Endodontics
Course Review
Enoch Ng, DDS 2014
Inflammation
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Acute inflammation
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Vascular/exudative response
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Leukocyte migration
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Chronic inflammation
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Long term irritation
o
Primarily cellular response (macrophages, B and T lymphocytes, plasma cells)
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Proliferative – fibroblasts, collagen production, neovascularization
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Increased osteoblastic/osteoclastic activity
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Pulpal response to caries
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Chronic
acute
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Primary immune cells in initial response (lymphocytes and plasma cells)
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Carious exposure increases inflammation, increased PMNs and macrophages
Distance between pulp/pathogen important – inflammation becomes great <0.5mm from pulp
o
Diffusion of bacterial toxins through tubules induces inflammation before pulpal exposure
With absence of filtration pressure, endotoxin can diffuse though 0.5mm dentin in 15min-4h
o
Exposed pulp with bacterial exposure has severe inflammatory response
Endotoxin concentration very high in necrotic symptomatic teeth and apical lesions
Endotoxin can progress past root canal into apical area – endotoxin found in 75% of
apical lesions associated with necrotic pulp
Apical advancement continues until entire canal is infected and tooth is overwhelmed
Vital tissues can still be present even in necrotic pulp
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Pulpal inflammation – thermal, spontaneous, and referred pain
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Apical inflammation – biting, percussion, and palpation pain
Technique
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Eliminate both infection and inflammation, since infection from caries and endo infections causes inflammation
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NEED rubber dam (standard of care)
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Contact time and appropriate delivery of NaOCl, intracanal medicament CaOH
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Adequate cleaning/shaping, temporary filling, final restoration
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Aseptic technique needed to prevent introduction into cleaned canal system
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Soak GP in NaOCl for 1min before obturation to sterilize them
Antibiotic resistance
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Adherence to prescription guidelines is low
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10%-42% for pediatric patients in common dental scenarios
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14%-17% compliance during weekends
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Indications for antibiotics
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Fever >100
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F
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Malaise, lymphadenopathy, trismus, increased swelling, cellulitis, osteomyelitis, persistent infection
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34% of prevotella strains from dentoalveolar infections resistant to amoxicillin
