Week 1 PP Flashcards
What are the 9 Dental Specialties recognized by CDA
- Dental Public Health
- Endodontics
- Oral and Maxillofacial Surgery
- Oral Medicine and Pathology
- Oral & Maxillofacial Radiology
- Orthodontics and Dentofacial Orthopedics
- Pediatric Dentistry
- Periodontics
- Prosthodontics
What is Endodontics?
The branch of dentistry dealing with prevention, diagnosis and treatment of the dental pulp and the surrounding periapical tissues
- the diagnosis of pulpal damage, infection or necrosis and subsecquent root canal or apical surgery
What does peri-radicular mean?
around the root
What does periapical mean?
around the apex/apices
Why is it important to treat the pulp and peri-radicular or apical tissues?
- the pulp is the heart of the tooth
-if the pulp is not happy it can become sick and mabye even die and affect the surrounding tissues
-if the tooth dies, we need to do a root canal so that we can at least save the body of the tooth
Causes of Pulpal Nerve Damage
-Physical irritation:
-range from mild sensitivity to complete nerve death or infection of surrounding tissues
-extensive decay moving into the pulp
-abscess can also form
-Trauma
What is the most common cause of pulpal damage?
Cavities!!!
Process of Pulpal Damge due to Physical Irritation
- Tooth decay can spread deep into your teeth and affect your dental pulp and roots. When the bacteria travel deeper into a tooth, past the hard enamel portion of a tooth and into the
dentin the bacteria have easier access to the pulp. - Therefore if a “small” cavity that exists in the enamel/dentin layers of a tooth is not repaired the bacteria can travel into the pulp causing “extensive decay”.
- Once in the pulp chamber, the bacteria will continue to travel through this soft tissue layer with ease.
- The bacteria will eventually reach the nerves and blood vessels an infection or abscess (a localized area of pus)
- When we see pus we know that there is an active infection because pus contains factors from your immune to fight unwanted intruders such as the cavity causes bacteria.
Process of Pulpal Damage due to Trauma
Blow to jaw and/or surrounding tissues > Damage to surrounding tissues > Damage to nerve tissues and blood vessels
Trauma can cause pulpal damage via..
- Broken teeth
- Chipped teeth
- Cracked teeth
- Fractured teeth; or
- Sometimes a pulp will be injured from trauma without clinically visible damage to the tooth (such as in the case of this image)
Trauma (causing pulpal damage) may include:
- Attrition
- Erosion
- If a filling is too high and is not taken down that can cause trauma to the tooth’s pulp
- Parafunctional habits - Grinding, Clenching
Surrounding tissues experiencing force due to trauma..
- The periodontal ligaments may tear from the force
- The bone may initiate a resorption process due to damaged periodontal ligaments or plain damage to the bone on its own.
- Parts of the tooth can break and be driven into surrounding tissue to cause damage
Common signs and symptoms of pulpal damage
-Pain - when occluding, during mastication
-Sensitivity - to hot or cold beverages
-Swelling - of the face
What is Subjective Examination?
-Symptoms as described by the patient
“There is a shooting pain when I bit on something hard”
What is Objective Examination?
What the dentist sees - based on clinical assessments
Clinical Assessment for Endodontic Diagnosis
- Usually the dentist will first assess a control tooth (a similar “healthy” tooth on the opposite side) and then do the exact same test on the tooth in question. So if there was a concern with the 3.6 they would choose the 4.6 as the control tooth
- Extent of decay
- Periodontal conditions surrounding the tooth in question
- Presence of an extensive restoration
- Tooth mobility
- Swelling or discoloration
- Pulp exposure
What is Percussion and Palpation used for?
used to assessthe extent of inflammation into the periapical tissues
Thermal Test - Cold Test uses..
-Ice
-Dry ice (carbon dioxide)
Thermal Test - Heat Test
-Gutta percha
-Heated instrument
*lingering pain to heat is NOT normal
Electric Pulp Testing is used for..
is used to identify if a tooth is vital or not
What are we looking for in Radiographic imaging?
-Dental Caries
-Depth of restorations
-Periapical infections
-Location and # of pulp canals
Characteristics of Normal Pulp?
-No subjective symptoms
-No objective signs
-Normal response to sensory stimuli
-Healthy layer of dentin surrounds the pulp
Characteristic of reversible pulpitis?
Pain to thermal stimuli
Treatment for reversible pulpitis?
Eliminate irritant & placing a sedative material can save the pulp
Characteristics of Irreversible pulpitis?
-Lingering pain
-Pulp cannot and will not heal
Treatment for Irreversible pulpitis?
Root Canal or Extraction
Characteristics of Periradicular Abscess
-asymptomatic
-some discharge of pus (its draining elsewhere)
Characteristics of Acute Periradicular Abscess
Pain, tenderness to pressure, pus formation, swelling
What causes a Periodontal Abscess?
Bacteria trapped in a periodontal sulcus
What is Pulp Fibrosis?
- A decrease in living cells within the pulp that causes fibrous tissue to take over the pulpal canal
- Seen in older adult patients as well as patients who have sustained a traumatic injury to a tooth
What is Necrosis Pulp?
-Necrotic or Nonvital
-this term is used to describe a tooth that does not respond to sensory stimulus
-the tooth can be considered nonvital but it is still attached to the alveolus by way of the cementum and periodontal ligaments which are still vital tissues
What is a Periradicular Cysts?
This type of cyst develops at or near the root of a necrotic tooth
the cyst develops as an inflammatory response to pulpal infection and necrosis of the pulp
What is Pulp Fibrosis?
- the number of living cells within a pulp decreases
-fibrous tissues take over the pulp chamber/canal
Pain Relief for Pulpal Damage
Once a diagnosis is made the first step is to make sure the patient is out of pain
* Medications
* Antibiotics
* Open and drain
* Or, start RCT
What is Open & Drain?
The pulp chamber of the tooth may be ‘opened’ to allow infection to drain and provide relief immediately
* The pulp chamber is opened using rotary instruments – often as soon as the instrument hits the chamber, infectious fluid begins to drain from the tooth
* if not, an endodontic file can be inserted into the canals to create a pathway for drainage to occur
* If this is not enough to provide relief, or if the infection has collected below the tissue through a ‘fistula’ the dentist may drain the infected fluid from the apical area by surgically opening the tissue with a scalpel
What is IRM and its use in Endo?
IRM is a temporary filling material, contains meds to help
-done after open and drain
-used to allow healing between root canal appointments
-used when diagnosis is not definite (pulp? cracked tooth? decay?)
What does IRM stand for?
Intermediate Restorative Material
