Canadian Acfd Eligibility Exam Thread 2

[tinman831]

The last thread has been closed due to the discussion of remembered questions on the exam. Remember that you are not permitted to discuss exam questions per the non disclosure clause you sign when taking it. Any future posts discussing remembered questions will be deleted and the user infracted. This will be your only warning.

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[Sarna]

My suggestions in green

The initial histological appearance of a successful apicectomy would show on a radiograph as

A. a radiolucent area -wud choose thisI would say A, but also was wondering why they ask about histological. Woven bone is what we want to achieve, but takes a few weeks.
B. woven bone
C. cortical bone around surgical site this could be, if you remove the lesion up to the cortical bone which is not a rule
D. sclerotic dentin

When root canals are treated topically with antibiotics rather than with disinfectants

1. a greater success rate results
2. the same rules of mechanical preparation and filling must be observed
3. treatment may be completed in fewer appointments
4. there is greater assurance that all microorganisms are destroyed
5. there is a danger of sensitizing patients to antibiotics.

A. 1,3,4
B. 2,4,5
C. 1,2,3
D. 2,5- i wud choose thisI would say 2,5. Placement of antibiotics will not do the job for us + they say ALL microorganism are destroyed, which rules this option out
E. All of the above
i am not sure abt 4th option


I agree with the first.
The second I think is B. 2,4,5

 

[Sarna]

I am not sure either..my endo book does not compare the spectrums of desinfectants and antibiotics. it only explains why the former are more hazardous to the periapical tissues and the trend not to use them ..instead antibiotics can be used safely...

Leda, which book do you use? Is there a trend not to use disinfectants? Did they mean irrigation?

 

[dent rdh]

the answer is barbed broaches i checked it in Pathways of pulp.
this is because of theri unique design with bigger depth of cuts and slender form

 

[dent rdh]

A carious maxillary central incisor with acute suppurative pulpitis requires
A. immediate endodontics and apicectomy
B. incision and drainage
C. opening of the canal and drainage for one week-most likely answer
D. pulpotomy
firstly becoz i have seen it happening here,secondly becoz option A is not feasible,pulpotomy would only make things worse,incision and drainage would be not necessary as ac.suppurative pulpitis is still in the pulp ,the abcess has not formed periapically yet.

 

[dent rdh]

this is an old qs i believe becoz these days i don't think they will wait for a whole week for the tooth to drain.

 

[Sarna]

A carious maxillary central incisor with acute suppurative pulpitis requires
A. immediate endodontics and apicectomy
B. incision and drainage
C. opening of the canal and drainage for one week-most likely answer
D. pulpotomy
firstly becoz i have seen it happening here,secondly becoz option A is not feasible,pulpotomy would only make things worse,incision and drainage would be not necessary as ac.suppurative pulpitis is still in the pulp ,the abcess has not formed periapically yet.

dent rdh, what do you understand by drainage for one week? Leaving the tooth open without any temporary dressing? Do you see that in Canada?

 

[dent rdh]

yes thats exactly what it is sometimes they would drain it out in office or maybe for a couple of hours,they would ask the patient to come back ina couple of hours and then place a temporary filling on top.depending on how things are.
it's maybe a coincidence but i have seen it happen in 2-3 patients mostly int he anteriors.they would have a really aching tooth one of them had an abcess ,one of them i remeber had no periapical pathology on the x-ray the dentist opened the root canal for both of them.for one of them he put the temp filling right away while for the other one he said he will wait

 

[leda]

yes thats exactly what it is sometimes they would drain it out in office or maybe for a couple of hours,they would ask the patient to come back ina couple of hours and then place a temporary filling on top.depending on how things are.
it's maybe a coincidence but i have seen it happen in 2-3 patients mostly int he anteriors.they would have a really aching tooth one of them had an abcess ,one of them i remeber had no periapical pathology on the x-ray the dentist opened the root canal for both of them.for one of them he put the temp filling right away while for the other one he said he will wait

dent rdh many dentist here do not practice the standard of care... I have seen horrible dentists and poor dentistry here in Canada.

regarding the question I do not think that leaving the canal open for a week is an acceptable treatment for infections limited to pulp cavities. I think this question is missing an answer option here. ...among the alternatives none is correct in my oppinion.

Sarna , my endo text book as I have mentioned before is Endodontic therapy by Franklin S. Weine

 

[leda]

Leda, which book do you use? Is there a trend not to use disinfectants? Did they mean irrigation?

there is a strong recommendation not to use desinfectants in canals and leave them there between appointments..irrigation is highly recommended with antiseptics such as peroxide hydrogen..antibiotics are recommended to treat especially periapical lesions...

As I have said previously there is no clear spectrum comparison between the desinfectans and antibiotics and which is more effective..I have to do more research on that...

 

[leda]

if we really have to choose among these endo treatments I would choose pulpotomy as the least bad treatment

 

[dent rdh]

leda i never said that the dentist let the canal be open for a week ,they put in a temp filling.i do know what u are talking abt regarding standard of care but in this particular case i do not think there was any compromise in standard of care ...the treatment for ac. suppurative pulpitie is root canal ,read it in pathways of pulp.ac.suppurativ epulpitis is irreversible pulpitis and leads to pulp necrosis and eventually abcess formation.

I do want to mention one thing abt the salivary gland questions accessory glands is also the name for accessory glands associated with parotid gland,i am just confused becoz why would they give labial glands as an option and then accessory glands too.

 

[dent rdh]

but pulpotomy will aggravate everything it will not help with the pain ...in ac.suppurative pulpitis the tooth is what u call a hot tooth ...the pain is relieved by cold application .if you do a pulpotomy i don't understand how u r going to help the symptoms

 

[dent rdh]

one more thing pulpotomy is hardly ever doen on permanent teeth unless the apex is open or there is a slight pulp exporure during cavity prep even then it is not recommended for permanent teeth .in the long run the patient would come back with an abcess requiring root canal anyways.

 

[chanty]

I found some info about this. Ingle's endodontics page 1006 and 1011.

And, after read that I would say D 2,5 is the correct one. Although it doesn't mention anything about the sensitizing part.

 

[chanty]

one more thing pulpotomy is hardly ever doen on permanent teeth unless the apex is open or there is a slight pulp exporure during cavity prep even then it is not recommended for permanent teeth .in the long run the patient would come back with an abcess requiring root canal anyways.

I agree with you, but I think Leda and I are thinking more like an emergency option, just for a day or two, and I think we all agree that neither of those options seems correct.
But If I had to chose, I would also choose pulpotomy.

 

[dent rdh]

pathways of pulp does mention abt eh sensitising and systemic effect so yes i wud stick to d. 2,5

 

[chanty]

pathways of pulp does mention abt eh sensitising and systemic effect so yes i wud stick to d. 2,5

Perfect, we have the answer then.

 

[dent rdh]

ok but still read about pulpotomy in any endo book and it is not recommended een as an emergency treatment, it would be better if you open the canal and drain and put a temp filling in.

 

[dent rdh]

in ac.suppurative pulpitis things have already involved the whole pulp how can one just remove a part of it in pulpotomy.

 

[chanty]

Dent rdh, was the sensitising referring to topical antibiotics?

 

[dent rdh]

let me read up on it more maybe I am missing something

 

[leda]

I found some info about this. Ingle's endodontics page 1006 and 1011.

And, after read that I would say D 2,5 is the correct one. Although it doesn't mention anything about the sensitizing part.

what do they say exactly , that antibitics are not as effective as desinfectants ?

dent rdh, the formocresol pulpotomy will be just the initial treatment leading to another appointment in which a full root canal treatment is performed.

 

[leda]

Dent rdh, was the sensitising referring to topical antibiotics?

chanty, antibitics suchas penicillin can provoke allergic reactions... my endo book at least says soo..

 

[dent rdh]

they no longer recommend formocresol pulpotomy leda, secondly why put the patient through a pulpotomy and then pulpectomy just do it in one go.

 

[leda]

they no longer recommend formocresol pulpotomy leda, secondly why put the patient through a pulpotomy and then pulpectomy just do it in one go.

totally agree, that is what I would do, but unfortunately it is not an option in this question

 

[chanty]

what do they say exactly , that antibitics are not as effective as desinfectants ?

dent rdh, the formocresol pulpotomy will be just the initial treatment leading to another appointment in which a full root canal treatment is performed.

They reach the conclusion that "In general, specific information about the effectiveness of intracanal antibiotics in infection control in endodontics is limited"

 

[dent rdh]

i think when they say opening of the canal and drainage for one week ...thats what they mean and go ahead with rct .

 

[Sarna]

there is a strong recommendation not to use desinfectants in canals and leave them there between appointments..irrigation is highly recommended with antiseptics such as peroxide hydrogen..antibiotics are recommended to treat especially periapical lesions...

As I have said previously there is no clear spectrum comparison between the desinfectans and antibiotics and which is more effective..I have to do more research on that...

Which disinfectants? Could you give any names?

 

[leda]

Which disinfectants? Could you give any names?

phenols or related volatile compounds..

 

[Sarna]

yes thats exactly what it is sometimes they would drain it out in office or maybe for a couple of hours,they would ask the patient to come back ina couple of hours and then place a temporary filling on top.depending on how things are.
it's maybe a coincidence but i have seen it happen in 2-3 patients mostly int he anteriors.they would have a really aching tooth one of them had an abcess ,one of them i remeber had no periapical pathology on the x-ray the dentist opened the root canal for both of them.for one of them he put the temp filling right away while for the other one he said he will wait

I don't agree with that kind of approach. It happens very rarely when you cannot achieve dry canal and place a dressing. It should not be regarded as routine management. Moreover it is not needed in suppurative pulpitis.
So I believe they did that when the apical abscess was present. But I still disagree with leaving the tooth open.

The question asks about acute suppurative pulpitis, does not say anything about coexistent abscess. The treatment is as you've mentioned rct, and there is no such option..

 

[Sarna]

phenols or related volatile compounds..

OK. I forgot about them.

 

[Sarna]

they no longer recommend formocresol pulpotomy leda, secondly why put the patient through a pulpotomy and then pulpectomy just do it in one go.

It is better to remove everything at one visit, but it occasionally happens in emergency appointments that only coronal pulp is removed (multi-rooted teeth) and usually it is a relief for a patient, unless there is infected necrotic pulp.

 

[dent rdh]

ok i think my previous posts have caused a lot of confusion
firstly yes the drainage is done right there in the clinicor for a ocuple of hours and then a tempoorary placed ,for a couple of hours th edrainage i required only in conditions with large swellings and abcess.
for ac.suppurative pulpitis they will open and extirpate right away depending on the situation they would either close with temp or go ahead with the whole treatment ,but no pulpotomy.pulpotomy will not give any relief.
moreover sarna u talk abt multirooted teeth and the question is asking abt a single rooted teeth.
Multi rooted teeth even for them pulpotomy is not recommended, at least that is what i see here, btw not only here but back home no one ver does pulpotomy on adult closed apex teeth.

 

[Sarna]

ok i think my previous posts have caused a lot of confusion
firstly yes the drainage is done right there in the clinicor for a ocuple of hours and then a tempoorary placed ,for a couple of hours th edrainage i required only in conditions with large swellings and abcess.
for ac.suppurative pulpitis they will open and extirpate right away depending on the situation they would either close with temp or go ahead with the whole treatment ,but no pulpotomy.pulpotomy will not give any relief.
moreover sarna u talk abt multirooted teeth and the question is asking abt a single rooted teeth.
Multi rooted teeth even for them pulpotomy is not recommended, at least that is what i see here, btw not only here but back home no one ver does pulpotomy on adult closed apex teeth.

Yes, you're right, the question was about a single-rooted tooth, but someone mentioned that pulpotomy could be the answer and I think that yes, but in multi-rooted teeth.
If the suppurative pulpitis is partial and you open the tooth and remove the coronal pulp there is usually a relief. But not if you leave pus or necrotic pulp in canals. I prefer to extirpate everything, but in certain cases it is acceptable to do pulpotomy on emergency aapointment. (the pulp in canals may still be in a good condition even if coronal part of the pulp was abscessed, and you are able to distinguish that clinically)

 

[chanty]

Well, I think that question will remain unsolved (because of the limited and inaccurate options).
Here is a new one:
Root canal therapy may be safely and successfully undertaken for
1. Hemophiliacs
2. Patients with a history of rheumatic fever
3. Patients with rheumatoid arthritis
4. Cerebral palsy patients
5. Adolescent diabetics

A. 2,3,4
B. 2,3,5
C. 1,2,3,5
D. All of above
E. None of the above

 

[leda]

Well, I think that question will remain unsolved (because of the limited and inaccurate options).
Here is a new one:
Root canal therapy may be safely and successfully undertaken for
1. Hemophiliacs
2. Patients with a history of rheumatic fever
3. Patients with rheumatoid arthritis
4. Cerebral palsy patients
5. Adolescent diabetics

A. 2,3,4
B. 2,3,5
C. 1,2,3,5
D. All of above
E. None of the above

we have discussed this question before....it is not specified if the diabetes is controlled or uncontrolled...also if the canal is instrumented beyond the apex...If we assume that diabetes is controlled and we are only cinfined within the canal I think the right answer will be
d. all of above..

 

[chanty]

sorry.... and thank you for the outcome!!!

 

[dent rdh]

if any of you have Jack Wells and reeds Review of basic sciences and Clinical Dentistry vol 11 pls read page297

 

[chanty]

mmm... I don't have it, but I will try to find it!!!

 

[chanty]

I think is E. Yes, abscesses from lateral incisors may appear palatally. Check out the oral pathology booklet (dental decks) #26.

I just want to add this reference that I found.
".....Infection frequently spreads to the palate form lateral incisors because of the palatal inclination of the root. Occasionally, infection may also spread palatally form a palatal root of a molar or premolar. The canine root is long and infection may spread superficially to the side of the nose rather than intraorally."
Master Dentistry Vol.1 Second. edition, page 74

 

[chanty]

Just when I thought we had the answer...I found this new question

In the maxilla, which of the following teeth may drain through the palatal plate of bone and present as a palatal abscess?

1. Second incisors
2. First premolars
3. First molars
4. first incisors
5. Third molars

A.1 and 2
B. 2 and 3
C. 1 and 3
D. 2 and 4
E.1 and 5

So, I think maybe the answer in this one is C. 1 and 3.

And in the question that we had already discussed:
Infection from which of the following max teeth can drain in the palatal..... I think the answer would be B) 1,3

 

[dent rdh]

i read ur reference it seems 1 and 3 is the right option

 

[dent rdh]

for the previous Q i think 123 would be a better option becoz it seems mostly the infection spreads from lateral .incisors,premolars and molar.palatally.

 

[dent rdh]

i finally found the exact definition of Ac. suppurative pulpitis and it is not irreversible pulpitis this is complete pulpal necrosis,wud u change the treatment now .
this is in the before mentioned book Jack wells and Reeds clinical dentistry.

 

[chanty]

Don't you think this term is a a little outdated? I haven't found it in any "recent" book.

 

[chanty]

I found a reference of pulpotomy as an emergency treatment of irreversible pulpitis when minimal time is available (in molars though). Endodontics, Principles and practice, Torabinejad, 2009. page 153

 

[dent rdh]

it is an old terminology and u know what Jack Wells and Reeds puts down the treatment for ac suppurative pulpitis as opening of canal and drainage.
i agree i have seen pulpotomy in Pathways of pulp as a possible temp treatment for irreversible pulpitis,but i thinkac.suppurative pulpitis is when there is complete pulpal necrosis this is different then having irreversible pulpitis.

 

[chanty]

so, maybe this question is not valid anymore but for this test, we should go then with the drainage if we have the reference, don't you think?

 

[chanty]

dent rdh if you don't mind, could you give me the definition you found in that book..... I am thinking that I will have to review all the question that mention that term, I always assumed that it was irreversible pulpitis

 

[dent rdh]

actually if i get the time i will try scanning this chart and uplaoding it for u guys it is quite good.
yes maybe the bes option wud be to open and drain ,i guess.