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

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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
article/2007/02/27/AR html

8. 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

9. 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

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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

16. Fractured Incisors Leading to Necrotic Pulp

17. 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