3BDS: Endodontics 4+5
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- Created by: DianaIspas
- Created on: 05-11-20 07:05
what is subjective and objective information when it comes to history taking and examination
• Subjective: gained by talking to the patient prior to the clinical examination
• Objective: clinical examination, special tests, radiographic examination, CBCT
• Objective: clinical examination, special tests, radiographic examination, CBCT
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what is phase 2 and 3 in pulpal and periapical diagnostic flow chart
2: clinical tests (periapical-palpation and percussion; periodontal (BPE and mobility) radiographic examinition
3: special tests (caries removal, selective anaesthesia, bite tests, sensibility testing, transillumination )
3: special tests (caries removal, selective anaesthesia, bite tests, sensibility testing, transillumination )
2 of 28
what to ask for pain history
- Location
- Commencement
-Duration of symptoms
- Onset
- Provocation
- intensity
- quality
- Commencement
-Duration of symptoms
- Onset
- Provocation
- intensity
- quality
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if the patient is taking painkillers what should you ask
o What type of a painkiller it was?
o How many tablets in the last 24 hours?
o Was it effective?
o How many tablets in the last 24 hours?
o Was it effective?
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what is the max does of paracetamol
4g (8*500mg tablets) in 24 hours for a 70kg person
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talk through BPE scores
0: no probing depth >3.5, no BPO, no calculus
1: just BPO
2: just calculus present
3: probing depths of 3.5-5.5 mm present
4: probing depths of 6mm or more present
* furcation involvement
1: just BPO
2: just calculus present
3: probing depths of 3.5-5.5 mm present
4: probing depths of 6mm or more present
* furcation involvement
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talk through tooth mobility classification
o: physiological mobility
I: less than 1mm B-L
II: definite mobility 1-2mm B-L
III: gross mobility >2mm B-L and or vertical mobility
I: less than 1mm B-L
II: definite mobility 1-2mm B-L
III: gross mobility >2mm B-L and or vertical mobility
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what does the percussion periapical test determine and what does a severe and mild response show
Percussion: determines the presence of periapical inflammation
-Severe response- periapical inflammation, sharp pain, patient withdraws
-Mild to moderate response- periodontal inflammation, periodontal disease
-Severe response- periapical inflammation, sharp pain, patient withdraws
-Mild to moderate response- periodontal inflammation, periodontal disease
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how to do a percussion test
Tap on incisal or occlusal surface with mirror handle held perpendicular to crown
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what does the palpation test determine
determines if inflammation has extended periapically
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what would you look for in the assessment of the tooth
Tenderness to percussion (vertical and horizontal)
Type and quality of restoration
Position and size of the access cavity, if present
Dental caries, cervical resorption
Tooth wear
Restorability
Estimation of long-term survival based on th
Type and quality of restoration
Position and size of the access cavity, if present
Dental caries, cervical resorption
Tooth wear
Restorability
Estimation of long-term survival based on th
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what would you look at when assessing the soft tissues adjacent to tooth in question
Swelling (firm/fluctuant, bony swelling)
Tenderness to palpation (exact position)
Presence of sinus tract. (patent/closed) + size + exact position
Gingival recession (in mm)
Perio exam: 6 point probing (MB, mid-M, DM, MP, mid P, DP) + furcation involvemen
Tenderness to palpation (exact position)
Presence of sinus tract. (patent/closed) + size + exact position
Gingival recession (in mm)
Perio exam: 6 point probing (MB, mid-M, DM, MP, mid P, DP) + furcation involvemen
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what are the key useless for pulp testing
a. Prior to operative procedures
b. Diagnosis of pain
c. Investigation of radiolucent areas
d. Post-trauma assessment
b. Diagnosis of pain
c. Investigation of radiolucent areas
d. Post-trauma assessment
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what does an intense/ prolonged and a no response mean
Intense, prolonged response: suggestive of irreversible pulpitis
No response: necrotic pulp, false negative (calcified canal, immature apex, recent trauma)
No response: necrotic pulp, false negative (calcified canal, immature apex, recent trauma)
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how could you differentiate between reversible and irreversible pulptitis using the cold test
Reversible- pain subsides on removal of stimulus
Irreversible pulpitis- pain lingers after removal of stimulus
Irreversible pulpitis- pain lingers after removal of stimulus
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what can be used for the cold testing
Ethyl chloride -5 degrees
Dichlorodifluoromethane DMM
Tetrafluoroethane -26 degrees
Propane/butane/isobutane (endo frost) – 50 degrees
Ice sticks
Dry ice (carbon dioxide snow) -78 degrees
Dichlorodifluoromethane DMM
Tetrafluoroethane -26 degrees
Propane/butane/isobutane (endo frost) – 50 degrees
Ice sticks
Dry ice (carbon dioxide snow) -78 degrees
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EPT interpretation of results: positive and negative
Positive response: presence of sensory a delta nerve fibres
Negative response: pulpal pulpal necrosis
Negative response: pulpal pulpal necrosis
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what is the test cavity preparation and when would you use it
A last resort in testing pulpal vitality, only when other results are inconclusive. No evidence to support its effectiveness
- drill through enamel and dentine junction of an unaaesthetused tooth under rubber dam isolation using a small round diamond/ wat
- drill through enamel and dentine junction of an unaaesthetused tooth under rubber dam isolation using a small round diamond/ wat
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what does it mean of the patient does feel any pain during test cavity preparation and what do we do in that situation
If the patient doesn’t feel any pain when dentine reached= the pulp is necrotic, and we carry on with cavity prep to carry out RCT
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what is sensitivity and specificity
sensitivity: the ability of a test to detect disease in patients who actually have the disease: in pulp sensibility testing- the ability to identify non vital teeth
specificity: the ability of a test to detect the absence of disease
in pulp sensibility
specificity: the ability of a test to detect the absence of disease
in pulp sensibility
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when is LDF indicated for use
Pulp testing in children
Traumatised teeth
Monitoring revascularisation of replanted teeth
Differential diagnosis of periapical radiolucensies
Traumatised teeth
Monitoring revascularisation of replanted teeth
Differential diagnosis of periapical radiolucensies
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give examples of special investigations in Endodontics
a. Direct dentine stimulation
b. Selective anaesthesia
c. Transillumination
d. Bite test
e. Diagnostic gutta percha cone placed in sinus
b. Selective anaesthesia
c. Transillumination
d. Bite test
e. Diagnostic gutta percha cone placed in sinus
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how to look at radiographs for Endodontics. what do you look first etc
crown-root-periapical tissues
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what do you look at when assessing the roots and periapical tissues on a radiograph
number and morphology of roots, size and shape of root canals, presence of resorption, presence of periapical pathology, previous RCT( quality, typer of material, iatrogenic defect)
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what do you look at when assessing the crown radiographically
depth of restoration, presence of caries/ recurrent caries, presence of tertiary. dentine or pulp stones, size and location of pulp chamber
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talk about RCT follow up
- Clinical and radiographic follow up at least 1year after treatment. We would expect the lesion to have healed or decrease in size if not..
- Further follow up for up to 4 years before carrying out any more endo treatment on tooth
- Further follow up for up to 4 years before carrying out any more endo treatment on tooth
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what are the 4 prognostic factors
pre-operative absence of periapical radiolucency. Root canal filling with voids. RCF extending within 2mm of radiographic apex. satisfactory coronal seal
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what are the guidelines on the quality of RCT
rubber dam isolation, proximity of preparation to apical constriction, sufficient taper of preparation, adequate irrigation and placement of interappoinment medicament, correct extension of RC obturation without extrusion , adequate coronal seal to preven
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Other cards in this set
Card 2
Front
what is phase 2 and 3 in pulpal and periapical diagnostic flow chart
Back
2: clinical tests (periapical-palpation and percussion; periodontal (BPE and mobility) radiographic examinition
3: special tests (caries removal, selective anaesthesia, bite tests, sensibility testing, transillumination )
3: special tests (caries removal, selective anaesthesia, bite tests, sensibility testing, transillumination )
Card 3
Front
what to ask for pain history
Back
Card 4
Front
if the patient is taking painkillers what should you ask
Back
Card 5
Front
what is the max does of paracetamol
Back
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