ENDO 101

RCT doesn’t cause pain; it relieves it

PREGNANT PATIENT
 NOT advisable to perform rct during 1st and last trimester
 Its BEST to perform it during 2ND TRIMESTER
o If retreatment remove old gp and use apex locator don’t fill unless okay na mag
xray
o Do not treat in supine position - nakatagilid sya dapat.

 Lidocaine – category B drug (FDA) okay for preggy..

 Epi – Category C drug (use with caution)
*aspirate always to prevent to flow intravascularly

leongs Premolar – tx: easy pulp exposure

2 ways to manage
(dahan dahan igrind then place gi liner)
(place flowable composite to support protruberance)
( pag nabali prematurely do RCT – bacterial infection)

DIALYSIS – do endo after dialysis session

STROKE – no elective dental procedure after 6 months

DIABETIC PATIENTS
 Appointmenys should be scheduled with consideration to their meal time and medication
 Prophylactic antibiotic are not indicated for endodontic surgery in well-controlled blood
sugar levels
*only patients with the highest risk of infective endocarditis are to receive prophylactic antibiotics
- px with prosthetic heart valves, congenital heart disease, cardiac transplantation who develop
cardiac valvulopathies.

PROPHYLACTIC ANTIBIOTICS FOR HIGH RISK PROCEDURE

• Extractions
• Intraligamentary local anesthesia 2gms amox PO 1hr before the
• Endodontic surgery procedure
• Endodontic instrumentation beyond the apex
• Extractions or
• Intraligamentary local anesthesia
• Endodontic surgery 600mg clinda PO 1hr before
• Endodontic instrumentation beyond the apex procedure (allergy to penicillin)
MEDICATIONS
• Pantoprazole (for GERD)
• Doxofylline (bronchodilator for asthma and COPD)
• Diltiazem (for HTN, angina and arrhythmia)
• Isosorbide (for angina pectoris)
• Citicoline (for stroke)
• Clopidogrel (antiplatelet to reduce risk of stroke and CVD)
• Sitagliptin (for DM)
• Aspirin (for prevention of blood clot and stroke)
• Rosuvastatin (statin for the prevention of CVD)
• Gliclazide (for DM)
• Insulin degludec (for DM; long acting)
• Insulin glulisine (for DM; rapid acting)

INDICATION/CONTRAINDICATION

TRUE CONTRAINDICATION
Fracture line – fiber optic light to check fractures (one side is bright, and one side is dark)
*more gingival swelling – perio prob/ fracture (vertical)
*more apical swelling – for endo
*multiple sinus tracts – vertical root fracture

FALSE CONTRINDICATIONS
 Lentulo – prone to breakage (DONT USE)
 Nickle titanium – Material for curved canals
 Canal calcification use heat treated files (c pilot files)
 Sealer puff – wait and see after recall

ENDO DRUGS

PULPITIS – No point for antibiotic, access prep.. use articataine, or pulpX.

NO antibiotic treatment for traumatic injuries

For antibiotic – trismus, increased swelling, cellulitis, lymphadenopathy, medically compromised,

rheumatoid arthiris

ADJUNCTIVE ANTIBIOTICS FOR ENDODONTICS

 PEN V
o 1000mg (LD)
o 500 mg every 4-6hrs for 3-7 days
 AMOXICILLIN
o 1000mg (LD)
o 500 mg every 8 hrs for 3-7 days
 AMOXICILLIN AND CLAVULANIC ACID
o 1st drug of choice for sinusitis
o 1000mg (LD)
o 500 mg every 8hrs for 3-7 days
 AMOXICILLIN AND METRONIDAZOLE
o Add metronidazole if healing does not subside after 2-3 days
 o Used in dental infection of bacterial origin
 periradicular abscess, periodontal abscess, pericoronitis
 CLINDAMYCIN
o 600mg LD
o 300mg every 6 hrs for 3-7 days
o Given if the patient’s condition is not improving after 2 – 3 days, Initial loading dose of
metronidazole is 1,000 mg, followed by 500 mg every 6 hours for 3 - 7 days

Heat
Heat test
test Same as cold
Same as cold test
test

lingering
lingering ==
irreversible
irreversible
pulpitis
pulpitis
Therm true
true

al tests +
Short
Short =
= reversible
reversible
pulpitis
pulpitis or
or vital
vital
+

false
false Gingival response
Gingival response
Cold
Cold test
test

True
True =
= necrotic
necrotic
pulp
pulp
--
False
False =
= calcified
calcified
canal
canal
High
High reading
reading =
=
Pulp necrosis
necrosis

Tests Electric
+
+
Low
Low reading
reading =
=
pulp test vital
vital
-- =
= calcified
calcified

Dentin +
+== vital
vital

stimulati
on -- =
= nonvital
nonvital

Pulpal
High
High blood
blood blood
flow=inflammed
flow=inflammed
flow