Lesson 48

Patient: Hello, Doctor. I have an appointment today at 4 p.m.

Doctor: Good afternoon. Yes, I remember. We have planned for today a canal treatment of the tooth that has an unfilled canal.

Patient: Yes, that’s right. You told me last time that you have to treat upper central incisor more time, if it is to be covered with a crown.

Doctor: So please sit down. Before I place a rubber dam I will remove the old filling.

After a while

Doctor: Well now I can insert a rubber dam. I used it once before, during the treatment of your upper molar.

Patient: Yes, I remember. It was not too bad.

Doctor: OK, done. Now I’ll try to remove the old filling from the canal.

After some time

Doctor: I have for you some bad news. Unfortunately, one of the instruments has been broken. I tried to remove it, but I can not. After I apply a temporary filling and remove a rubber dam, I’ll explain the whole situation for you.

After a while

Doctor: As I said before, unfortunately, the instrument broke in your root canal. Because it happened quite deep inside I cannot reach it.

Patient: Well, what now?

Doctor: I’ll refer you to my colleague with whom I work. He specializes in this type of surgery. He also has a microscope, and I hope he can cope with pulling the instrument out.

Patient: What if it does not work?

Doctor: If he can’t do it, such instrument can be left in the canal. Fortunately, I cleaned the canal completely. If the instrument had not broken, I could have applied the filling even today, even though I planned to insert some disinfectant. So, if my colleague does not remove the instrument, I will fill the canal eventually. Because the instrument is located in the apex, the whole canal will be filled.

Patient: And it should be all right?

Doctor: I really hope so; though unfortunately sometimes periapical tissues may become inflamed and we’ll have to take some action then. In such case, there will be no problem to perform resection. Such procedures are performed by a surgeon or specially skilled endodontist. He will make an incision in the gums and cut off a piece of the root – just the apex – and after performing a retrograde filling he stitches the wound.

Patient: Does it hurt?

Doctor: The procedure is performed under local anesthesia, so it is painless. Sometimes it is painful afterwards, but common painkillers should relieve pain. Anyway, let’s not talk about it, because if my colleague manages to pull the instrument out, there won’t be a case.

Patient: I hope so. I’m a bit upset about it.

Doctor: Do not worry about it. I’ll call my friend to schedule your appointment.

After a while

Doctor: I’ve scheduled your appointment for the day after tomorrow at 5 p.m. Please make sure you’ll make it. Here is a card with the address and telephone number.

Patient: Of course. Iֹd like to avoid the surgery. I’ll definitely go and after a visit I’ll call you to let you know how it ended up.

Doctor: Of course. I’ll be waiting for your phonecall.

Patient: Goodbye, Doctor.

Doctor: Goodbye.

VOCABULARY PRACTICE

Match words with definitions

handpiece	root canal irrigation	kofferdam
apex	tooth sealing	gutta-percha
the gum	isolating	files

Also known as dental dam.
The highest point of a tooth. Plural form ‘apices’.
The instruments used during root canal treatment which look like tapered straight pins but on close inspection it can be seen or felt that their surface is rough, not smooth. These instruments literally are miniaturized rasps.
Specialized dental drill.
This process involves flushing out root canals to remove debris and contaminants.
To fill a hollow interior.
Root canal filling material that is a rubber compound.
This apparatus warms a tube of gutta-percha which then can be squeezed out into the tooth.
The process of protecting the tooth from contaminating or keeping it dry during dental procedures with the help of a rubber dam.

Read the text below and decide if the sentences are True or False
A dental dam or rubber dam (sometimes referred to “kofferdam” – from German), is a thin, rectangular sheet, usually latex rubber, used to isolate the operative site (one or more teeth) from the rest of the mouth. Its purpose is both to prevent saliva interfering with the dental work (e.g. contamination of oral microorganism during root canal therapy, or to keep filling materials such as composite dry during placement and curing), and to prevent instruments and materials from being inhaled, swallowed or damaging the mouth. Use of a rubber dam is sometimes referred to as isolation.

How does the procedure of placing rubber dam look like?
After numbing the patient up, dentist will „isolate” the tooth by way of placing a rubber dam.

Dentist will punch a tiny hole near the dam center.
He/she’ll then stretch the sheet over patient’s tooth so it alone sticks through the punched hole.
A metal clamp is then positioned to hold the dam in place.

The portion of the tooth that sticks through the dam lies in a region where its environment can be controlled. The tooth can be washed, dried and kept saliva-free. A rubber dam sets the stage so treatment can be successfully performed.

Kofferdam is a term which describes the procedure of isolating in dentistry. T / F
Rubber dam is square and made of latex rubber. T / F
Rubber dam has a draining property. T / F
Rubber dam prevents microorganisms from multiplying. T /F
Dental dam has also a safety role. It protects patient’s mouth during the procedure. T / F
Inserting rubber dam into patient’s mouth is very painful procedure for him/her. T /F

Read the extract from the e-mail sent by one of your patients. Use the hints below to answer it and provide some advice.
’I just had a root canal done today due to a deep filling I’ve had for a while. During the procedure, the general dentist broke the file inside the root. According to him, it should not be a problem but I am extremely concerned and don’t feel comfortable having something there that should’t be. He said the tip broke off pretty deep. I am in a lot of pain. Could it be from the file or just the rct itself? Should I be concerned that the file broke and remains in my root canal?’

recommend/ evaluation/ endodontist ..................................................................................................................................
necessary/ to be removed/ if there is a root fracture .........................................................................................................
broken instrument/ incorporate/ into canal filling ...........................................................................................................
painkillers/ relieve pain .....................................................................................................................................
pain persisted/ dentist evaluate the tooth again ...............................................................................................................……………………

Lesson 48 - answers