General dentists are able to perform endodontic treatment. Endodontists have 3 years of continued training in endodontics. What is another name for endodontics? What is the name for the specialist who deals with the diseases of the pulp?
Symptoms: pain on occlusion, pain during mastication, sensitivity to temperature, and facial swelling Who has had a root canal? What was the source of the nerve damage? What were the symptoms?
Symptoms differ from patient to patient. Other symptoms include a dull ache in a tooth that lasts over a period of time. How would we put these symptoms in lay terms?
The subjective examination includes an evaluation of all symptoms the patient describes. All symptoms should be documented in the patient’s chart. What may be a patient’s chief complaint?
The objective examination includes all findings by the dentist in the oral cavity. All findings must be documented in the patient’s chart. Control tooth: What is it? How is it selected? Students: If tooth 14 is hurting, which tooth would be the control tooth?
What can we see on this radiograph? Which teeth are involved? What was the probable cause of pulpal damage? What may be the No. 1 symptom this patient is experiencing?
All findings should be documented in the patient’s chart. Where are the periapical tissues?
Which tooth is the dentist testing? Which tooth would be the control tooth?
All findings should be documented in the patient’s chart. The dentist uses the fingertips to palpate the mucosa.
Which area is the dentist palpating? What is the dentist looking for?
Thermal stimuli are never placed on a metallic restoration or the gingival tissue. Why? A control tooth is used. The heat test is not used very often. Cold relieves pain = irreversible pulpitis Pain in teeth lingers = irreversible pulpitis What is pulpitis? What does necrotic mean?
Ice is applied to the cervical area of the tooth only. What would be the control tooth for this photograph? All findings must be documented in the patient’s chart.
Electric pulp testing is used to determine whether a tooth is vital or nonvital. The test can produce a false-positive or false-negative response. Would this type of diagnostic testing be used alone or in conjunction with another test?
All findings must be documented in the patient’s chart. Explain to patient that he or she may feel a tingling or warm sensation during this test. Toothpaste is used as a conductor. Testing should only be done on the facial surface of the cervical third of the tooth.
Initial radiograph should be of diagnostic quality; the dental assistant must see the apex of tooth or teeth in question. The working-length film is taken once the pulp is accessed. Final film: The radiograph shows the files in place in the canal. Completed film: The root canal procedure is complete. Recall films: Taken at prophylaxis appointments or as needed to check the status of a tooth. What type of film should be taken?
What type of film would be taken? What if we didn’t get the apex of the tooth? What would we need to do?
Top radiograph: Shows at least 4 mm beyond the apex; apex is not distorted; good contrast Bottom radiograph: Does not show at least 4 mm beyond apex; apex is distorted; poor contrast is evident What would we need to do to make the bottom radiograph of diagnostic quality?
If a tooth is “normal,” what could be the cause of the pain for the patient?
“ itis” = inflammation Reversible pulpitis: When the irritant is removed, the tooth can be saved from root canal treatment. What could be the irritant? Irreversible pulpitis: The pulp is incapable of healing. If root canal therapy does not improve the situation, extraction of the tooth is the next option.
What is another term for pus? (Exudate.) Odor/smell/color Chronic periradicular abscess: presence of a draining sinus tract Acute periradicular abscess: pain, tenderness, swelling as a result of the necrosis
Odor/smell/color Where is the sulcus located? Does a periodontal abscess always indicate that root canal therapy is needed?
Not very common.
Mostly seen in older patients Patients with recent trauma to a tooth may be susceptible.
What is another term for necrotic ? The tooth is still attached to the alveolus by means of the cementum and periodontal ligaments. If a tooth is necrotic, will it fall out on its own?
Capping can be used as an attempt to save the pulp Mostly used when bacteria have come very close to infecting the pulp Goals: to promote pulpal healing and to stimulate production of reparative dentin Most commonly referred to as IPC or DPC The dentist must inform the patient that this procedure may not be a long-term solution.
Where is the coronal portion of the tooth? Most commonly done on deciduous teeth. Why wouldn’t root canal therapy be done on a deciduous tooth?
Most root canal instruments are slim in design to fit inside the canals of the teeth and flexible enough to adapt to the curves of the canals. Hand instruments: endodontic explorer, endodontic spoon excavator, spreaders, pluggers, Glick No. 1. Finger files: broaches, K-type files, Hedstrom files. Rotary files: Gates-Glidden burs, Pesso reamers. Ancillary instruments: rubber stops, paper points
Universal color-coded system. For example, a white file may have a diameter of 15, 49, or 90. Most manufacturers place the number on the handle of the file.
Irrigation solutions help remove debris, bleach and the deodorize canal, and control hemorrhaging. Sodium hypochlorite is the most commonly used solution. A high-volume evacuator must be used at all times during irrigation. Why is this important? Filling materials: Gutta-percha is solid at room temperature, but a heat source is needed during filling. Variety of sizes; the first gutta-percha point in a canal is referred to as the “master cone.” The size should be documented in the patient’s chart. What does “obturation” mean?
Local anesthetic is most commonly used. Infiltration for maxillary teeth; nerve blocks for mandibular teeth. Sedatives may also be used to alleviate apprehension. Rubber dams are always used during root canal procedures. Why is the use of a rubber dam important? What is d é bridement? What problems could occur if the working length is incorrect?
Root canals have a 10% to 15% chance of failure. Used to save a tooth from extraction.
Invasive procedure. A flap is made on the buccal mucosa to gain access to the apex. An endodontist generally performs this procedure.
Used in conjunction with apicoectomy, apical curettage, or both. Commonly referred to as “root-end filling.” Amalgam is most commonly used filling material. Why would this procedure be done by an endodontist rather than a general dentist?
A root amputation is performed at the furcation. What is furcation? Hemisections are most commonly performed on mandibular molars. Why wouldn’t hemisections be performed on maxillary molars?