Lesson 52

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The following day

Patient: Good morning, I am here as we scheduled. I have a pantomogram with me, too.

Doctor: Good morning. Give me a moment, please. I’ll be with you momentarily.

A few minutes later

Doctor: Come in, please. Can I see the pantomogram, please? Well, as I suspected. There is no bone up to mid roots around your front teeth. I’ll need to implement appropriate treatment. Today, as we agreed before, I will remove tartar. During your next visit, I’ll place in some immobilization.

Patient: Immobilization?

Doctor: Yes. I’ll use a special splint that will connect your teeth together.

Patient: And will it be visible?

Doctor: It should not. The splint is made from the aesthetic fibers that I’ll cover with another material resembling the tooth. Anyway, it’ll be placed on the tongue side.

Patient: But you won’t have to drill?

Doctor: No, there is no need. Only once the splint is in place, I’ll have to adjust slightly the cutting edges with a drill, of course. Your teeth may be in another setting, and it may happen that they will interfere with the bite. Anyway, even now two of your incisors slightly exceed the occlusal plane, so you bite on them first. This means that they are overused, and this is an anomalous situation which accelerates the destruction of the bone.

Patient: Oh my! It’s good that I’ve decided to come to you Doctor.

Doctor: Of course. It would be better if we had already begun treatment, but it is how it is. However, we have already established treatment plan. Today, I will remove the tartar, and in a week we’ll perform splinting procedure. Let me check also vitality of your teeth, but it seems to me that they all should be vital.

Patient: And how will you check?

Doctor: By using an electric device. I’ll touch your tooth with a special tip, and you tell me if you feel anything. I will say straight away, that at the beginning you may feel tingling, but then there is pain, so please immediately give me a sign.

Patient: All right.

After the tooth vitality testing

Patient: It was not so bad.

Doctor: The most important thing is, that all the teeth are alive. Now I can safely proceed with removing the tartar. You took the pill, didn’t you?

Patient: Yes. I did.

Doctor: Then let’s get down to work. Just rinse your mouth with water, please. I added to it some disinfectant.

Patient: Thank you so much again.

Doctor: No problem. This is my job.

VOCABULARY PRACTICE

Read the text about Electric pulp test (EPT) and complete it with the words from the table

threshold	membrane	gloveless
stimuli	probe tip	electric current
along	accurate	tingling
pacemakers	varies	flat
essential	manuals	safety

Electric pulp testing (EPT) works on the premise that electrical 1)____________ cause an ionic change across the neural 2)___________, thereby inducing an action potential with a rapid hopping action at the nodes of Ranvier in myelinated nerves. The pathway for the 3)___________ is thought to be from the 4)___________ of the test device to the tooth, 5)____________ the lines of the enamel prisms and dentine tubules, and then through the pulp tissue. The “circuit” is completed via the patient wearing a lip clip or by touching the probe handle with his/her hand; alternatively, the operator can have one “6)____________” hand that touches the patient’s skin. A “7)___________” sensation will be felt by the patient once the increasing voltage reaches the pain 8)___________, but this threshold level 9)___________ between patients and teeth, and is affected by factors such as individual age, pain perception, tooth surface conduction, and resistance.

The correct technique for using the electric pulp tester is also important for 10)_____________ responses. In order to ensure that the appropriate current pathway is followed, correct placement of the EPT probe tip 11)_________ against the contact area, and having a conducting medium such as toothpaste between the probe tip and the tooth surface is 12)____________.

13)__________ Concerns of EPT

In EPT operation 14)___________, warnings have been made that the current produced by the testing device may cause danger to patients who have cardiac 15)_____________, with the risk of precipitating cardiac arrhythmia via pacemaker interference.

Match ways to see/check tooth vitality with a proper technique/test/sign

TEST CAVITY HOT TEST LASER DOPPLER FLAWMETRY COLD TEST ELECTRIC PULP TESTING DISCOLOURATION

A. _____________– This involves sending an electric current through the patients tissues to assess the pulp vitality. The sensation will quickly disappear when the stimulus is removed. When the sensation lingers, it signifies stimulation of C fibres, and irreversible pulpitis. No response means that the nerve is non-vital.

B. _____________– Applying heat source can be very fiddly. Textbooks suggest hot gutta percha or isolating with rubber dam and immersing the tooth with hot water. The test results are largely similar to that of electric pulp testing.

C.______________– Whether it is Ethyl chloride or a good old fashioned ice stick. A sensation that lingers indicate a pulpitis, no sensation indicates a non-vital tooth.

D.______________– A non invasive test for blood flow within the pulp tissue. It has been shown to be quite reliable, except it is very technique sensitive and time consuming.

E._______________-– Not strictly a test, but this sign on patient’s tooth can indicate pulpal haemorrhage, necrosis, microleakage from enamel crazing or leaking restorations.

F._______________- Last resort. Cut into the interior of the tooth, without local anasthesia. If it hurts, the tooth is vital.

Translate into English

1. Proszę poczekać chwilę. Zajmę się Panem za sekundę.

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2. Może Pan poczuć nieprzyjemne mrowienie.

3. Proszę mi dać znać, gdy tylko poczuje Pan ból.

4. Wygląda na to, że ten ząb jest martwy.

5. Czy cierpi Pan na jakiekolwiek choroby serca? Czy ma Pan rozrusznik?

6. Dopełnieniem testu żywotności zęba będzie zdjęcie rentgenowskie.

7. Test żywotności polega na przyłożeniu do zęba watki nasączonej chlorkiem etylu, co w przypadku żywego zęba jest odczuwalne jako przenikliwe zimno. Brak reakcji na chlorek etylu zwykle oznacza martwicę miazgi.
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Lesson 52 - answers