endo Flashcards
What is the psysiology of the pulp?
Hydrodynamic theory with activation of mechanoreceptors in the nerve fibers of the superficial pulp (A-beta, A-delta, C-fibers).
- Generation of movement of tubular fluid leading to activation of the nerve fibers.
- A-beta and A-delta fibers are responsible for sharp pain of short duration
- C-fibers are responsible for dull, throbbing pain of long duration
WHat bacteria prevents the healing in a RCT?
Enterococcus faecalis
prodominently gram -positive anaerobs
What is classed as a normal pulp?
- pulp is symptom free and response is normal to the sens testing
What is classed as reversable pulpitis?
When the pulp is irritated/inflammed but still vital and is stimulated by sens testing - reaction which last short duration
- no radio signs
What is classed as irreversable pulpitis?
vitally inflammed pulp which is not able to heal itself and thus requires RCT.
-sharp pain on therma stimuli
- may not be TTP due to the periapical tissues not being reached
can be asymtomatic or symptomatic
What is classed as pulp necrosis?
no response to pulp testing and probs asymptomatic
- TTP
- radiographic signs `
What would be contraindicators for RCT?
- Pregnancy -First trimester emergency intervention only
- Cardiovascular disease -Myocardial infarction within the past 6 months is a contraindication
- Emergency treatment, should be provided in consultation with the patient’s cardiologist
- Stress Reduction Protocol
• Cancer -A thorough history essential
- Chemotherapy and radiotherapy to the head and neck region can compromise healing
- Consult with the oncologist
- Diabetes mellitus -An acute endodontic infection can compromise even a well controlled diabetic;
- Bisphosphonate therapy
- Allergies
What are the stages of mechanical preperation?
- preperation of the tooth
- Access cavity preperation
- creating straight line access
- initial negotiation
- coronal flaring
- working length determination
- apical preperation
How does sodium hypochlorite work?
in water breaks down to Na+ and OCl-, which becomes HOCl which is responsable for the antibacterial action
How would you take a pain history?
- Site
- Onset
- Charcteristics
- Radiation
- Association
- Time course
- Exasberating/relieving factors
- Severity
what is EDTA?
17% is a chelating agent that removes the smear layer with one min contact time.
What is apical zipping/transportation?
- overenlargement of the outer curve
- underprep of the inner aspect
- creates a hour glass
- poor filling
How would you avoid zipping?
– Always pre-curve the initial small sized hand instruments
– Do not skip instruments in the sequence
– Never rotate the instruments in curved canals
what are some topical heamostatic agent?
– Epinephrine pellets • Most effective and economic
– Ferric sulphate • Agglutination of blood proteins
– forms a plug • Cytotoxic, tissue necrosis • Adverse effects on osseous healing
– Calcium sulphate • Mechanically blocks open vessels • Aids in bone regeneration
