Introduction to Endodontics Flashcards
Endodontics
Endodontics is the dental specialty
pertaining to the prevention and
treatment of apical periodontitis
The white paper form focuses on three key areas critical to
competent endodontic treatment:
diagnosis, treatment planning
and prognosis
skipped
Diagnostic standards include
the ability of the dentist to
assimilate the necessary subjective, objective and
radiographic information to establish a pulpal and/or
periapical diagnosis, provide appropriate emergency care
and referral, and maintain proper patient records and
documentation.
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Treatment planning standards include
case
assessment to evaluate the difficulty of treatment
and consideration of referral, development of a
treatment plan that takes into account the
restorability of the tooth, and special consideration
for traumatic dental injuries.
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Competency in the prognosis of
endodontic treatment requires
that clinicians
be able to forecast the outcome of initial
nonsurgical root canal treatment.
— diagnosis and treatment of oral pain of pulpal
and/or periapical origin
Differential
— — therapy such as pulp capping (direct/indirect) and
pulpotomy;
Vital pulp
— treatment of root canal systems with or without
periradicular pathosis of pulpal origin, and the —
(filling) of these root canal systems;
Nonsurgical
obturation
Selective — removal of pathological tissues resulting from
pulpal pathosis;
surgical
Intentional (2); — of avulsed
teeth
extraction and replantation
replantation
Surgical removal of tooth structure such as in
root-end resection,
bicuspidization, hemisection and root resection; root-end filling,
endodontic implants, etc.
Internal — of discolored dentin and enamel (teeth)
bleaching
— of teeth previously treated endodontically; and
treatment procedures related to coronal restorations by means
(2) involving the root canal space.
Retreatment
of post and/or cores
REGENERATIVE ENDODONTICS
• The incorporation of newer biological
therapies seek to allow us to:
(4)
– Revitalize previous necrotic teeth
(dead pulps)
– Re-establish normal tooth sensation
– Continue the root formation of
immature teeth with open apices
– Newer materials and protocols
Endodontist:
A dentist with two or more
years of advanced training in the scope of
endodontics who has received a certificate in
endodontics from an advanced education
program accredited by the ADA Commission
on Dental Accreditation and who limits his or
her practice to endodontics.
Board-certified endodontist:
As
defined by the American Board of
Endodontics, an endodontist who has
passed the certifying examination
administered by the American Board
of Endodontics. . . Written, Oral, Cases
Generally speaking, when root canal
treatment (RCT) is performed competently,
greater than —% of treatments will heal,
depending on factors of —, quality
of RCT and whose study you read.
90
selection
AAE vs. AES & the Focal Infection Theory (2)
AAE is the reliable source of endodontic information
Accepted as a dental specialty by ADA and recognized
globally as the premier Endodontic organization.
All CODA accredited Post Graduate Endodontic
Programs (about 50 in US with 400 students)
American Endodontic Society (AES)
(4)
NOT Accepted by ADA or any recognized faction of
organized dentistry in the World.
Not affiliated with any recognized graduate Programs,
SODs in US or military.
Standards of care are questionable and open to
possible legal liability.
Encourage non-recognized, dangerous and often
illegal methods and materials such as N2, RC2B or
Sargenti method
N2: Sargenti Technique
(6)
• Non-FDA approved material
• Sloppy technique (not biologically sound)
• Contains para-formaldehyde and other
hazardous chemicals that are left in the treated
tooth PERMANENTLY
• Court precedent of large judgments following
damage related to N2 usage (no defense for its
use)
• Malpractice insurance companies may ask (on
their application) if you use this material
• Some insurance companies will “rate” you for
using N2
• Use at your own risk
Focal Infection Theory
Focal infection theory (FIT) is the notion that a local infection
affecting a small area of the body can lead to subsequent infections
and/or symptoms in other parts of the body.
400 BC- Hippocrates first proposed
1891-WD Miller first paper
1900 & 1911-Wm Hunter, an English physician
wrote extensively about why he believed in FIT
Rosenow continued the idea in 1931
By the mid 30s, validity began to be questioned.
1952-JAMA heralded the end of the FIT, but 60+ years later, FIT still has its
uneducated proponents.
Focal Infection Theory (FIT)
Seeks to
establish RCT teeth as the source of infection within
the body & seeks removal of the RCT tooth as a cure for
many and sundry (unrelated) diseases and maladies.
Focal Infection Theory (FIT)
Not based in fact & remains
unproven by scientific studies in
> 100 years.
Focal Infection Theory (FIT)
It may be true that severe periodontal disease has a role in
increased risk of (3)
low birth weight babies, cardiovascular
disease and diabetes.
The universally preferred schema of organization &
documentation of case histories.
SOAP
Think in terms of using this method for
all cases
SOAP is reqired by many
insurance companies
S:
Subjective (What the patient tells you)
This is an expansion of the Chief Complaint from your questions and the
patient’s answers
O:
Objective (What you observe to be true) ie. your pulp
tests»>The results of your clinical examination and testing
A:
Assessment (Diagnosis) What your findings indicate to be the
problem. This must relate to the chief complain (CC.) Need both Pulpal DX and
Peri=Radicular DX.
P:
Plan or Procedure (This is how & what you plan to
accomplish in the way of treatment relating to the DX)
A Proper — precedes everything.
Medical History
Before you do anything else –
Document the Health History and ask appropriate questions for clarification of medical conditions and medications
The “Patient Interview” is NEXT:
Major Objective: obtain
CC (Chief Complaint) in
the exact words of the patient –document it.
As soon as the Subjective (S) phase is documented,
you may progress to the Objective (O) phase.
A. Now do a brief oral examination with mirror to
determine the area(s) of concern.
B. Take diagnostic radiographs of the areas of
immediate concern.
C. Your objective is to develop your preliminary
Hypothesis of what may be going on and how you
may design your Clinical Testing to prove or disprove
your hypothesis.
Do your own Detective
Work. Do NOT trust
Records or what others say.
Best to standardize your Clinical Exam routine:
(3)
A. Perform an in-depth problem focused Examination
B. Perform the indicated Clinical Testing Procedures
C. Record results in an permanent & organized manner
it is necessary to be certain you and the patient are
— — with each other.
communicating clearly
Additional questioning of the patient may generate further
—- of the complaints and of test results.
clarification
— are studied to add to the data available.
Radiographs
SOAP” : A = Assessment
• After thorough evaluation of all organized
data collected, an Assessment of the problem
related to the CC is thoughtfully determined.
• NOW it’s not a hypothesis any more; it’s a
Diagnosis (DX) supported by your
documentation of your examination and
clinical testing.
–Pulpal DX
–Peri-radicular DX
P = PLAN
• If you know what it is; it should be a simple matter to know
what to do for it. If you DON’T have a DX, you can do NO
TREATMENT*
• Limited treatment planning (problem focused but with an eye
to comprehensive care) is done at this point.
• All Reasonable Options for the CC are explored and
presented to the patient to involve the patient in treatment
decisions and to obtain informed consent.
• Only then can treatment proceed.
