Introduction to Endodontics Mr. caputo Unit #2 Lesson #1

Today’s Class Driving Question: What is endodontics? Learning Intentions: We will be able to identify the causes of pulpal damage. Anchor: Explain the purpose of dental cast.

This Unit This unit provides information on the dental specialty that is involved in the prevention, diagnosis, and treatment of the pulpal portion of the tooth. Endodontic treatment is most often referred to as a “root canal.” A root canal provides treatment for a tooth that may otherwise need to be extracted. Endodontics may be performed by a general dentist or by a specialist known as an endodontist. Following the completion of endodontic treatment, a final restorative restoration will be placed to complete the process.

This Unit This lesson focuses on the identification of pulpal damage and the signs and symptoms experienced by individuals with pulpal damage. Additional information is included on the various tests that can be utilized to diagnose diseased endodontic tissues. Regardless of the signs and symptoms that a patient may be experiencing, pulpal nerve damage may be clinically evident or may be undetectable from a visual inspection. The dentist needs to use various diagnostic tests to determine the presence as well as extent of pulpal nerve damage prior to implementing treatment. Emphasis in this lesson is placed on the dental assistant’s responsibilities in the preparation of the endodontic setup as well as duties during endodontic treatment.

Endodontics Specialty involving treatment of tooth pulp and periapical tissues Pulp infection from root apex can travel to periapical area and then spread to periradicular tissues If not treated, infection can spread to bone and next to oral soft tissues

Endodontist Click here for a question to consider Specialist in root canal treatment Endodontic specialist completes dental school and attends advanced training in endodontics for an additional two years General dentists refer difficult-to-treat cases to an endodontic specialist Click here for a question to consider

Question to Consider Can there be a relationship between a brain infection and a tooth infection? Read the story of a Maryland boy who died of brain infection by clicking here or visiting http://www.washingtonpost.com/wp-dyn/content/ article/2007/02/27/AR2007022702116.html

Causes of Pulpal Damage Aggressive tooth decay reaching the pulp chamber Trauma to tooth due to a physical blow separating tooth from nerve supply, either recently or in the past Trauma to tooth due to complete or incomplete fracture

Causes of Pulpal Damage Microbial irritation—caused by destructive tooth decay that allows harmful bacteria to enter the pulpal chamber. Mechanical and thermal irritation from tooth preparation Chemical irritation when restorative materials are placed too close to pulp

Symptoms of Pulpal Damage Oversensitivity of tooth to hot or cold food and beverages Pain or discomfort from tooth when chewing or biting Facial swelling due to periapical abscess Aching of tooth without definable reason, possibly keeping patient awake at night Sometimes there are no obvious symptoms

Pulpal Tissue Inflammation A toothache may develop with sharp and throbbing pain, which is generally an acute condition, or the patient may experience mild to dull pain, which indicates a chronic condition of inflammation of the pulpal tissue. Pulpitis is inflammation of the tooth pulp that may be reversible or irreversible, or the pulp may already be dead.

Pulpal Tissue Inflammation A periapical abscess is an infection from within the tooth that spreads out through the tooth’s apex and into the surrounding bone. A vital pulp has reactions to cold and other stimuli.

Reversible Pulpitis If tooth is able to respond to treatment and symptoms of inflammation subside Procedure involves: removing caries placing medicated sedative temporary filling allowing symptoms to subside placing sedative filling with calcium hydroxide to provide tooth a chance to produce reparative dentin and heal itself

Irreversible Pulpitis When tooth is unable to respond to treatment and patient’s symptoms of pain continue No visual changes on periapical radiograph may be seen Endodontic treatment is indicated Only alternative to root canal therapy is extraction of tooth

Pulpal Necrosis Necrotic pulp is nonvital pulp that is infected and dead Necrotic pulp has been deprived of its blood and nerve supply and is no longer composed of living tissue Nonvital tooth will not respond to heat, cold, or electrical stimulation Nonvital pulp may range from being asymptomatic to being very sensitive

Fractured Incisors Leading to Necrotic Pulp

Periapical Abscess Results from an infection of pulpal tissue causing pulp to die Pus and fluid accumulate and form in the bone surrounding tooth Fistulous tract is formed Image courtesy Instructional Materials for the Dental Team, Lex. KY