Outcome 5 - Endodontics Flashcards
What is Endodontics?
A dental specialty that prevents, diagnoses, and treats not only dental pulp but also surrounding tissues such as nerves, blood vessels and tissues that surround the tooth.
What are reasons for the pulp nerve to have trauma?
-Physical irritation due to tooth sensitivity such as hot and cold (exposed dental tubules)
-Trauma due to blow to the tooth or jaw
-Extent of the decay
-Periodontal condition
-Presence of extensive restorations
-Tooth mobility
-Swelling or discoloration
-Pulp exposure
What are the symptoms of pulp trauma?
-discomfort or pain when eating
-discomfort or pain when in neutral occlusion
-Sensitvity to hot and cold
-Facial Swelling and/or tooth discoloration
-Fever
“Yes” answers to these questions will indicate urgent care is needed
- Do you have moderate to severe lingering “toothache” pain when drinking hot liquids or eating hot foods?
- Do you have pain when chewing or biting on a tooth?
- Is your tooth sensitive to touch or pressure?
- Do you experience slight swelling in the area? Do you have a bubble on the gum that looks like a pimple, when pressed in the region may release blood or pus?
- Does toothache pain wake you up at night?
- Are you taking any medications now, if so is the pain relieved?
- Do you have pain that starts at one tooth and then radiates or is referred to other regions of the upper or lower jaw, or head?
4 Pulp Testing Techniques
- Radiographs
- Percussion and Palpation
- Thermal Testing
- Electrical Pulp Testing
How can radiographs diagnose pulp trauma?
a. Periapical radiographs may show the precense of infection, extent of dental caries, and proximity of the caries lesion to the pulp.
What is Percussion?
Tapping the incisal or occlusal surface of the tooth with the handle of a mouth mirror and comparing it to a “control” tooth
What is Palpation for Pulp trauma?
Applying firm pressure with the index finger to the mucosa near the apex of the tooth and to a “control” area
What is Thermal Testing?
-Dry ice or ethyl chloride on a cotton applicator are used to apply a cold stimulus to a non-restored tooth and a “control” tooth
-a heated piece of gutta percha may also be used
What is Electrical Pulp Testing?
Using small electrical current to test the pulp
How does Normal Pulp react to Thermal Testing?
reacts to hot and cold with a sudden reaction which disappears as soon as the stimulus is removed
How does Early Pulp Disease react to Thermal Testing?
reacts with a sharp pain in the tooth that lingers as a throbbing pain once the stimulus is removed this is called pulpitis and depending on the circumstance, the pulp may recover
How does Irreversible Pulpitis react to thermal testing?
Reacts as a sharp severe pain which remains as an intolerable throbbing once the stimulus is removed - the pulp will not recover if this is the reaction as the vitality of y the pulp decreses heat may create pain. Cold may relieve it - the pulp will not recover at this stage
How does Necrotic Pulp react to thermal testing?
No sensation at all within the pulp when either hot or cold stimulus is applied
-endo treatment or extraction
If applicaple, what is the first endodontic treatment?
Pulpal therapy will be preformed first to generate pulpal stimulation or regeneration. When pulpal therapy is not effective, root canal therapy or surgery will be performed.
What are the 3 Pulpal Regeneration Procedures?
Pulp Capping
Pulpotomy
Pulpectomy
If pulpal therapy is not successful or not applicable due to diagnostic prognosis, what treatment will be done?
Root Canal Therapy
How many appointments for RCT?
Nowadays, root canal therapy can be completed within one appointmnt, unless the dentist is not able to remove infection, in this case the dental assistant will place intermediate temporary restoration and the patient will be scheduled for another appointment.
When are surgical endodontic procedures performed?
They are performed when conventional root canal treatments are not successful or they are not an option for a particular patient.
The most common reasons for surgical endodontic procedures are…
-when there has been a failure of the root canal treatment
-when surgery is required into the apex and periapical tissue
-to perform biopsy
Types of Surgical Endodontic Procedures?
Apical curettage
Apicoectomy
Retrograde restoration
Root amputation
Hemisection
What is Apical Curettage?
Removal of pathologic soft tissue around the infected root apex with the use of a curette
What is Apicoectomy?
The surgical removal of the apex of a root with a high-speed handpiece and bur
It is usually required because penetration through the apex has occurred during root canal treatment.
What is Retrograde Restoration?
Gingival tissue is flapped
Small portion of bone is cut to access apex of affected tooth
Root apex is sealed with: guttapercha/amalgam/composite
Reasons for failure to reach the apex during endodontic procedure include…
-Curved Roots
-Canal Calcification
-Operator Error
What is Root Amputation?
The removal of one or more roots of a multi-rooted tooth without the removal of the crown. The amputations occur at the point where the root joins the crown (furcation) and is often seen on maxillary teeth.
What is Hemisection?
the crown and root are cut vertically, with one root and a half of the crown being removed.
Often seen on mandibular molars.
How long can temporary filling be in place for?
No longer than 90 days
Purpose of temporary restorative materials?
to maintain occlusion and keep the patient comfortable for a limited time
What does IRM stand for?
Intermediate Restorative Materials
What are the post operative instructions for patient following endodontic treatment?
-Instructions regarding anesthetics used
-Instructions regarding any medications used or prescribed
-to call the office if any pain or swelling occurs after treatment
-let the patient know that they will need to return to the office for a final restoration (if temp was placed)
-follow up appointment is required to check on the healing of the completed root canal
What is a Pre-Op Instruction for a patient for endodontic treatment?
-What to expect througout the treatment procedure
If a temporary restoration is placed, the patient should also be notified that…
-if the filling breaks or becomes dislodged in anyway they need to notify the office
-temporary fillings are not to be left for more than 90 days and the patient will need to return to have a permanent restoration completed
-if their bite feels off or high to call the office
What solution is used to irrigate canals?
Solution can be hydrogen peroxide, a hypochlorite solution or sterile water injected from a syringe.
MUST NOT be obtained from a municipal water source in order to not contaminate the pulp chamber
Purpose of an apicoectomy?
remove remaining persistent infection of the root apex
Purpose of Apical Curettage?
Removes remaining persistent infection of the peri-radicular tissues.
Decreases infection/bateria causing/promoting infection
Promotes healing at the site
When is a Retrograde Restoration required?
when the apical seal is not adequate
When is a Root Amputation required?
if only one root of a multi-rooted tooth is infected
When is a Hemisection required?
Required if only one side of a tooth is affected
