach the apex (not as good an outcome) & compromises suitability for taking successful dental implants

Question 6

What are the different stages of root canal therapy?

Answer 6

• Diagnosis
• Access
• Canal preparation
• Canal medication
• Obturation
• Follow up

Question 7

What is the history of endodontics?

Answer 7

• Worm theory = caries and abscesses caused by a white worm with a black head that lived within the tooth (treated with arsenic)
• Greeks and Romans destroyed the pulp by cautarising it with a hot needle, using boiling oil, placing opium and hyoscyamus in the pulp)
• Opening the tooth to allow drainage, post crowns placed on the remaining open tooth stumps, sepsis around crown and bridges = ivory tooth plugged in = acts like cork), draining sinuses were common (non life threatening), bacteriology and radiology
• Modern treatment

Question 8

What bacterial mix is found in the root?

Answer 8

Aerobic and anaerobic (changes to more anaerobic gram negative over time)
= symbiotic relationship of bacteria (streptococci, prevotella oralis, porphyromonas commonly in root canals) = different groups around failing root fillings

Question 9

What is the modern treatment?

Answer 9

Shape, clean, obturate (fill

Question 10

What is an apical seal?

Answer 10

Root fillings with a stable, non-irritant and perfect seal

Question 11

What is a coronal seal?

Answer 11

Total obturation of the canal space

Question 12

What happens if you lose a coronal seal?

Answer 12

The sealers resorb out = failure of the filling (micro-leakage)

Question 13

Why is it difficult to root canal a crowned or heavily filled tooth?

Answer 13

No natural surface anatomy

Question 14

What does diagnosis include?

Answer 14

History (medical, dental i.e. history of pain, swelling and trauma and social history)
Clinical examination
Special investigations

Question 15

How is medical health relevant to endodontics?

Answer 15

• No longer conditions that contraindicate endodontics
• Special care required in: Bleeding tendencies, immuno-supressed patients and any patient finding lengthy treatment difficult
• Conditions where endodontics is preferred to extraction i.e. Osteoporosis or other conditions treated with bisphosphonates

Question 16

Which questions should be asked when taking a history of pain?

Answer 16

How long? Constant or intermittent?
Can the patient identify the tooth?
The type of pain? Throbbing (dying pulp), stabbing (inflammation), dull, shooting, severity
Initiating, provoking, relieving factors? (hot and cold = vital tooth, sweet = caries)
Can the pain be localised?
Does the pain stop sleep?

Question 17

When do we get pulpal pain?

Answer 17

A result of inflammation of the pulp

Question 18

How do we manage pulpal pain?

Answer 18

Is the inflammation reversible? Conservative treatment i.e. removal of irritant such as caries, sedative dressing

Is the inflammation irreversible? Tooth removed or root canal therapy to remove the pulp

Question 19

What questions need to be asked about the history of swelling?

Answer 19

Site
Size
Shape
Consistency
Draining pus? 
History of previous episodes?

Question 20

What questions need to be asked about the history of trauma?

Answer 20

• Exposure of pulpal tissues at time of injury
• Silent death of a pulp many years later
• Generalised calcification of the canals (cant find canals, problem if remenants of pulp = can flare up and be difficult to access)

Question 21

When assessing a tooth radiographically what should you look for in the pulp chamber?

Answer 21

• Position of roof and floor

- Note the amount of reparative dentine

Question 22

When assessing a tooth radiographically what should you look for in the root canals?

Answer 22

• Number of roots and canals
• Degree of generalised calcification, pulp stones
• Curvature

Question 23

What sized pulp chambers do young peoples teeth have?

Answer 23

Large (older people start sclerosing closed)

Question 24

How do we assess the mouth?

Answer 24

• dental status = missing teeth, active caries, restorative condition
• soft tissues = periodontal inflammation, plaque control, evidence of draining sinus. swelling, erythema, ulceration

Question 25

How do we assess an individual tooth?

Answer 25

LOOK:

• > colour
• > caries/ restorative status
• > presence of sinus
• > erythematous over apex

TOUCH:

• > mobility
• > tender to tapping
• > tender to palpation over apex

INVASIVE:

• > Vitality
• > Local periodontal condition
• > Radiography to show pulpal morphology (number of cusps, radiography)