Module: Endodontics
Faculty Teaching Guide for Specialty Chairside Assisting
Module – Endodontics
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
Resources
This 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.
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
Part B: Materials and Procedures
Learning Objectives and Competencies
These 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 Activities
These learning activities directly address the Learning Objectives and Competencies as stated.
[Insert Homework Assignment icon] Key Term Glossary (Part A, All Objectives)
[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
Overview
Endodontic 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 Activities
1. 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 / Slides /Introduction 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
[Insert Home Ass icon] Textbook Assignment, / Slides 7-19
[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Act [ ] Evaluation
[Insert In-Class Act icon] In-Class Activities
q 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 Discussion
1. 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 Assignments
Key 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]SCA – Stands for Specialty Chairside Assisting. The 1st “1” indicates the Module called Endodontics. The 2nd number indicates the slide number. / Power Point Presentation for Specialty Chairside Assisting
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.
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 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 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.
Part B: Materials and Procedures
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 Activities
1. What are some of the fears a patient may experience if they are having a root canal?
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 / Slides /Material 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
q 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.
q 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 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 Discussion
1. 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 Assignments
Workbook 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 …
q 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.