Week 2: Endodontic irrigation Flashcards
What are the primary goals of irrigation
- Dissolution of organic tissue and pulpal remnants
- Dissolution of select inorganic components
- Killing of micro organisms and neutralisation of Endo toxins
- Lubricate canals
Why is irrigation important
to clean to canals properly
Because instruments do not reach all of the anatomy of the complex root canal
Name the different irrigation options we have?
- Sodium hypochlorite
- Chlorohexidine
- EDTA
- Iodine potassium iodide
- Hydrogen peroxide
- Saline/ water/ local anaesthetic
Name the gold standard irrigant
Sodium Hypochlorite
What are the benefits of Sodium Hypochlorite?
- It works on the flora
- Causes tissue dissolution
- Causes endotoxin deactivation
- Cheap
What are the disadvantages of Sodium Hypochlorite ?
- Doesn’t remove the smear layer
2. Isn’t substantive
How does Sodium Hypochlorite work?
Halogen ions
How does Chlorhexidine work?
Bisguanide
What are the benefits of Chlorhexidine
- Works on the flora
- Causes endotoxin deactivation
- Is substantive
What are the disadvantages of Chlorhexidine
- Dont dissolve tissues
- Cant remove the smell Layer
- Bit more expensive
How does EDTA work?
Chelating agents
What are the benefits of EDTA
Very effective at removing the inorganic smear layer
What are the disadvantages of EDTA
- Not that good at working on the flora
- Doesn’t dissolve tissues
- Doesn’t deactivate endotoxins
- Isn’t substantive
- Bit more expensive
How does Iodine Potassium Iodide work
Halogen ions
What are benefits of Iodine Potassium Iodide
Works on the flora
What are the disadvantages of Iodine Potassium Iodide
- Doesn’t dissolve tissue
- Doesn’t deactivate endotoxins
- Doesn’t remove inorganic smear layer
- Isn’t substantive
- Is a bit more expensive
How does hydrogen peroxide work?
Peroxide
What are the benefits of hydrogen peroxide
Cheap
WWhat are the disadvantages of hydrogen peroxide
- Doesn’t dissolve tissue
- Doesn’t deactivate endotoxins
- Doesn’t remove inorganic smear layer
- Isn’t substantive
- Doesn’t effectively work on flora
When do we irrigate
As much as possible and between every file change
How do we irrigate
Ideally we should be passing the tip of our irrigation needle to at least 3mm from our apical preparation
How far does irrigation reach from the needle tip?
2mm
Area further than 2mm from the needle tip is classed as….
Why
The dead zone as it remains unirrigated
What do we need to remember when irrigating
- Light pressure with forefinger and NOT your thumb whilst keeping the needle moving within the canal
- Do not allow needle to lock with the canal
What flow rate should we aim to achieve?
1ml over 15 seconds
What happens if we increase the irrigation rate over 4ml per min
It can increase the risk of extrusion
What are the DOs of irrigation
- Ensure you irrigate after each instrument change
2. Ensure you have flipped the rubber dam over the wings and sealed with oraseal
What are the DON’Ts off irrigation
- Down allow your needle to lock in the canal or use excessive pressure
- don’t irrigate and take a radiograph
- Don’t allow Chlorhexidine to mix with hypochlorite
What happens take a radiograph Chlorhexidine mix
Can form a precipitate the is carcinogenic and will impair disinfection
What can small amounts of hypochlorite ingestion result in?
Not harmful but will cause mucosal irritation and a bad taste
Give some signs and symptoms of extrusion
- Sudden pain irrespective of the presence of LA
- Profuse bleeding from within the canal
- Extensive oedema
How do we manage a hypochlorite incidence
- STAY CALM
- Irrigate canal with saline
- Give additional LA for pain relief
- Dress canal with non setting calcium hydroxide
- Reassure patient
- Advise of analgesia – Paracetomol and Ibuprofen
- Arrange a further appointment to review the patient
