1 - Introduction to Endodontics Flashcards
(52 cards)
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
2
Q
what is endodontics?
A
the clinical discipline that deals with the prevention, diagnosis and treatment of endodontic disease
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
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
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
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
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
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
9
Q
how microbes enter teeth: examples of physical trauma?
A
infractions
crown/root fracture
10
Q
how microbes enter teeth: examples of tooth surface loss?
A
- attrition
- abrasion
- erosion
- abfraction
11
Q
how microbes enter teeth: microleakage - why does it occur?
A
due to poor adaptation of materials, allowing bacteria to enter
12
Q
how microbes enter teeth: how does it occur in peridontal disease and treatment?
A
- through the patent lateral accessory canals
- surgical procedures
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
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
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
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
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
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
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
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
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
pregnancy and endodontic treatment:
- avoid treatment when?
- treat what first?
- radiographs only when?
- avoid treatment in first trimester, relief pain first and continue treatment in second or third trimester
- use radiographs only when necessary
26
antibiotics in pregnancy: what to use? what to avoid?
use:
- penicillin V
- amoxicillin
- clindamycin
- metronidazole
avoid:
doxycycline
tetracycline
vancomycin
27
```
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?
```
- 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
aetiology of pulpal and periradicular disease? which studies can back this up?
- 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
root canal microorganisms: polymicrobial infection - how many species per canal?
what types of microorganisms?
- 20 species per canal
- facultative anaerobes decrease
- obligate anaerobes
- more gram negatives
- fungi + viruses
30
microbial distribution:
most located where?
what forms on canal walls?
- mostly located in suspension within the root canal
- bioflims form on canal walls
- dentinal tubules occluded?
31
microbial distribution: list the various species found? x9
```
prevotella
porphyromonas
fusobacterium
veillonella
peptostreptococcus
eubacterium
actinomyces
lactobacillus
streptococcus
```
32
pulp chamber:
located where?
dimensions vary according to?
projects into what in well developed cusps?
- portion within crown
- dimensions vary according to
1. outline of crown
2. structure of root
- projects into pulp horns
33
```
pulp root canal:
continuous with?
how does shape change at apex?
constriction at the end known as?
emerges where?
```
- continuous with pulp chamber
- tapers towards the apex
- apical constriction
- apical foramina
34
anatomy of the root canal system:
- describe it and how the canals are
- how does the diameter change
- where is the narrowest point?
- 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
root canal classification: known as? how many are there?
vertucci canal types
| - there are 8 types
36
pulp and periodontal tissue can also connect through?
accessory and lateral canals
37
lateral canals:
found where?
where in molar teeth?
- 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
accessory canals: found at?
apical region
39
anatomy of the root apex:
apical preparation should end at?
where is the apical constriction?
apical foramen found where in relation to anatomical apex?
- 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
distance of apical constriction from radiographic apex: how does it vary in older people? why?
the distance (between apical constriction & radiographic apex) increases in older teeth with secondary cementum
41
stages of RCT: before starting treatment - what to do? what to study and take note of?
- 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
why must all caries and defective restorations be removed and replaced by a temporary restoration?
to prevent it from leaking during treatment
43
LA in endo treatment: which are the 3 to use? and why should each be used?
- 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
reasons for LA failure?
- 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
difficulties with anaesthesia? x4
apprehension _ anxiety
tiredness
tissue inflammation, vital pulps
previous unsuccessful anaesthesia
46
teeth with irreversible pulpitis:
what state?
inflamed tissue: how are they altered?
changes can affect where?
- 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
supplementary injections: list x4
palatal
mental
infraorbital
intra-ligamental (PDL anaesthetic injection)
48
```
PDL anaesthetic injection
- useful when?
what kind of needle length?
- LA is redirected where?
- do not inject into ___?
- what is a common after effect?
```
- 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
intraosseous injection:
how is it done?
what is used?
where is it done?
- cortical bone perforated by creating small hole between roots of teeth
- special rotary instrument, light pecking motion
- 5mm apical to the buccal papilla
50
```
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?
```
- 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
intra-pulpal injection
- best used if?
- why need to warn patient before?
- best used in pulp chamber is very small
| - it can be very pain
52
computer controlled LA: market name?
| LA given at what rate?
The Wand STA
| LA given at slow rate
