Specialty Chairside Assisting 1.doc.doc

Module: Endodontics

Faculty Teaching Guide for Specialty Chairside

Assisting

Module – Endodontics

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Faculty Teaching Guide for Specialty Chairside Assisting


Module: Endodontics

Module Overview

This module will discuss the dental assistant’s responsibilities as a team member for the specialty of endodontics.

The specialty of endodontics is concerned with diseases of the dental pulp and surrounding tissues. Specialty

procedures may be performed by a general dentist or the patient may be referred to an expert limited to a

particular discipline. Patient’s are refered to an endodontist for procedures such as root canal treatment and

periapical surgery. The DA who understands the various dental specialties is better able to assist the dentist and

be a valued member of the health care team.

The Big Picture

ResourcesThis module utilizes the following learner resources:

Textbook: Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead.

Delmar Learning, 2004. ISBN 1-4018-3480-9.

Workbook: Workbook to Accompany Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J.

Phinney and Judy Halstead, prepared by Karen L. Waide, Delmar Learning, 2004. ISBN 1-4018-3483-3.

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Faculty Teaching Guide forSpecialty Chairside Assisting

Module:Endodontics

Section 1:Endodontics

Part A: The Endodontic Patient

Part B: Materials and Procedures

Module: Endodontics

Instructor’s Manual: Instructor’s Manual to Accompany Delmar’s Dental Assisting, A Comprehensive Approach,

2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN 1-4018-3482-5.

Electronic CD-ROM: Delmar’s Dental Assisting Interactive Skills and Procedures CD-ROM, ISBN 1-4018-3485-

X.

Faculty CD-ROM: The faculty CD-ROM includes this Faculty Guide and the PowerPoint Presentation for

Specialty Chairside Assisting.

Section 1: Endodontics

Section Overview

Endodontics is the branch of dentistry concerning the diagnosis and treatment of the tooth pulp and periapical

tissues. Success of endodontic treatment depends on sterile technique, medications, profound anesthesia, and

proper seal of the pulp canal. The dental assistant has a vital role to ensure universal precautions are followed

and to know the specialized armamentarium used during these procedures. Periapical radiographs taken by the

dental assistant during endodontics must be precise in order to show exact details of the tooth anatomy and

surrounding tissues.

Outline of Section Part A: The Endodontic Patient


Learning Objectives and CompetenciesThese learning activities directly address the Learning Objectives and

Competencies as stated.

Knowledge

1. Define the Key Terms.

2. Define endodontics, pulpal and periapical disease.

3. List endodontic diagnostic procedures.

4. List instruments and materials used in endodontic treatment and their functions.

Application

5. Demonstrate the ability and the knowledge to assist during an endodontic procedure.

6. Demonstrate the ability and the knowledge to assist during an apicoectomy procedure.

Learning ActivitiesThese learning activities directly address the Learning Objectives and Competencies as stated.

[Insert Homework Assignment icon] Key Term Glossary (Part A, All Objectives)

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Be sure that learners thoroughly understand each learning objective and how the learning activity relates to them. Adults do not appreciate busy work and sometimes by merely pointing out the relationship between the activities and learning, they are more interested in completing the activities successfully.

Teaching Tip


[Insert In-Class Activity icon] Electronic Pulp Testing (Part A, Objective 3)

[Insert Homework Assignment icon] Textbook Assignment (Part A, All Objectives)

[Insert In-Class Activity icon] Endodontic Set Up and Assist (Part B, Objective 5)

[Insert In-Class Activity icon] Apicoectomy Set Up and Assist (Part B, Objective 6)

[Insert Homework Assignment icon] Workbook Assignment (Part B, All Objectives)

[Insert Homework Assignment icon] End of Chapter Activities (Part B, All Objectives)

[Insert Homework Assignment icon] Interactive Skills and Procedures CD-ROM (Part B, Objective 4)

Part A: The Endodontic Patient OverviewEndodontic therapy will enable the patient to retain their tooth and therefore the alveolar bone. The dental

assistant will not only help the dentist throughout the procedure, but will also coordinate information with the

referring dental office, make the patient comfortable, and explain much of the process to the patient.

Initial Questions and Activities1. What will happen if decay extends into the tooth pulp?

Learners should be able to easily answer this question from the

previous studies. If this question does pose problems or confusion

make sure to review prior to moving on to this modules material. The

tooth pulp will become irritated and infected all the way to the apex,

and cause discomfort for the individual. Over time the pulp tissues will

die and develop a periapical abscess.

Key Concepts References and Activities SlidesIntroduction to Module Slides 1-2

Introduction to Section Slides 3-4

Key Terms [Insert Home Ass icon] Key Term Glossary Slides 5-6

Periapical Diseases Chapter ___, pgs. ____

[Insert Group Activity icon] Electronic Pulp

Testing

Slides 7-19

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When starting any topic, encourage learners to think in general about what you are going to say. The more you can engage their interest, the more they will focus on the material.

Teaching Tip

Module: Endodontics

Key Concepts References and Activities Slides[Insert Home Ass icon] Textbook Assignment,

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Act [ ] Evaluation

[Insert In-Class Act icon] In-Class Activities Electronic Pulp Testing (Part A, Objective 3). Goal: For learners to understand how an electronic pulp tester

is used. Instructor should provide a pulp tester and ensure supplies are available. Learners should be placed

into groups. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____.

Learner workbooks contain check off sheets that can be utilized.

[Insert In-Class Dis Ques icon] In-Class Discussion1. Why is it important to always review a patient’s medical history?

Ensure learners realize how important a complete and accurate medical history is before any type of

anesthesia is administered. Present medications being taken by the patient could cause an adverse,

or an exacerbated reaction, if the dentist is going to prescribe other drug therapy for the patient. A

thorough medical history will also ensure the patient hasn’t developed new drug allergies since the

last appointment.

[Insert Home Ass icon] Homework AssignmentsKey Term Glossary. Learners will define key terms listed in the PowerPoint

presentation. They are to enter this glossary on disk, in a dedicated notebook or

in a designated part of a notebook. They are expected to augment information

from text or lecture with other resources including any available in the school or

public libraries or on the Internet and will be graded at the end of the module on

completeness and presentation.

Textbook Assignment. Learners are to read Chapter ____ .

Presentation Tools

Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.Slide 1 [Insert SCA 1-1] Power Point Presentation for Specialty Chairside

Assisting

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Encourage learners to talk amongst themselves about the course topics during breaks, or before or after class. Self-discovery is enlightening, and the sharing of information helpful in a way that can be very powerful and safe.

Teaching Tip


SCA – Stands for Specialty

Chairside Assisting. The 1st “1”

indicates the Module called

Endodontics. The 2nd number

indicates the slide number.

Module: Endodontics

Prior to introducing this module. Ask learners if any

questions remain from the previous module. If questions

remain review the material as needed.

Introduce this Module.

Slide 2 [Insert SCA 1-2] Module: Endodontics

Introduce the sections and each part.

Slide 3 [Insert SCA 1-3] Section 1: Endodontics

Discuss each objective in detail. Learners need to know

what they will be learning and why. Try to relate it back to

their careers as dental assistants.

Slide 4 [Insert SCA 1-4] Section 1: Endodontics (cont.)

Continue to discuss each objective in detail.

Slide 5 [Insert SCA 1-5] Key Terms

Review each key term and discuss.

Slide 6 [Insert SCA 1-6] Key Terms (cont.)

Continue discussing each term.

Homework Assignment: Stop here and go over the Key

Term Glossary assignment.

Slide 7 [Insert SCA 1-7] Part A: The Endodontic Patient

Introduce the specialty field of endodontics.

Explain that the only alternative to endodontic treatment

is an extraction.

Review who the members are on the endodontic team.

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Module: Endodontics

Discuss the responsibility that the DA has when it comes

to communicating with a referring dental office.

Slide 8 [Insert SCA 1-8] Pulpal and Periapical Diseases

Discuss the difference between vital and non-vital pulp.

Point out that non-vital pulp is either dead or dying.

Explain that with reversible pulpitis, the pulp may recover

if the irritation is removed, but that with irreversible

pulpitis, the inflammation is so severe that either the

tooth is extracted, or can be saved with endodontic

therapy.

Explain that a necrotic pulp is dead pulp.

Point out that if the pulpal inflammation continues, a

fistula will develop, in order to drain the infection. The

fistula will create a path through the bone and create a

“gumboil," in which case, the exudate will need to be

drained by the dentist.

Note to Instructor: Correct error in the textbook in the

Endodontics chapter. (Phinney & Halstead). Under pulpal

necrosis, the term “gumball” should be “gum boil.”

Discuss that both apical periodontitis and a periapical

abscess destroy bone, and that the longer an infection is

present in the periapical tissues, the more alveolar bone

loss there will be.

Slide 9 [Insert SCA 1-9] The Endodontic Patient

Ensure learners understand how important it is to take a

thorough medical and dental history from the patient

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before beginning treatment.

Discuss the difference between objective and subjective

symptoms.

Address that a treatment plan should be discussed with

the patient prior to beginning any procedure.

Slide 10 [Insert SCA 1-10] The Clinical Examination

Explain that quality radiographs are essential diagnostic

aids for the clinical examination of a patient.

Ensure learners understand that an intraoral exam

includes procedures performed inside the patient’s mouth

and extraoral procedures are completed outside of the

oral cavity.

Slide 11 [Insert SCA 1-11] Clinical Tests

Describe each test procedure.

Explain that palpation is applying pressure to oral tissues,

or checking the oral cavity, face, and neck by gently

touching.

Discuss how percussion is performed by tapping a few

teeth gently with an instrument handle, which assists the

dentist in distinguishing between a tooth with periapical

inflammation from those without problems. Inform

learners that if there is bone loss from longstanding

infection, the tooth may be mobile.

Discuss how temperature testing and an electronic or

digital pulp test, helps determine the extent of pulpal

damage. Explain that if there is little reaction from the

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Module: Endodontics

patient, the pulp may already be necrotic.

Describe how a fractured tooth may not be detected on a

radiograph, and that a fiberoptic light, shown through the

tooth, may indicate a fracture.

Inform learners that sometimes the patient cannot

determine which tooth is bothering them and the dentist

may anesthetize the area to ensure the correct tooth is

identified.

In-Class Activity: Stop here for the Electronic Pulp Test

activity.

Homework Assignment: Stop here to assign and

discuss the homework.


Overview

There are variety of materials that are used in performing endodontic procedures.

Some of the endodontic instruments used are very small and pointed and will be

passed by the dental assistant to the endodontist very carefully using cotton

pliers or specialized instrument holders. The dental assistant will also obtain a

complete medical and dental history, take and process radiographs, prepare

specialized tray set-ups, materials, and supplies, and assist throughout the

procedure. In addition to assisting the endodontist, the DA must be responsive to

complaints of pain and swelling of the patient’s tooth and be capable of calming

the anxious patient’s concerns regarding the endodontic procedure.

Initial Questions and Activities1. What are some of the fears a patient may experience if they are having a root canal?

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Suggest to learners that they take small breaks every thirty minutes or so when they are studying. The quick change of scene will refresh them, thus allowing them to concentrate better on the content when they return.

Teaching Tip


Pain is generally the biggest fear. Some may also think that they might lose their tooth. The dental

team should never assume a patient understands what will happen in the procedure. Asking the

patient questions to confirm their understanding, to help relieve unfounded fears is important.

Key Concepts References and Activities SlidesMaterial and Procedures Chapter ____, pgs. ____

[Insert Group Activity icon] Endodontic Set Up

and Assist

[Insert Group Activity icon] Apicoectomy Set

Up and Assist

[Insert Home Ass icon] Workbook

Assignment

[Insert Home Ass icon] End of Chapter

Activities

[Insert Home Ass icon] Interactive Skills and

Procedures CD-ROM

Slides 12-19

Assessment Questions Slide 20

Summary of Module Slide 21

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation

[Insert In-Class Act icon] In-Class Activities Endodontic Set Up and Assist (Part B, Objective 5). Goal: For learners to prepare a set-up and assist during

an endodontic procedure. Instructor should ensure enough materials and supplies are available, and should be

the operator for this procedure. Learners should be separated into groups. Learners should be graded on the

procedure steps as outlined on pg. ____, Chapter ____. Learner workbooks contain check off sheets that can

be utilized.

Apicoectomy Set Up and Assist (Part B, Objective 6). Goal: For learners to prepare a set-up and assist

during an apicoectomy procedure. Instructor should ensure enough materials and supplies are available, and

should be the operator for this procedure. Learners should be separated into groups. Learners should be

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Module: Endodontics

graded on the procedure steps as outlined on pg. ____, Chapter ____. Learner workbooks contain check off

sheets that can be utilized.

[Insert In-Class Dis Ques icon] In-Class Discussion1. What happens to the bone during a periapical abscess or periodontitis?

There is localized destruction of bone from the infection around the tooth.

2. What is the purpose of a post and core?

This should be a review question based on previous studies. A post is placed inside of the root canal

following endodontic therapy in order to provide stability for the tooth, and the core is the filling

material used to restore the tooth to it’s natural contour. Every endodontically treated tooth will need

a crown for support and strength.

[Insert Home Ass icon] Homework AssignmentsWorkbook Assignment. Learners are to complete the workbook Chapter ____ questions. Learners should be

prepared to review these in class.

End of Chapter Activities. Have learners complete the Review Questions and Critical Thinking Questions in

Chapter ___ .

Interactive Skills and Procedures CD-ROM: Learners should practice setting up for endodontic procedures

using the two case studies on the CD-ROM.

Ideas for learners struggling with this material … Web Research. Have learners go on the Internet and find a Web site for patients with questions about

endodontic treatment. One recommended site is: http://www.aae.org, sponsored by the American Association

of Endodontists. Learning how patient’s questions are answered should help the learner to further understand

the endodontic process and to be able to answer these questions when asked by patients.

Ideas for learners who are ahead and want to learn more … Web Research. To learn more about dental pain (pulpitis) have learners go to http://www.ncemi.org and enter

“pulpitis” in the search. Have learners write a short paragraph on their findings and be prepared to present it

to the class.

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http://www.ncemi.org/

http://www.aae.org/


Presentation Tools

Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.Slide 12 [Insert SCA 1-12] Part B: Materials and Procedures

Review Part A. Review the homework from Part A and

make sure any remaining questions are answered.

Introduce Part B.

Explain that barbed broaches remove pulpal tissue, files

are used to enlarge and smooth the canal walls, and

reamers are designed to widen the opening of pulp canals.

Ensure learners understand that the various intracanal

instruments used are color coded by their width size and

number.

Discuss how each intracanal instrument is used

consecutively to widen the canal, thereby removing any

further diseased tissue (also known as mechanical

debridement) and to create a space for the filling material.

Address the importance for sterilizing endodontic

instruments before, during, and after use. This may be

done with a glass bead or salt sterilizing unit.

Explain that the rubber stops are placed on the file to

determine the millimeter length of the tooth root.

Point out that Gates-Glidden drills and Peeso Reamers are

used on slow speed handpieces. Explain that the Gates-

Glidden will remove dentin, and the Peeso Reamer is used

to remove some of the endodontic filling material in

preparation for a post.

Remind learners that ideally endodontically treated teeth

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Module: Endodontics

will eventually need a post and core, and a crown, in order

to strengthen the tooth following root canal treatment.

Slide 13 [Insert SCA 1-13] Intracanal Instruments (cont.)

Explain that the Lentulo spiral is placed on a slow speed

handpiece and used to place root canal sealer.

Point out that the endodontic spoon is longer than other

spoon excavators, and endodontic explorers are tapered in

order to reach into the pulp chamber, so the dentist can

locate the canal opening.

Discuss how the spreader is a hand instrument used to

laterally condense the gutta percha filling material, and to

create a space for the next gutta percha point, and the

endo plugger used to condense the filling material.

Explain that the Glick #1 is an endodontic instrument with a

condenser / plugger on one end, and a flat end used to

place the temporary filling material.

Slide 14 [Insert SCA 1-14] Endodontic Materials

Inform learners that paper points are placed into the canal,

near the end of treatment, to dry out the canal in

preparation for the filling material, and that gutta percha is

used to fill, or obturate, the root canals.

Ensure learners understand that paper points and gutta

percha points are transferred to the dentist using locking

cotton pliers.

Slide 15 [Insert SCA 1-15] Endodontic Materials (cont.)

Describe how irrigation solutions are placed into the canal

with a Luer-Lock syringe, in order to remove debris,

disinfect, and dissolve necrotic tissue.

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Point out the use of formocresol in dissolving residual

nerve tissue.

Ensure learners understand that the DA must have the tip

of the oral evacuator very close to the tooth opening, so the

irrigation solution doesn’t spray out of the area.

Discuss the terms mechanical debridement and chemical

debridement.

Explain that the dentist may place a disinfectant into the

canal to help sterilize the inside of the tooth, or a material

used to help dissolve dentin in order to expose a root

canal.

Inform learners that there are a variety of cements and

methods used to seal the root canal.

Slide 16 [Insert SCA 1-16] Advanced Technologies

Explain that advances in technology are changing

endondontic procedures. The apex finder will tell the dentist

the exact length of the tooth, the heating unit has many

dental applications, and the endodontic low-speed

handpiece may be used in conjunction with hand

instruments.

Slide 17 [Insert SCA 1-17] Root Canal Therapy

Review the basic steps of a root canal treatment.

Ensure learners understand that the gutta percha filling

material should be placed within 1-2 millimeters of the tooth

apex.

Discuss the use of radiographs during and after the filing

procedure.

Slide 18 [Insert SCA 1-18] Other Endodontic Procedures

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Module: Endodontics

Discuss that pulpectomy and pulpotomy procedures are

usually performed on children.

Explain that a pulpectomy is the complete removal of the

pulp fibers in the pulp chamber and the root canals, and a

pulpotomy is the removal of the pulp in the coronal portion

of the pulp only, leaving the root portion intact.

Point out that the intention of a pulpotomy is to maintain the

vitality of the roots, especially for children, where the apex

of the tooth isn’t fully developed. Inform learners that

materials used for pulpotomy will be discussed in the

module covering pediatric dentristry.

Slide 19 [Insert SCA 1-19] Surgical Endodontics

Explain that an apicoectomy is the surgical removal of the

apex of a tooth in order to control an area of infection.

Point out that this procedure is done when a persistent

infection follows the endodontic seal. Make clear that this is

a surgical procedure where the infectious debris and

infected apex tip are removed, a small preparation cut into

the tooth structure is performed, and a retrograde filling is

placed to facilitate sealing the tooth.

Explain that root amputations and hemisections are done

only on multi-rooted teeth, as a last resort, to save a tooth

and alveolar bone. Discuss that these procedures are

completed most often to retain teeth being used as

abutments for a permanent bridge.

Slide 20 [Insert SCA 1-20] Assessment Questions

Short Activity: Stop here and have learners answer the

questions on the slide. Review material as needed to

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enhance understanding.

Short Activity: Stop here for the class to discuss the Case

Study in Chapter ____.

In-Class Activity: Stop here for the Endodontic Set Up

and Assist activity and the Apicoectomy Set Up and Assist

activity.

Homework Assignment: Stop here to assign and discuss

the homework.

Slide 21 [Insert SCA 1-21] Summary of Module

Review the topics from this module. Ask for questions and

clarify the material as needed.

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