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23 Endodontics > 7 - Treatment Planning > Flashcards

7 - Treatment Planning Flashcards

1
Q

what are questions we ask during tx planning

A
  1. Does the tooth require endodontic therapy or not?
  2. Does it need emergency treatment?
  3. Can the tooth be saved or is it better to extract?
  4. Does it need additional procedures?
  5. Is it a complicated case?
  6. How many appointments will it take?
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2
Q

what do you do to determine if tooth needs RCT

A
  1. Review Symptoms
  2. Examine tooth and surrounding tissues
  3. Perform pulp tests
  4. Review radiographs

“REPR”

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3
Q

if you have irreversible pulpitis or pulpal necrosis, what is needed?

A

endodontic therapy (RCT)

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4
Q

if not endo, what could it be?

A
  1. pericornitis
  2. perio
  3. TMJ
  4. non odontogenic pain (sinus, heart attack, neuralgia)
  5. atypical orofacial pain
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5
Q

how do you know if pt needs emergency tx

A
  1. depends on symptoms
  2. assess pain severity
  3. determine course of action (what procedure needs to be done today)
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6
Q

what is a partial tx designed to provide quick and timely relief for cases of severe pain

A

emergency tx

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7
Q

is emergency tx definitive?

A

NO! patient has to be reappointed for treatment completion

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8
Q

what procedures remove coronal pulp only

A

pulpotomy

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9
Q

what procedure removes coronal AND radicular pulp

A

pulpectomy

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10
Q

what procedure involves more thorough instrumentation and irrigation requires WL

A

canal debridement

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11
Q

what are emergency procedures

A
  1. pulpotomy
  2. pulpectomy
  3. canal debridement
  4. incision and drainage
  5. extraction
  6. referrals
  7. prescriptions
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12
Q

tx: symptomatic irreversible pulpitis for normal molars and anterior? are these effective?

A

pulpotomy for molars
pulpectomy for anteriors

usually provides fast effective relief

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13
Q

what is needed post-op for symptomatic irreversible pulpitis tx

A

NSAID

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14
Q

tx: symptomatic irreversible pulpitis w/ symptomatic apical periodontitis? does the pt get better?

A
  1. pulpectomy
  2. reduce occlusion if practical (don’t reduce occlusion if tooth has crown)

spontaneous pain and temp symptoms usually get better quickly but pain to chewing might persist for a few days

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15
Q

how can you distinguish if it is endo or something else?

A

do a pulp vitality test. if pulp is vital, then it is not endo

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16
Q

what to prescribe for pt w/ symptomatic irreversible pulpitis w/ symptomatic apical periodontitis

A

NSAIDS

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17
Q

tx: pulpal necrosis w/ symptomatic apical periodontitis? does it get better?

A
  1. canal debridement w/ good NaOCL irrigation
  2. if practical, reduce occlusion

sensitivity to chewing/pressure could persist for few days

18
Q

what to prescribe pt w/ pulpal necrosis w/ symptomatic apical periodontitis

A

NSAIDS

19
Q

tx: pulpal necrosis w/ acute apical abscess

A
  1. establish drainage if possible thru tooth or soft tissue
  2. canal debridement
20
Q

prescribe: pulpal necrosis w/ acute apical abscess

A
  1. prescribe (Requires) antibiotics
  2. pain medication - usually NSAID
21
Q

what does it mean to “reduce occlusion if practical”

A
  • only done on posterior teeth
  • do not reduce occlusion on crowns or crown will be ruined
22
Q

what types of diseases are addressed during non emergencies

A

progressive disease - pathological and asymptomatic but need tx

(“but doc it doesn’t hurt”

so discus tx w/ pt bc ticking time bomb analogy

23
Q

what should you considered whether or not tooth should be saved or if extraction is better?

A
  1. Is it restorable?
  2. Periodontal condition?
  3. Root fractures?
  4. How does it fit in the overall treatment plan
  5. Patient desires?
24
Q

what additional procedures may need be done before RCT

A
  1. build up before RCT
  2. crown lengthening
  3. root amputations
  4. PA surgery
  5. orthodontic extrusion
25
Q

what are examples of complicated cases

A
  1. calcifications
  2. root curvature
  3. resorption: internal/external
  4. unusual anatomy
  5. previous failed endo
26
Q

what should you ask to determine if needs to be referred

A
  1. Are they routine cases or do they need a special approach?
  2. Are special instruments and materials required?
  3. Does it need a multidisciplinary approach?
27
Q

what is important to do when referring pt

A
  1. COMMUNICATION is key!
  2. share tx problems
  3. discuss ideas
28
Q

can tx plan and prognosis CHANGE as diagnosis and tx progress?

A

YES

29
Q

what are reasons to have multiple appts

A
  1. lack of time
  2. complexity of case
  3. pt tolerance
  4. presence of exudate in canal
  5. swelling
30
Q

is there a difference of incidence of post-op pain between one and multiple appts in endo

A

NO

31
Q

is there a difference in success rate between one and multiple appt in endo

A

NO

32
Q

how far apart should you make endo appts

A
  1. generally should be one to two weeks apart
  2. extenuating circumstances such as pt moving out of town (so come in sooner) or tx has to be completed before surgery (so come in sooner)
33
Q

better or low success rate if there is pre-existing PA lesion

A

LOWER

34
Q

better or low success rate on retreatments

A

LOWER

35
Q

better or low success if calcium hydroxide placed between appts

A

BETTER

36
Q

prior to __ must explain what kind of restoration the tooth will need afterwards

A

RCT

37
Q

should you include the price of restoration when discussion fees

A

YES

38
Q

what restoration should you place on anteriors? why?

A

composite on anterior that are not too damaged do not use amalgam or you will get a horrible esthetic result

39
Q

what restoration to use on all molars and some anteriors

A

build-up/crown

40
Q

when do you place a pulp restoration

A

if there is not retention for build up

41
Q

what temporary restoration can be used in between appointments

A

Cotton and Fuji

42
Q

can you use temporary crowns on restorations

A

yes

23 Endodontics (12 decks)

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