Tx Planning

Question 1

What 3 things do we assess on every tooth?

Answer 1

TOOTH TISSUE

PERIODONTIAL SUPPORT

APICAL ASPET/PULPAL

Question 2

What do we assess in terms of tooth tissue?

Answer 2

Do we have enough tooth tissue to support restoration and create coronal seal?

extent of decay?

cracks?

margins supra or sub?

ferrule?

Question 3

What do we assess in terms of periodontial support?

Answer 3

bone levels
pcoket depth
mobility

Question 4

What do we assess in terms of pulpal aspect?

Answer 4

root morphology
number of roots
Prev RCT?
Size of swelling
extent of infection
sinus
good apical seal?

Question 5

When do we radiographically review endo tx?

Answer 5

According to DSE and ESE guidelines radiograph 1 year post tx to assess healing

if still present review yearly for next 4 years unless tooth becomes symptomatic then intervention required and RCT failed

Question 6

How do we determine recall appts?

Answer 6

NICE guidelines

High risk - 3-6 monthly
Low risk - maximum of 2 yearly

Question 7

How do we classify caries?

Answer 7

SDCEP guidance

INITIAL MODERATE SEVERE

ENAMEL
OUTER 2/3RDS DENTINE
INNER 1/3RD DENTINE
PULP

CAN USE ICDAS

Question 8

What are the pulpal diagnoses?

Answer 8

Normal Pulp - symptom free, normal response to testing

Reversible Pulpitis - inflamed vital pulp capable of healing once remove aetiology (short sharp sensitivity to cold, stops second or two after stimulus removed, localised)

Symptomatic irreversible pulpitis - inflamed vital pulp not capable of healing, spontaneous pain, keeping awake, not working painkillers, RCT indicated (deep caries, extensive rests) - may not be TTPas infectionn hasn’t reached apical tissues yet

Asymptomatic irreversible pulpitis - vital inflamed pulp incapable of healing but pt has no symptoms, trauma, deep caries, may have widening of PDL space

Pulp Necrosis - death of pulp, needs RCT, non responsive to testing, asymptomatic, doesn’t cause apical perio unless canal infected , may prev had symptoms which then settle

Prev initiated RCT - this is where pt has prev had RCT started (pulpotomy or pulpectomy)

Pre Tx tooth - this is where pt has had RCT before and wont respond

Question 9

What are the apical dx?

Answer 9

Normal apical Tissues - healthy,, not Top or sensitive to percussion, LD is intact and PDL uniform

Symptomatic APICAL PERIODONTITIS - this is where inflammation of apical periodntium, TTP, sensitive to percussion, may have radiographic changes such as widening of PDL, apical radiolucency

ASYMPTOMATIC APICAL PERIODONTITIS - inflammation of apical periodontium but tooth not TTP or symptomatic

CHRONIC APICAL ABSCESS - long standing, draining sinus, little to no symptoms may have bad taste, radiolucency due to osseous destruction

ACUTE APICAL ABSCESS - acute, painful, spontaneous extreme tenderness of tooth to pressure, pus fomration, swelling, lymphadenopathy, may be no radiographic signs