disinfection

Question 1

pulpal system anatomy, implication?

Answer 1

very complex anatomy, instruments fail to reach all parts which can allow bac and substrate to persist

Question 2

to be successful we must remove/destroy:

Answer 2

Remove & Destroy both the Bacteria and their Substrate to be successful*

Question 3

what % of pulpal anatomy can we access with instruments

Answer 3

We can access only a percentage of the complex anatomy & “protected areas” by any instrumentation. 60-70%

Question 4

major cleaning solution

Answer 4

8.3%Sodium Hypochlorite
(NaOCl)

Question 5

major weapons of disinfection

Answer 5

CLEANING AND SHAPING with NaOCl and INTRA CANAL MEDICAMENTS

Question 6

ADMINISTRATION OF NaOCl:

Answer 6

use of side vented needle to prevent NaOCl from PA/ keeps you 2mm short WL: TIP OF NEEDLE CANNOT GO PAST APICAL CONSTRICTION
must bend the needle
do not allow tip to bnd to canal, in and out gently

Question 7

NaOCl functions in pulp system

Answer 7

1. NaOCl kills micro-organisms on contact
2. NaOCl destroys & dissolves substrate
3. Disorganizes Biofilm
4. Dilutes Toxins in canal system
5. Disinfects RC System & Instruments
6. Lubricates Canals
7. Floats out Debris

Question 8

where?

NaOCl breaksdown into?

Answer 8

NaCl and H2O, occurs in tooth

Question 9

NaOCl replenishment

Answer 9

NaOCl becomes inactive after 3-5
min. in the canal so it must be
replenished every 3-5 min.

Question 10

what must be done after each active instrument

Answer 10

irrigation

Question 11

TIME and EFFECT of NaOCl on pulpal tissue

Answer 11

Question 12

our NaOCl vs normal cleaning solution

Answer 12

Dakin’s solution is often used
for surface disinfection. It is
0.25% NaOCl.
8.3% NaOCl (Clorox) is 33.2
times STRONGER and
MORE TOXIC – also more
effective!

Question 13

cc NaOCl per visit

Answer 13

Typical case requires about 10-12
cc. of NaOCl
as irrigant per visit

Question 14

how long must NaOCl contact canal? enlarged to what size?

Answer 14

NaOCl must be in contact with shaped canal a minimum of 30 minutes after canal enlarged to #30 or larger.

Question 15

patency file used for?

Answer 15

breaking vapor lock and ensuring NaOCl reaches apical portion of canal

Question 16

NaOCl recapulation

Answer 16

*“Recapitulate” following each active instrument
*“Recapitulation” means:
*Flood canal system with NaOCl
*Do this EVERY 3-5 minutes
*Use a #10 file to WL (as necessary)
*Then move on with next active instrument
*Remember the “30-30 Rule”

Question 17

NaOCl strengths

Answer 17

Strong Oxidizer
Powerful Disinfectant
Dissolves Necrotic Tissue @low concentration
Dissolves Living Tissue @higher concentration
Med. of CHOICE (Endodontics)

Question 18

NaOCl cons

Answer 18

Strong Oxidizer
Powerful Disinfectant
DANGEROUS !
Extremely TOXIC

Question 19

what should we never forget when using NaOCl

Answer 19

No Dam leakage
Never forget Eye Protection and Never PASS anything over Face

Question 20

even with sde vented tip, vigorous injection can cause:

Answer 20

irrigant to express
apically= extremly toxic, Tastes Terrible in mouth (Burns throat)

Question 21

how to avoid apical expression of irrigant

Answer 21

do not let tip bind, keep tip moving and loose
no dam leakage

Question 22

results if tip binds in canal

Answer 22

NaOCl can be easily forced out the end of the tooth into the P/A tissues with disastrous results:
Immediate & Extreme pain for several days
Ecchymosis
Swelling
Temporary disfigurement
Court appearance ?

Question 23

can NaOCl accicdents be undone

Answer 23

There is NO WAY to UNDO a NaOCl accident after it
happens
PREVENT NaOCl Accidents

Question 24

eye protection with NaOCl

Answer 24

*Your Patient
*Your Assistant
*Yourself
EYE WASH STATIONS AVAILABLE in BOTH LABS FIND THEM – KNOW HOW TO USE THEM

Question 25

protective clothing and NaOCl

Answer 25

Protect clothing: The tip of the syringe WILL LEAK as you remove it from the tooth= rubber gloves

Question 26

what to do when removing syringe

Answer 26

place your gloved hand under the syringe as you remove it from the tooth.

Question 27

Sonic/Ultrasonic Vibration of NaOCl

Answer 27

endo activator: will agitates irrigation solutions during endodontic treatment. Evidence-based endodontics has shown that cavitation and acoustic streaming significantly improve debridement and the disruption of the smear layer and biofilm. may be helpful with difficult and unusual canal systems

Question 28

can endoactivator decrease tx time?

Answer 28

no

Question 29

smear layer

Answer 29

The SMEAR LAYER is produced when we do any mechanical shaping in dentin. It lies on the surface of the dentinal tubules.

Question 30

removal of the smear layer

Answer 30

It is NOT removed by NaOCl and the SMEAR LAYER occludes access to the Dentinal Tubules so must be removed to complete the CLEANING procedure before OBTURATION or when using various Sealers and Cements. EDTA removes the layer

Question 31

technique of remving smear layer

Answer 31

17% EDTA is introduced to the canal system and allowed to work for 60 seconds. Then followed by 8.3 % NaOCl to stop action of Ethylene Diamine Tetra-acetic Acid

Question 32

why not use chlorohexidine in canal?

Answer 32

we don’t believe this is necessary. No Biofilm removal, precipitate formation possible

Question 33

can we sterilize the canal system?

Answer 33

Even with all the latest methods of Cleaning & Shaping, Irrigation and Disinfection, It may NOT ALWAYS be possible to eliminate 100% of the micro-organisms, toxins and substrate within the complex canal systems present.

Question 34

intracanal medicatons

Answer 34

Medications placed within the canal system between appointments. Intended to increase local anti-microbial action and to further decrease the microbial challenge within the RC system.

Question 35

universal intracanal med

Answer 35

CaOH

Question 36

CaOH preffered why/

Answer 36

pH between 11 and 12 - Discourages most microbial growth- Long lasting (effective over extended periods)- No reported allergic responses- Easy to apply & remove as a paste- Available in clinic as “Ultracal”

Question 37

sealing portals of entry and exit

Answer 37

All potential “Portals of Entry/Exit” must therefore be sealed creating a Dense Liquid Tight (Hermetic) Seal “OBTURATION” and FINAL RESTORATION to PREVENT LEAKAGE