Week 1 PP

Question 1

What are the 9 Dental Specialties recognized by CDA

Answer 1

• Dental Public Health
• Endodontics
• Oral and Maxillofacial Surgery
• Oral Medicine and Pathology
• Oral & Maxillofacial Radiology
• Orthodontics and Dentofacial Orthopedics
• Pediatric Dentistry
• Periodontics
• Prosthodontics

Question 2

What is Endodontics?

Answer 2

The branch of dentistry dealing with prevention, diagnosis and treatment of the dental pulp and the surrounding periapical tissues

• the diagnosis of pulpal damage, infection or necrosis and subsecquent root canal or apical surgery

Question 3

What does peri-radicular mean?

Answer 3

around the root

Question 4

What does periapical mean?

Answer 4

around the apex/apices

Question 5

Why is it important to treat the pulp and peri-radicular or apical tissues?

Answer 5

• the pulp is the heart of the tooth
  -if the pulp is not happy it can become sick and mabye even die and affect the surrounding tissues
  -if the tooth dies, we need to do a root canal so that we can at least save the body of the tooth

Question 6

Causes of Pulpal Nerve Damage

Answer 6

-Physical irritation:
-range from mild sensitivity to complete nerve death or infection of surrounding tissues
-extensive decay moving into the pulp
-abscess can also form

-Trauma

Question 7

What is the most common cause of pulpal damage?

Answer 7

Cavities!!!

Question 8

Process of Pulpal Damge due to Physical Irritation

Answer 8

• Tooth decay can spread deep into your teeth and affect your dental pulp and roots. When the bacteria travel deeper into a tooth, past the hard enamel portion of a tooth and into the
  dentin the bacteria have easier access to the pulp.
• Therefore if a “small” cavity that exists in the enamel/dentin layers of a tooth is not repaired the bacteria can travel into the pulp causing “extensive decay”.
• Once in the pulp chamber, the bacteria will continue to travel through this soft tissue layer with ease.
• The bacteria will eventually reach the nerves and blood vessels an infection or abscess (a localized area of pus)
• When we see pus we know that there is an active infection because pus contains factors from your immune to fight unwanted intruders such as the cavity causes bacteria.

Question 9

Process of Pulpal Damage due to Trauma

Answer 9

Blow to jaw and/or surrounding tissues > Damage to surrounding tissues > Damage to nerve tissues and blood vessels

Question 10

Trauma can cause pulpal damage via..

Answer 10

• Broken teeth
• Chipped teeth
• Cracked teeth
• Fractured teeth; or
• Sometimes a pulp will be injured from trauma without clinically visible damage to the tooth (such as in the case of this image)

Question 11

Trauma (causing pulpal damage) may include:

Answer 11

• Attrition
• Erosion
• If a filling is too high and is not taken down that can cause trauma to the tooth’s pulp
• Parafunctional habits - Grinding, Clenching

Question 12

Surrounding tissues experiencing force due to trauma..

Answer 12

• The periodontal ligaments may tear from the force
• The bone may initiate a resorption process due to damaged periodontal ligaments or plain damage to the bone on its own.
• Parts of the tooth can break and be driven into surrounding tissue to cause damage

Question 13

Common signs and symptoms of pulpal damage

Answer 13

-Pain - when occluding, during mastication
-Sensitivity - to hot or cold beverages
-Swelling - of the face

Question 14

What is Subjective Examination?

Answer 14

-Symptoms as described by the patient

“There is a shooting pain when I bit on something hard”

Question 15

What is Objective Examination?

Answer 15

What the dentist sees - based on clinical assessments

Question 16

Clinical Assessment for Endodontic Diagnosis

Answer 16

• Usually the dentist will first assess a control tooth (a similar “healthy” tooth on the opposite side) and then do the exact same test on the tooth in question. So if there was a concern with the 3.6 they would choose the 4.6 as the control tooth
• Extent of decay
• Periodontal conditions surrounding the tooth in question
• Presence of an extensive restoration
• Tooth mobility
• Swelling or discoloration
• Pulp exposure

Question 17

What is Percussion and Palpation used for?

Answer 17

used to assessthe extent of inflammation into the periapical tissues

Question 18

Thermal Test - Cold Test uses..

Answer 18

-Ice
-Dry ice (carbon dioxide)

Question 19

Thermal Test - Heat Test

Answer 19

-Gutta percha
-Heated instrument

*lingering pain to heat is NOT normal

Question 20

Electric Pulp Testing is used for..

Answer 20

is used to identify if a tooth is vital or not

Question 21

What are we looking for in Radiographic imaging?

Answer 21

-Dental Caries
-Depth of restorations
-Periapical infections
-Location and # of pulp canals

Question 22

Characteristics of Normal Pulp?

Answer 22

-No subjective symptoms
-No objective signs
-Normal response to sensory stimuli
-Healthy layer of dentin surrounds the pulp

Question 23

Characteristic of reversible pulpitis?

Answer 23

Pain to thermal stimuli

Question 24

Treatment for reversible pulpitis?

Answer 24

Eliminate irritant & placing a sedative material can save the pulp

Question 25

Characteristics of Irreversible pulpitis?

Answer 25

-Lingering pain -Pulp cannot and will not heal

Question 26

Treatment for Irreversible pulpitis?

Answer 26

Root Canal or Extraction

Question 27

Characteristics of Periradicular Abscess

Answer 27

-asymptomatic -some discharge of pus (its draining elsewhere)

Question 28

Characteristics of Acute Periradicular Abscess

Answer 28

Pain, tenderness to pressure, pus formation, swelling

Question 29

What causes a Periodontal Abscess?

Answer 29

Bacteria trapped in a periodontal sulcus

Question 30

What is Pulp Fibrosis?

Answer 30

* A decrease in living cells within the pulp that causes fibrous tissue to take over the pulpal canal * Seen in older adult patients as well as patients who have sustained a traumatic injury to a tooth

Question 31

What is Necrosis Pulp?

Answer 31

-Necrotic or Nonvital -this term is used to describe a tooth that does not respond to sensory stimulus -the tooth can be considered nonvital but it is still attached to the alveolus by way of the cementum and periodontal ligaments which are still vital tissues

Question 32

What is a Periradicular Cysts?

Answer 32

This type of cyst develops at or near the root of a necrotic tooth the cyst develops as an inflammatory response to pulpal infection and necrosis of the pulp

Question 33

What is Pulp Fibrosis?

Answer 33

- the number of living cells within a pulp decreases -fibrous tissues take over the pulp chamber/canal

Question 34

Pain Relief for Pulpal Damage

Answer 34

Once a diagnosis is made the first step is to make sure the patient is out of pain * Medications * Antibiotics * Open and drain * Or, start RCT

Question 35

What is Open & Drain?

Answer 35

The pulp chamber of the tooth may be ‘opened’ to allow infection to drain and provide relief immediately * The pulp chamber is opened using rotary instruments – often as soon as the instrument hits the chamber, infectious fluid begins to drain from the tooth * if not, an endodontic file can be inserted into the canals to create a pathway for drainage to occur * If this is not enough to provide relief, or if the infection has collected below the tissue through a ‘fistula’ the dentist may drain the infected fluid from the apical area by surgically opening the tissue with a scalpel

Question 36

What is IRM and its use in Endo?

Answer 36

IRM is a temporary filling material, contains meds to help -done after open and drain -used to allow healing between root canal appointments -used when diagnosis is not definite (pulp? cracked tooth? decay?)

Question 37

What does IRM stand for?

Answer 37

Intermediate Restorative Material