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Module 5 - Endodontics > I and C of RCT > Flashcards

I and C of RCT Flashcards

1
Q

What are the 2 types of root resorption?

A

external, internal, cervical (part of external).

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2
Q

What is the function of antiangiogenic drugs/ what are they used to treat?

A
  • Used in cancer treatment to restrict tumor vascularization.
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3
Q

What INR value is acceptable when considering a Warfarin patient for RCT?

A
  • INR below 4 –> continue warfarin without adjustment.
  • INR greater than 4 –> NOT SAFE to undertake any procedure.
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4
Q

What is safe pain relief and safe antibiotics for Warfarin patients?

A
  • Pain relief: paracetamol, dihydrocodeine.
  • Antibiotics: amoxicillin, clindamycin.
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5
Q

What is the policy for periapical radiographs in pregnancy?

A

o No need to avoid periapical radiographs as they have negligible risk to the fetus.

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6
Q

How long must exposed bone persist in the mandible (following surgical procedure) to be considered MRONJ?

A

MORE THAN 8 weeks.

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7
Q

What are two examples of anti-resoptive drugs?

A

Bisphosphonates, Denosumab

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8
Q

Would you ever root treat 8s?

A

Only if they are in function

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9
Q

What tool can be used to assess the difficulty of a root treatment case?

A

American Association of Endodontics (AAE) Endodontic Case Difficult Assessment

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10
Q

What are two antibiotic prophylaxis regimens. How long before the procedure are they given to patients?

A
  • AMOXICILLIN: 3g oral powder (1 sachet) 60 minutes before procedure.
  • CLINDAMYCIN: 600mg (2 capsules) 60 minutes before procedure (for patients allergic to penicillin).
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11
Q

How does tooth location and malpositioning affect RCT? What is the indicated treatment?

A
  • can make it difficult to isolate tooth –> extract/ ortho treatment.
  • 8s can be difficult to treat/access, not treated unless FUNCTIONAL.
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12
Q

Name 3 abnormal canal configurations

A
  • dens invaginatus
  • lingual developmental groove (lateral incisors)
  • taurodontism.
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13
Q

What are the two types of drugs which put patients at higher risk of MRONJ?

A

anti-resorptive, anti-angiogenic.

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14
Q

What classification is used for dens invaginatus?

A

oehler’s classification

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15
Q

What antibiotic prophylaxis should be given to a patient who was on antibiotics the past few weeks?

A

For a patient who has received a course of antibiotics in the preceding 6 weeks, select a drug from a different antibiotic class.

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16
Q

What heart problems (other than IE) may be considered in patients considerd for RCT?

A
  • Past myocardial infarction.
  • Routine treatment and LA with adrenaline should be avoided for 6 months.
  • Angina
  • how stable is the angina/ how often is the spray used. Patient should bring GTN with them.
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17
Q

How long post MI must pass for routine dental treatment to be performed?

A
  • Routine treatment and LA with adrenaline should be avoided for 6 months.
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18
Q

What does cervical root resorption look like? What is the most appropriate treatment?

A

pathognomonic sign of PINK SPOT LESION in the cervical region of the tooth.

  • combination of surgical and endodontic treatment most ideal.
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19
Q

What are 5 TRUE CONTRAINDICATIONS of RCT?

A
  1. Insufficient periodontal support (ex. grad 3 mobility)
  2. non-restorable teeth
  3. vertical root fracture.
  4. conditiion of remaining teeth (ex. poor OH, several missing teeth, poorly motivated patient).
  5. non-strategic teeth (no current or possible function)
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20
Q

What is the mode of action of bisphosphonates? How does it affect physiology in relevance to dentistry?

A
  • Reduce bone resorption by inhibiting enzymes essential for formation, recruitment and function of osteoclasts.
  • Linked with delayed soft tissue healing and may inhibit angiogenesis.
  • Accumulated at sites with high bone turnover, ex. jaws  may reduce bone turnover and blood supply and lead to OSTEONECROSIS.
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21
Q

How can sickle cell anemia cause signs/ symptoms that may mimic periapical disease?

A
  • bone pain which mimics odontogenic pain + loss of trabecular bone pattern which can mimic a lesion.
22
Q

How can radiation to the jaws cause signs/ symptoms that may mimic periapical disease?

A

increased tooth sensitivity, osteonecrosis. Incomplete root development (short roots) may mimic old resorption.

23
Q

What procedure (related to endodontics) may be contraindicated in Warfarin patients and why?

A

Peri radicular surgery should be carefully considered in such patients as hemostasis is extremely important for success

24
Q

What are 7 conditions which signs and symptoms can be similar to periapical disease?

A

Abbreviation: RAT MIST

Radiation to the jaws, acute Sinusitis, tuberculosis, multiple myeloma, iron deficiency anemia/ PA/ leukemia, sickle cell anemia, trigeminal neuralgia.

25
Q

How can tuberculosis cause signs/ symptoms that may mimic periapical disease?

A
  • involvement of local lymph nodes and lymphoma may mimic LN enlargement due to dental problem.
26
Q

Define MRONJ?

A

Exposed necrotic bone in the maxilla and mandible that has persisted for more than 8 weeks following a surgical procedure in patients taking anti- resorptive and anti- angiogenic drugs.

27
Q

What are 5 medically related complications to RCT treatment?

A
  • cardiac disease
  • bleeding disorders
  • diabetes mellitus
  • cancer treatment
  • pregnancy
28
Q

When should the INR be checked for patients on Warfarin?

A
  • Ideally checked within 24 hours, 72hrs if INR stable.
29
Q

What is Warfarin?

A

An anticoagulant.

30
Q

What is canal obliteration? What is it caused by? How does it influence treatment?

A
  • the pulp response to trauma, characterized by rapid deposition of mineralized tissue in the root canal space.
  • caused by old age/ chronic inflammation/trauma.
  • obscures internal anatomy thus can result in errors during preparation and difficulty finding canal orifices.
31
Q

How can iron deficiency/PA/ leukemia cause signs/ symptoms that may mimic periapical disease?

A

paraesthesia of the soft tissues.

32
Q

What is the risk of developing IE in the general population?

A

1:10,000

33
Q

Name two antiplatelet medications. What is safe pain relief for them?

A

Clopidogrel, aspirin.
- Safe pain relief: paracetamol.

34
Q

What are 4 conditions that increase the risk of developing IE?

A

Valve disease, previous IE, congenital heart disease, valve replacement.

35
Q

What does internal root resorption look like? What is the required treatment?

A

OVOID, RADIOLUCENT shape inside the canal.
- RCT may stop resorption.

36
Q

List some iatrogenic problems that may occur during RCT ?

A
  • perforations, broken instruments, ledging, canal blockages.
37
Q

What can cause persisting signs/ symptoms following RCT (3)?

A
  • insufficient canal disinfection, missed canal, root fractures.
38
Q

What are the two types of latex allergy?

A

Type I - Anaphylactic reaction: patient must be seen in latex-free room, latex-free rubber dam and all other materials.

Type IV - allergic contact dermatitis: use latex free-rubber dam. Use of gutta percha cones safe as long as they do not come into contact with peri-radicular tissues.

39
Q

What are 13 TOOTH RELATED CONTRAINDICATIONS?

A
  1. abnormal canal configurations.
  2. immature apex.
  3. root resorption.
  4. hypercalcification.
  5. crown/root ratio.
  6. tooth location and malpositioning.
  7. retreatment.
  8. iatrogenic problems.
  9. traumatic injuries.
  10. endodontic-periodontic lesions.
  11. persisting signs and symptoms after treatment.
  12. approximation to vital structures.
  13. existing restorations.
40
Q

How do existing restorations influence RCT?

A
  • may make pulp chamber and canals difficult to locate.
  • Accessing through crowns and bridges (metal, ceramic).
41
Q

How does the crown: root ratio affect RCT?

A
  • If ratio exceeds 1:1 it is more susceptible to eccentric occlusal forces. (minimum required root support is 1:1)
  • restoration in UNRELIABLE and likely to fail.
42
Q

When is antibiotic prophylaxis required in dentistry?

A

Only for INVASIVE procedures in patients with Valve disease, previous IE, congenital heart disease, valve replacement.

43
Q

What is an immature apex? Why does it make RCT more difficult? What is an indicated treatment?

A
  • Characterized by wide canal and narrow dentinal walls.
  • difficult to obturate (may require apical plug) + difficult to establish working length.
  • vital pulp therapy to dentinal walls grow stronger and apex to close overtime.
44
Q

What is taurodontism?

A

a very long pulp chamber which divides into different canals in the apical third.

45
Q

How can acute sinusitis cause signs/ symptoms that may mimic periapical disease?

A

toothache (teeth very sensitive to cold and percussion)

46
Q

What are 4 PATIENT POTENTIAL COTRAINDICATIONS to RCT?

A
  1. Age (young patients have immature roots with open apices, older patients have shallow pulp chambers, narrow root canals and systemic conditions).
  2. physical limitations.
  3. financial status.
  4. patient motivation and availability.
47
Q

What is Denosumab?

A
  • a RANKL inhibitor.
  • A human antibody which inhibits osteoclastic function and associated bone resorption by inhibiting RANKL.
48
Q

How can trigeminal neuralgia cause signs/ symptoms that may mimic periapical disease?

A

referred pain from cardiac angina, multiple sclerosis –> may be taken for dental pain.

49
Q

How can multiple myeloma cause signs/ symptoms that may mimic periapical disease?

A

unexplained mobility of teeth.

50
Q

What causes external root resorption?

A

infection or external forces like orthodontic treatment.

51
Q

What are 3 dentist related contraindications?

A
  • Lack of knowledge and/ or skills.
  • Lack of devices and technology.
  • Lack of time.
52
Q

How does RCT help teeth become a healthy, functioning unit?

A
  1. remove cause (bacteria) to allow healing.
  2. prevent reinfection of RC system by providing adequate coronal seal.

Module 5 - Endodontics (11 decks)

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