ENDODONTICS

From the Clinic Manual

Associated Links

GRADE SHEETS

CLINIC FORMS

Case Difficulty Assessment Form

2009 Scoring Criteria

Endodontic Emergency Triage Suggestions

Endodontic Emergency Protocol

Endo Referral Form

OVERVIEW

A. Definition: Endodontics is the branch of dentistry that is concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic clinical sciences including biology of the normal pulp; the etiology, diagnosis, prevention, and treatment of diseases and injuries of the pulp; and associated periradicular conditions.

B. Scope of Care: The scope of endodontics is defined by the educational requirements for the training of a specialist in this discipline. The scope of endodontics includes, but is not limited to, the differential diagnosis and treatment of oral pain of pulpal or periradicular origin; vital pulp therapy such as pulp capping and pulpotomy; root canal therapy such as pulpectomy, nonsurgical treatment of root canal systems with or without periradicular pathosis of pulpal origin, and the obturation of these root canal systems; selective surgical removal of pathological tissues resulting from pulpal pathosis; intentional replantation and replantation of avulsed teeth; surgical removal of tooth structure such as in apicoectomy, hemisection, and root amputation; endodontic implants; bleaching of discolored dentin and enamel; retreatment of teeth previously treated endodontically; and treatment procedures related to coronal restorations by means of post or cores involving the root canal space.

C. Considerations: Dental practitioners must perform endodontic therapy consistent with their educational training and clinical experience, keeping in mind that dentistry’s main goal is for the public to maintain a healthy, natural dentition and that every dental practitioner is expected to be able to recognize and effectively treat pulpal injuries and disease that are commonplace and within the skills acquired by graduates of dental schools in the United States. Endodontic cases that are beyond the training, experience, and expertise of DMD students should be referred to the endodontic residency program that can more appropriately provide for the patient’s care. All endodontic treatment procedures that are undertaken should be of such quality that predictable and favorable results would routinely occur.

CLINICAL EXPECTATIONS FOR DMD STUDENTS

A. All students must be able to:

1. Diagnosis conditions of the pulp and periradicular tissues
2. Identify and determine etiologic factors responsible for pulpal and periradicular disease.
3. Identify and use appropriate measures to prevent disease of the pulp and perirardicular tissues.
4. Identify factors that nay affect the proposed treatment.
5. Demonstrate sound clinical judgment in selection of cases for treatment and referral.
6. Determine a prognosis for cases selected for treatment
7. Evaluate completed endodontic procedures.

B. All predoctoral students must be able to:

1. Take and record medical and dental histories.
2. Identify the patient’s chief complaint.
3. Construct a systematic visual and tactile extra- and intraoral examination.
4. Perform appropriate clinical procedures such as percussion, palpation mobility assessment, occlusal analysis, thermal tests, and electric pulp tests.
5. Utilize radiographs to assist in accurate diagnosis and aid in treatment of all endodontic situations.
6. Be aware of all endodontic tests necessary to diagnose difficult specific problem (i.e., tests for tooth fractures, test cavity, and anesthetic test).
7. Utilize radiographs to determine whether or not a tooth is treatable (by them) to determine tooth condition, dilacerations, calcification, or resorption (internal or external).

C. Treatment Planning:

1. Predoctoral clinical students must be able to identify the normal pulp, reversible pulpitis, irreversible pulpitis, pulpal necrosis, acute and chronic apical periodontitis, and apical abscesses.
2. These students must understand vital pulp conditions and deviations from same.
3. DMD and endodontic students must be proficient in management of endodontic emergency situations (i.e., pulpotomy, pulpectomy, and incision and drainage procedures).

D. Root Canal Treatment:

1. Predoctoral clinical students must be capable of performing root canal treatment on uncomplicated anterior and posterior permanent teeth.
2. They must be able to achieve adequate anesthesia for all clinical procedures.
3. They must prepare the tooth and the field of operation for a controlled environment, including application of a rubber dam.
4. They must be able to gain ideal access to the pulp chamber, irrigate the root canal system, clean and shape the pulp cavity, place and remove temporary dressing, and adequately obdurate the root canal system.
5. Predoctoral students must be able to recognize and manage procedural errors. They must understand when to treat or continue treating, when to refer and where to refer. These procedural errors include: ledges or shelves in the root canal, perforation of the crown or root, transportation of the root canal, inadequate obturation, and fractures of the crown or root.
6. Predoctoral students must be able to evaluate the post-treatment course for a tooth treated endodontically for success or failure, both radiographically and clinically.

E. Endodontic Surgery: All predoctoral clinical students must be exposed to all endodontic surgical procedures. They must be able to determine which procedure is possible for specific situations (i.e., apical curettage, apicoectomy, retrograde root treatment, root resection, hemisection, and intentional homogenous replantations.

F. Bleaching: Predoctoral students should be familiar with the etiology of tooth discoloration and be able to recognize those teeth amenable to bleaching and be able to perform the appropriate bleaching procedure.

G. Infection Control: All persons involved in endodontic clinical treatment must be knowledgeable in required infection control procedures. The infection control procedures must be adhered to at all times.

H. Radiation Exposure Control: All persons involved with endodontic clinical treatment must:

1. Understand the radiographic process.
2. Keep all exposures to a minimum.
3. Record all exposures.
4. Maintain all x-rays in the patient’s chart.

I. Recall: All endodontic patients must be recalled at least on six-month cycles until the treatment is deemed a success and the patient is dismissed. Specific cases need specific recall schedules that will be set in conjunction with a department faculty member.