Y2 L1 Introduction to endodontology Flashcards
What is vital pulp therapy?
Preserving/restoring tooth health.
Keeps the tooth alive (unlike RCT).
Name possible routes of pulp infection.
- Caries
- Leakage around restorations
- Cracks in enamel
- Perio pockets
- Trauma
- Dental procedures e.g. those that cause vibration, heating or drying
The pulp reacts to damage/treatment, what is this reaction dependent on?
- Extent of tissue injury/infection
- Materials applied to pulp tissue
- Defence mechanisms
- Repair responses to encourage wound healing
What should be included in a history and examination prior to endodontic treatment?
- Full pain histroy
- Clinical examination
- Special tests and investigations e.g. sensibility
- Differential diagnosis
- Definitive diangosis
- Treatment plan
What clinical signs may indicate endodontic treatment?
- Tooth colour, discolouration
- Carious lesions
- Cracked/split tooth
- Restorations
- Swellings
- Periodontal status
What tests and investigations are required in endodontics?
- Tooth mobility?
- Tenderness to palpation- buccal or lingual
- Tenderness to percussion
- Pulp sensibility tests
- Radiographs
- Tests may confirm/exclude findings, tests may reproduce reported symptoms
Does thermal or electrical sensibility testing conclusively tell us if a pulp is vital?
- No, it indicates vitality but is not conclusive
- Need to evaluate patient response and compare several teeth
- Be aware of false positives (e.g. anxious pt) or false negatives (e.g. lots of tertiary dentine or heavily restored tooth)
- Mainly asssesses A delta fibres
Is ethyl chloride more reliable than EPT at identifying non-vital teeth?
- Yes, cold tests are more sensitive than EPT so more reliable to indicate a non-vital tooth
- Both tests are similarly effective at detecting vital teeth
Best practice is to use these results in combination with radiographs.
What is the difference between sensitivity and specificty?
- Sensitivity: ability to detect a non-vital tooth (ethyl chloride has higher sensitivity)
- Specificity: ability to detect a vital tooth (ethyl chloride and EPT have the same specificity)
Is heat testing used to test pulp sensibility?
- Hot GP is rarely used but is sometimes
- Not as accurate as ethyl chloride or EPT
Give the 4 brief pulp condition diagnoses.
- Intact, uninflamed (vital)
- Reversible inflammation: treated with vital pulp therapies
- Irreversible inflammation: treated with non-vital pulp therapies
- Necrosis: non-vital pulp therapies
What is the AAE recommended diagnostic terminology for pulp status?
- Normal pulp
- Reversible pulpitis
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Pulp necrosis
What treatments are covered by vital pulp therapy?
- Stepwise caries excavation
- Indirect or direct pulp capping
- Pulpotomy: partial or cervical (coronal)
What is a direct pulp cap?
Where a dental material (usually MTA/Biodentine/Calcium hydroxide) is placed on an iatrogenic/traumatic vital pulp exposure.
Facilitates formation of reparative dentine.
What is a partial/superficial pulpotomy?
Removal of 1-3mm of irreversibly inflamed pulp tissue to preserve vitality of remaining pulp.
Tooth restored with MTA or Biodentine.
What is a full/coronal/cervical pulpotomy?
Management of extensive carious lesion in younger patients with open apices by removing entire coronal portion of pulp and placement of hydraulic calcium silicate.
What is a pulpectomy?
Extirpation or complete removal of the pulp prior to RCT.
What are the predictors of success for vital pulp therapy?
Better success for:
- Teeth with only partially inflamed pulps
- No bacterial contamination (non-carious)
- Complete haemostais achieved
- Restoration with tight marginal seal against bacteria and toxins
Non-vital pulp therapy is indicated for what conditions?
- Symptomatic irreversible pulpitis
- Asymptomatic irreversible pulpitis
- Pulp necrosis
- Apical periodontitis
What are the aims of RCT when treating a tooth with apical periodontitis?
- Prevent spread of infection
- Eliminate infection
- Prevent re-infection
Summarise the treatment objectives in endodontics.
- Identify the disease and its cause
- Remove the cause of the disease
- Treat the effect of the disease
- Prevent further disease and complications
- Restore to normal function
- Monitor health and stability over time
