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3BDS ENDODONTICS > 1 - Introduction to Endodontics > Flashcards

1 - Introduction to Endodontics Flashcards

1
Q

what is endodontology?

A

a branch of dental science concerned with the study of:

form, function, health of, injuries to and diseases of the dental pulp and peri-radicular tissues

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2
Q

what is endodontics?

A

the clinical discipline that deals with the prevention, diagnosis and treatment of endodontic disease

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3
Q

what is considered endodontic treatment? examples?

A

any procedure designed to maintain the health of the pulp

e.g. stepwise, indirect pulp cap, direct pulp cap

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4
Q

how does endodontic treatment aim to solve:

  • injured/diseased pulps?
  • disease of periradicular tissues?
A
  • by maintaining or restoring health of the periradicular tissues
  • by restoring them to normality
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5
Q

root canal treatment is required for teeth when?

A
  • when the dental pulp is irreversibly damaged

- elective root canal treatment: required to allow placement of post-retained crowns

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6
Q

list the general methods of how microbes enter teeth? x6

A
  • caries
  • dental factors
  • physical trauma
  • tooth surface loss
  • micro-leakage
  • periodontal disease and treatment
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7
Q

how microbes enter teeth - caries: how does it occur? pulp becomes inflamed when?

A
  • occurs when bacteria penetrate the tubules and cause destruction of dentine
  • pulp becomes inflamed when bacteria is 0.5mm away
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8
Q

how microbes enter teeth - dental factors: what are the examples?

A
  • crown/bridge preparation
  • accidental pulpal exposure
  • inadequate water spray
  • over-drying exposed dentine
  • inadequate isolation of teeth from saliva
  • failure to adequately protect and seal tubules
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9
Q

how microbes enter teeth: examples of physical trauma?

A

infractions

crown/root fracture

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10
Q

how microbes enter teeth: examples of tooth surface loss?

A
  • attrition
  • abrasion
  • erosion
  • abfraction
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11
Q

how microbes enter teeth: microleakage - why does it occur?

A

due to poor adaptation of materials, allowing bacteria to enter

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12
Q

how microbes enter teeth: how does it occur in peridontal disease and treatment?

A
  • through the patent lateral accessory canals

- surgical procedures

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13
Q 
dentine hypersensitivity:
characterized by?
stimuli?
mechanism of sensitivity?
causes?
treatment?
A
  • exaggerated, sharp, transient pain
  • thermal, chemical, osmotic, tactile or physical stimuli.
  • fluid movement in the tubules activate A-delta fibres
  • caused by gingival recession and tooth surface loss
  • occlude or cover patent tubules
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14
Q

cracked tooth syndrome:

  • described as?
  • difficulty with?
  • what happens if untreated or unrecognized?
A
  • incomplete fracture of a posterior tooth with a vital pulp, fracture may include dentine and pulp
  • difficult to diagnose
  • may lead to vertical root fracture and extraction of tooth
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15
Q

cracked tooth syndrome:
aetiology?
symptoms?

A
  • occlusal forces, abnormal chewing habits, accidental trauma, structural fatigue
  • sharp shooting pain on biting hard objects
  • may be worse on release of pressure
  • sensitivity to thermal changes, sweet, acidic food
  • often difficult to diagnose
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16
Q

hyperplastic pulpitis:

  • characterized by?
  • appears as what in young patients?
  • symptoms?
  • radiographic changes?
A
  • proliferatin of pulpal tissue to produce a pulp polyp
  • large carious lesion
  • symptomless
  • not normally any radiographic changes
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17
Q

indications for root treatment?

A

age

  • no limit
  • canals narrow in older people, healing process slower

patient’s state of health

  • endodontics often easier and safer than extraction
  • bisphosphonates: risk of osteonecrosis
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18
Q

reasons to carry out RCT?

A
  • removes aetiological factors to allow healing
  • prevent reinfection of the root canal system by placing an effective coronal seal
  • allows the tooth to become a healthy functioning unit
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19
Q

general contraindications to RCT?

A
  • medical history: usually little to contraindicate, patients with diabetes type I and II may have a slower healing and reduced success rate
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20
Q

local contraindications to RCT?

A
  • difficult access to posterior teeth
  • patient MUST lie back
  • tooth must be isolated using rubber dam
  • patient must tolerate rubber dam
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21
Q

specific contraindications to RCT?

A
  • insufficient periodontal support
  • inadequate root/crown ratio
  • insufficient coronal tooth structure
  • root caries/furcation
  • internal resorption with perforation
  • vertical root fracture
22
Q

false contraindications?

A
  • fractured instruments
  • calcified pulp chambers, canals
  • anatomical complexities
  • difficult retreatments
  • size of periradicular lesion
23
Q

systemic disease and endodontics:

  • those at risk of infective endocarditis?
  • those with prosthetic joints?
  • steroids?
  • anticoagulants?
A
  • those at risk no longer require antibiotic prophylaxis
  • those with prosthetic joints at no special risk
  • patients on long term steroid medication do not require supplementary steroid cover for routine dentistry under LA
  • those on anticoagulants only require stable INR range of 2-4, those on warfarin should have INR checked 72hours before surgery
24
Q

patients on warfarin - what should NOT be prescribed to them following endodontic surgery?

A
  • NSAIAs

- cox-2 inhibitors

25
Q

pregnancy and endodontic treatment:

  • avoid treatment when?
  • treat what first?
  • radiographs only when?
A
  • avoid treatment in first trimester, relief pain first and continue treatment in second or third trimester
  • use radiographs only when necessary
26
Q

antibiotics in pregnancy: what to use? what to avoid?

A

use:

  • penicillin V
  • amoxicillin
  • clindamycin
  • metronidazole

avoid:
doxycycline
tetracycline
vancomycin

27
Q 
pregnancy and endo treatment: 
supine hypotension syndrome caused by compression of which vessel?
why is the vessel compressed? 
compression can result in?
how to manage during dental treatment?
A
  • inferior vena cava
  • IFC compressed by the uterus
  • reduced perfusion of uterus, fetal hypoxia
  • roll onto left side, or place small pillow under right hip
28
Q

aetiology of pulpal and periradicular disease? which studies can back this up?

A
  • bacteria
    1. surgical exposure of dental pulps in germ-free and conventional lab rats
    2. influence on periapical tissues of indigenious oral bacteria and necrotic pulp tissue in monkeys
29
Q

root canal microorganisms: polymicrobial infection - how many species per canal?
what types of microorganisms?

A
  • 20 species per canal
  • facultative anaerobes decrease
  • obligate anaerobes
  • more gram negatives
  • fungi + viruses
30
Q

microbial distribution:
most located where?
what forms on canal walls?

A
  • mostly located in suspension within the root canal
  • bioflims form on canal walls
  • dentinal tubules occluded?
31
Q

microbial distribution: list the various species found? x9

A 
prevotella 
porphyromonas
fusobacterium
veillonella 
peptostreptococcus
eubacterium
actinomyces
lactobacillus 
streptococcus
32
Q

pulp chamber:
located where?
dimensions vary according to?
projects into what in well developed cusps?

A
  • portion within crown
  • dimensions vary according to
    1. outline of crown
    2. structure of root
  • projects into pulp horns
33
Q 
pulp root canal:
continuous with? 
how does shape change at apex?
constriction at the end known as? 
emerges where?
A
  • continuous with pulp chamber
  • tapers towards the apex
  • apical constriction
  • apical foramina
34
Q

anatomy of the root canal system:

  • describe it and how the canals are
  • how does the diameter change
  • where is the narrowest point?
A
  • often complex
  • canals may divide and then rejoin, they tend to be broader buccolingually than mesiodistally
  • diameter decreases towards the apical foramen
  • 1-1.5mm from the apical foramen
35
Q

root canal classification: known as? how many are there?

A

vertucci canal types

- there are 8 types

36
Q

pulp and periodontal tissue can also connect through?

A

accessory and lateral canals

37
Q

lateral canals:
found where?
where in molar teeth?

A
  • found anywhere along the length of the root canal, at right angles to the main canal
  • molar: 59% in coronal, middle third
    76% at furcation
38
Q

accessory canals: found at?

A

apical region

39
Q

anatomy of the root apex:
apical preparation should end at?
where is the apical constriction?
apical foramen found where in relation to anatomical apex?

A
  • apical preparation should end at the narrowest part of the canal
  • 0.5-1mm from the apical foramen
  • apical foramen rarely coincides with anatomical apex, mean distance is 0.2 - 2mm away
40
Q

distance of apical constriction from radiographic apex: how does it vary in older people? why?

A

the distance (between apical constriction & radiographic apex) increases in older teeth with secondary cementum

41
Q

stages of RCT: before starting treatment - what to do? what to study and take note of?

A
  • full clinical examination + special investigations
  • periapical radiograph: show apex, 2-3mm of surrounding periradicular tissues

study anatomy of RC:

  • angulation of root in relation to adjacent teeth
  • check for complications e.g. pulp stones, sclerosed and curved canals
  • periradicular radiolucency present?
42
Q

why must all caries and defective restorations be removed and replaced by a temporary restoration?

A

to prevent it from leaking during treatment

43
Q

LA in endo treatment: which are the 3 to use? and why should each be used?

A
  • prilocaine hydrochloride with felypressin (Citanest 3% w/ octapressin)
  • used to avoid adrenaline, latex/preservative allergy, avoid in pregnancy
  • lidocaine hydrochloride 2% with adrenaline 1:80,000
  • used for most injections, avoid if unstable angina, severe cardiac dysrhythmia, allergy, caution with other cardiac conditions
  • articaine hydrochloride 4% with adrenaline 1:100,000
    superior diffusability through bone, risk of parasthesia
44
Q

reasons for LA failure?

A
  • poor technique
  • inadequate amount of LA
  • variation in patient’s anatomy
  • very inflamed tissue/bone
  • variation in absorption, metabolism and excretion of LA
  • psychological factors
45
Q

difficulties with anaesthesia? x4

A

apprehension _ anxiety
tiredness
tissue inflammation, vital pulps
previous unsuccessful anaesthesia

46
Q

teeth with irreversible pulpitis:
what state?
inflamed tissue: how are they altered?
changes can affect where?

A
  • state of hyperalgesia
  • inflamed tissues may alter the nerve’s resting potential, therefore decreasing excitability thresholds
  • changes not just confined to pulp, can affect the entire neuronal pathway
47
Q

supplementary injections: list x4

A

palatal
mental
infraorbital
intra-ligamental (PDL anaesthetic injection)

48
Q 
PDL anaesthetic injection
- useful when?
what kind of needle length?
- LA is redirected where?
- do not inject into \_\_\_?
- what is a common after effect?
A
  • useful in mandible when IDB not fully effective
  • 27/30 short gauge needles, bevel orientated to root surface
  • LA redirected NOT in apex, but into surrounding cancellous bone of the dental socket
  • do not inject into inflamed periodontal tissues
  • tenderness is common
49
Q

intraosseous injection:
how is it done?
what is used?
where is it done?

A
  • cortical bone perforated by creating small hole between roots of teeth
  • special rotary instrument, light pecking motion
  • 5mm apical to the buccal papilla
50
Q 
intraosseous injection: 
x-tip used for?
how much of cartridge used?
how long onset? 
not suitable if?
what is a side effect if vasoconstrictor used?
A
  • x-tip leaves guide in place to make it easer to insert needle
  • one quarter to half a cartridge
  • rapid onset, up to 60mins if vasoconstrictor used
  • not suitable for gross periodontal disease or acute periradicular infection
  • may be a transient increase in heart rate if using vasoconstrictor
51
Q

intra-pulpal injection

  • best used if?
  • why need to warn patient before?
A
  • best used in pulp chamber is very small

- it can be very pain

52
Q

computer controlled LA: market name?

LA given at what rate?

A

The Wand STA

LA given at slow rate

3BDS ENDODONTICS (4 decks)

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