Chapter 7 Endodontic Assistance

CHAPTER 7 ENDODONTIC ASSISTANCE DENTAL SPECIALTY OF ENDODONTICS Before major advances in the treatment of diseases of the dental pulp and periapical tissues were made, dentists extracted many teeth needlessly. Endodontics is the dental specialty primarily concerned with these diseases. In some dental clinics, an endodontist is assigned exclusively to this specialty. Often, some of the restorative dentists spend part of their time seeing patients who require endodontic treatment, also known as root canal therapy. As a basic dental assistant, you must be familiar with the following aspects of endodontics: Functions, causes, and diagnosis Types of procedures Steps in pulpectomy and root canal treatment Steps in apicoectomy and associated procedures You must also be able to identify: Endodontic instruments Endodontic materials Endodontic equipment When involved with endodontic procedures, you must follow BUMEDINST 6600.10, Dental Infection Control Program. Strict compliance to sterile technique, sterilization, and disinfection is absolutely essential in endodontic treatment. FUNCTION The primary purpose of endodontics is the treatment of diseases of the pulp and periapical tissues. The goal of this treatment is to retain the natural teeth rather than extract them. Often, the endodontic patient’s initial appointment is of an urgent nature because of the associated pain or infection. Understanding the causes of pulp disease and how a diagnosis is reached will increase your ability to be an effective endodontic assistant. CAUSES The dental pulp can be injured in several ways. Some injured teeth can be treated and returned to normal. Other injured pulpal tissue may undergo necrosis (die) after the slightest injury. Some of the most common causes of injury to the pulp include dental caries (covered in Dental Technician, Volume 1, NAVEDTRA 12572, chapter 5, "Oral Pathology"), traumatic blows to the teeth, pulp exposure (covered in Dental Technician, Volume 1, NAVEDTRA 12572, chapter 6, "Emergency Treatment of Oral Diseases and Injuries"), chemical irritation, and thermal irritation. Traumatic Blows Traumatic blows to the teeth can result from situations such as common household accidents, auto collisions, or athletic injuries. A sharp blow to one or more teeth can result in fracture of the crown or root, or even the avulsion (forcefully knocked out of the socket) of the complete tooth, cutting off the blood flow to the pulp. Chemical Irritation Chemical irritation after placement of certain chemical substances commonly used in restorative procedures can cause pulp injury or death. Another cause of chemical irritation is a faulty restoration, which allows oral fluids to leak between the restoration and dentin. Thermal Irritation Thermal irritation can cause pulp injury and patients will experience discomfort when they inhale cold air through their mouths. If metallic restorative materials are placed close to the pulp, the patient w-ill experience thermal irritation. DIAGNOSIS The diagnosis of pulp and periapical conditions must precede the treatment. Endodontic diagnosis is a result of the skillful use and interpretation of several methods. Some of the more common methods are discussed in the paragraphs that follow. 7-1