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• Endodontics is a branch of dentistry focused on managing the prevention, diagnosis, and treatment of the dental pulp and surrounding periradicular tissues.
• Periradicular refers to the area comprising nerves, blood vessels, and tissues around the root of a tooth.

Causes of Pulpal Damage

• Physical irritation can cause pulpal damage by extensive decay that enables bacteria to move into the pulp.
• Trauma to a tooth or jaw can cause pulpal damage over time by damaging the nerve tissue and blood vessels in the pulp.

Signs and Symptoms of Pulpal Nerve Damage

• Common symptoms include pain when occluding.
• Pain may be experienced during mastication.
• Teeth may be sensitive to hot or cold beverages.
• Facial swelling may be noticeable.

Indications for Endodontic Treatment

• Treatment is indicated for necrotic pulp.
• Fractured teeth or teeth knocked out of the socket may require treatment.
• Treatment may be done when there is a possibility of restoring the tooth to its natural function.

Contraindications for Endodontic Treatment

• Treatment is not advised if the tooth cannot be restored to its natural function.
• Do not treat if the medical condition of the client prevents it.
• Treatment is not advised for teeth unable to be maintained periodontally.
• Refusal of treatment by the client is a contraindication.
• Root fractures are a contraindication.

Endodontic Diagnosis:

• It is based on symptoms described by the client.
• It is based on a dentist's visual findings.
• It is based on tests conducted by the dentist.

Subjective Examination: Client Symptoms

• This includes the chief complaint.
• Need to know the character & duration of pain,
• Identify painful stimuli with sensitivity to biting & pressure.

Objective Examination: Dentist's Visual Findings

• Evaluation includes the extent of decay.
• Evaluation includes periodontal conditions.
• The presence of extensive restorations need to be noted
• The teeth are checked for mobility.
• Need to assess swelling & discoloration and evaluate possible pulp exposure.

Tests Conducted

• Percussion and Palpation.
• Thermal Sensitivity test are conducted.
• Electric Pulp Testing is performed.
• Radiographs are taken pre- and post-treatment.

Percussion & Palpation Tests details.

• These tests indicate inflammation in the periodontal ligament.
• Tests involve applying pressure on the mucosa.
• Dentists isolate infected canals by tapping each cusp separately and waiting for a response.

Thermal Sensitivity Tests

• Cold tests are used on control teeth and teeth in question, using dry ice, ice, or ethyl chloride.
• A necrotic pulp will not respond to cold.
• Heat based tests are not as useful because it can indicate either reversible or non-reversible pulpitis
• A necrotic pulp will not respond to heat either.

Electric Pulp Testing

• Electric pulp testers deliver small electrical stimuli to the pulp to determine if the pulp is vital or non-vital.
• A non-vital pulp will not react to the stimulus.
• The operator increases the strength of the stimulus to see the response.
• Testing is not always accurate because a large restoration may prevent stimulus from reaching the pulp.
• Teeth with multiple canals may have one vital canal and one not, also batteries may weaken
• Moisture can affect the reading, ideal to use other methods as well

Radiographs in Endodontics

• Initial radiograph for Diagnosis.
• Working length film determines canal length.
• Final instrumentation film taken with file/gutta percha cone in canals.
• Root canal completion film taken after canals filled, tooth temporized.
• Recall films taken at post-treatment evaluations.

Requirements of Endodontic Films

• Films should show 4-5 mm beyond the apex of the tooth with surrounding bone or any pathological condition.
• Must present an accurate image.
• Should exhibit good contrast for easy identification of structures.

Diagnostic Conclusions

• Made once subjective and objective tests are complete
• The diagnosis is then presented to the client.

Normal Pulp

• The tooth responds normally to sensory stimuli.
• Healthy dentin surrounds pulp with no subjective or objective signs.

Pulpitis

• Pulp tissues have become inflamed.

Reversible Pulpitis

• The pulp is irritated, patient experiences pain to thermal stimuli
• The pulp may be saved by eliminating irritants and placing a sedative material.

Irreversible Pulpitis

• The tooth will display symptoms of lingering pain.
• Clinical findings indicate the pulp is incapable of healing. The treatment options are root canal therapy or extraction.

Periradicular Abscess: Irreversible Pulpitis

• Chronic condition signs include draining sinus tract, exudate escaping, and little to no pain.
• Acute condition symptoms include pain, tenderness, lack of sinus tract, and swelling.

Periodontal Abscess

• An inflammatory reaction frequently caused by bacteria entrapped in the periodontal sulcus with symptoms of rapid onset, pain, tenderness and swelling.

Periradicular Cyst

• Cysts that develop at or near the root of a necrotic tooth as an inflammatory response to pulpal infection and necrosis

Pulp Fibrosis

• There is a decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal.

Necrotic Tooth

• Also referred to as nonvital
• Does not respond to sensory stimulus. It is important to remember that the tooth may be dead, but the attachment apparatus is still living

Endodontic Procedures

• The choice of endodontic treatment depends on the diagnosis.
• Attempts to save the pulp, called pulpal therapy, is the first line of treatment.

Pulp Capping

• This pulpal therapy involves placing Calcium hydroxide over an exposed or nearly exposed pulp to encourage dentin formation at the site of injury.

Indirect Pulp Cap

• Indicated when a thin partition of dentin is still intact.
• A small amount of decay is left and CAOH is used to stimulate secondary dentin and stop bacteria formation

Direct Pulp Cap

• Indicated when the pulp has been slightly exposed.
• It may not be as successful, ensure to warn the client that endodontic treatment may be inevitable

Pulpotomy

• It is done by removal of the coronal portion of an exposed vital pulp.
• The goal is to preserve vitality of the remaining pulp within the root.
• This commonly indicated for vital primary teeth, teeth with deep carious lesions, and emergency situations

Pulpectomy

• Also referred to as root canal therapy procedure
• Involves complete removal of the dental pulp.