Unit 309 Flashcards
What is the alternative to endodontics?
extraction
Name the 3 non-surgical endodontic treatments?
Pulpectomy
pulpotomy
pulp capping
There are 6 other ways a tooth may need endo treatment other than caries list the 4:
- thermal injury - underlined restorations
- chemical irritation - restorative materials
- tooth fracture
-severe impact injury
-irritation - from deep fills - accidental pulp exposure
Inflammation of the pulp is…
Pulpitis
reversible pulpitis
does not cause pulp death and is treated by restorative filling only.
irreversible pulpitis
partial or full pulp death and requires endodontic treatment.
What type of non-surgical endo treatment is suitable on deciduous teeth?
pulp capping
pulpotomy
How long does it take once an adult tooth has erupted for the root apex to close?
3 years
Ways a dentist can test if the pulp is alive or dead?
periapical radiograph
vitality tests - electrical or temperature
a widened periodontal ligament can inidicate what?
some level of inflammatory response
What symptoms will a patient begin to experience when a pulp is inflammed?
sensitivity, spasms of pain, throbbing pain continuous.
not affected by hot and cold, hypersensitive to vitality testing, no longer tender (TTP)
What to consider when deciding on endodontic treatment?
- Is the tooth useful
- possibility of a tooth restoration if it is badly broken down
- dental health of patient poor OH
- patient co-operation
- medical history - diabetes, heart problems due to re-occuring infections.
-cost
What type of medical conditions should be supportive in regards to endodontics over extractions?
- epilipsy - dentures unsafe
-bleeding disorders- clots unable to achieve - stroke- significant bleeding
- osteoporosis - bone necrosis
- cleft palate
How to gain consent for endodontic treatment?
- explain all treatment options
-costs
-advantages disadvantages
What is the success rate of endodontic treatment?
85%
If a root has more than a 15 degree curvature they should be referred to..
a specialist endodontist
When would antibiotics be required to a patient waiting for endodontic treatment?
to control any severe swelling or infection
What is a pulpectomy?
Remove all pulpal tissue from the pulp chamber.
Fully formed permanent tooth.
What does extirpation mean?
complete removal of the pulpal contents
what does obturation mean?
filling of the root canal
During irrigation what antibacterial disinfectants are used?
- sodium hypochlorite
- chlorhexidine
Success of a pulpectomy depends on what?
a leakproof seal at each end of the rooth canal.
preventing micro-organisms from entering or leaving it.
What is the first stage of pulpectomy?
remove infective material and prepare the canal
What is the second stage of pulpectomy?
ensure the canal is clear of residual contamination before the insertion of the root filling.
Barbed broach (1st stage)
the pulp is extirpated - removed
Reamers and files (1st stage)
to enlarge and shape the canal.
after this it is cleaned and disinfected to prepare a dry, smooth empty canal.
Antiseptic dressing + temporary fill(1st stage)
inserted to seal the entrance to the empty root canal to kill any residual bacteria and prevent contamination between visits.
Gutta Percha (2nd visit)
Canal is obturated with a GP point to seal of the entire canal within a millimetre of the apex.
Barbed broach is
single use disposable item
remove the pulp
Root reamers is
enlarge root canals in a circular fashion so that a filling can be inserted.
All the same lengths but different widths
By hand or rotary handpiece
FILES
Root canal files are
hand or handpiece instruments
same as root reamers but are flexible and for any canal shape present
smooth and clean the walls of enlarged root canals and remove debris.
curved n oval root canals
apex locators are used to
locate the apex
They sound an alarm when the tooth apex has been reached = the working length - all files are then based of this length
Irrigation syringes “endo needle”
wash around the root canal rather than being forced through the apex of the tooth.
Sodium hypochlorite can cause severe damage to soft tissues if they are accidently forced out of the root canal.
root canal pluggers or spreaders
Lateral condensers
long, tapered smooth point to condense the GP points against the canal walls and obliterate any gaps
Rotary paste fillers
inserting pastes into a root canal
materials and medicaments that could cause harm have all been risk assessed in accordance with…
COSHH regulations
Irrigation solution
Lubricate the instruments and wash out any debris.
sodium hypochlorite, chlorhexide, local anaesthetic
Antiseptic paste
non-settling and containing antiseptic anti inflammatories
dress infected root canals for a time before root filling
odontopaste
Cresophene
medical grade creosote
dress infected root canals for time, soaked onto paper points before insertion
lubricating gel
to use with handpieces to ensure the instruments dont snag on the canal walls and snap during use
Glyde
GP points
varying diameter, tapered rubber points used to fill the root canal
same colour coded system as files and reamers
sealing cement
setting cement used to aid the insertion of the GP points and to seal of any residual spaces in the root canal.
restorative materials
used to restore the tooth to full function and appearance after root filling
Why are rubber dams used?
prevent ingress of micro-organisms from the mouth into the canal
prevent accidents such as inhalation or swallowing of instruments
improving access and visibility for the dentist.
What can be used as an alternative for a rubber dam?
small instruments must have a length of dental floss or a parachute chain attached, to allow them to be retrieved if they slip out of the dentist hand.
All endodontic instruments are considered as…
single use items, disposed of in the sharps box
if a patient is due a second stage of endo treatment can their files be re-used?
YES once sterilised
Access to each root canal is gained by using what?
stainless steel bur
gates glidden drill
Access to the pulp chamber is gained by using what?
conventional diamond burs
The working length can be determind by:
Periapical X-ray
Apex locator
Paper points
dry the canals
tubliseal is a modified…
zinc oxide-eugenol cement
If a patient comes back for the second stage of root canal and the root canal is not dry when opened what does this mean?
the apical infection is still present
Pulpotomy is
the removal of the infected part of the pulp in the pulp chamber itself.
Pulp tissue is removed from the crown of the tooth ONLY
What allows healing to occur in an open apex?
very rich blood supply
what is a radicular pulp?
within a developing root that allows the root growth to its natural completion.
pulpotomy- the open root canal is covered with what dressing?
calcium hydroxide
calcium silicate based material - biodentine or MTA
What do the dressings used in pulpotomy procedures do?
stimulate the radicular pulp in the root canal to reduce inflammation, heal and form a secondary layer of dentine.
Pulpotomy - bleeding of the pulp is stopped using?
cotton wool pledgets and pressure
Pulpotomy- pulp tissue is removed from the pulp chamber using?
sharp sterile hand instrument such as excavators
When is a pulpotomy successful?
if the radicular pulp is vital and can seperate itself from the exposure site by laying down a secondary dentine bridge
Open apex root filling technique:
seals the open apex over time by the successive growth of calcium layers to narrow the open apex
RCT later date
Open apex technique - Spiral root canal filler
used to fill the entire canal with a special non-setting calcium hydroxide paste “hypocal” - disinfects the canals
open apex technique - why does the calclium hydroxide need to be non-setting?
so it can easily be removed and replaced at other appointments.
How long does it take for a hard tissue bridge to be formed after a pulpotomy and for an open apex tooth to seal the apex after treatment?
6 months or more
Is it true that pulp capping can be done in deciduous teeth and permanent teeth?
YES
What is the main aim of pulp capping?
to seal the exposed pulp from the oral cavity to prevent micro-organisms contaminating the tooth causing infection.
what liner is used in pulp capping?
calcium hydroxide
what dressing is the cavity temporarily sealed with during pulp capping?
zinc oxide and eugenol.
what can be applied to a tooth during pulp capping procedure to repair the tooth if the cavity was deep?
biocompatible calcium silicate based material
what is DIRECT pulp capping?
where the decay touches the pulp, the pulp will bleed.
May need RCT or XLA if the nerve dies
what is INDIRECT pulp capping?
the decay does not touch the pulp but is close.
What is nerve death called?
pulp necrosis
what kind of procedure is an apicectomy?
surgical endodontics
What is an apicectomy?
removal of the tip of an infected apex of a tooth and its surrounding infected tissue.
When is an apicectomy usually suggested?
If rct fails or is impossible to complete.
How would a dentist tell a RCT has been unsuccessful?
- pain and infection after procedure
- incomplete filling of an inaccessible canal
- enlarged periapical area on radiographs
- presence of a chronic sinus tract
How would a dentist know if a RCT is impossible to do?
- canal is blocked by instrument
- canal blocked by pulp stone
- alveolar abcess on tooth with post crown
Why is an apicectomy classed as a Minor oral surgery?
Mucoperiosteal flap is raised and the jaw bone is drilled to gain access to the root apex.
During an apicectomy what is the mucoperiosteal flap raised using?
periosteal elevator
How does a doctor gain access to the jaw bone during an apicectomy?
straight hand piece and surgical burs
During an apicectomy what is all infected soft tissue within the bone scraped out using?
mitchells trimmer
surgical curette - resembles a large excavator
The end of the root (apex) during an apicectomy is sealed using what permanent filling material?
retrograde filling
Signs of acute infections:
- pus
- raised body temperature = Pyrexia
- severe pain loss of function of the tooth
- swelling intraorally or extraorally
When a patient attends with an acute infection what will the dentist do, to get the patient out of pain?
Begin treatment if poss - ANTIBIOTICS
LANCING the intraoral abcess
opening the root canal and placing the tooth on OPEN DRAINAGE
What antibiotics will be perscribed to a patient with an acute infection?
- amoxicillin 500mg 3 x a day
or erythromycin if pt is allergic to penicillin - metronidazole 200mg or 400mg 3 x daily - if severe infection
