ENDODONTICS: Colleagues for Excellence
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- Includes Credits
CE Hours: 0.5
Description: The incidences of cracked teeth have increased significantly in the United States over the last decade! Even before the pandemic, the AAE 2015 Special Committee on the Methodology of Cracked Tooth Studies conducted a survey and found 49% of 941 endodontists had seen an increase of cracked teeth and vertical root fractures compared with the previous decades. (1) Poor occlusion, bruxism/parafunctional habits, and wedging events combined with repetitive forces are all potential etiologies for tooth cracks. As these early cracks develop, bacteria and biofilms can form, eventually progressing towards the pulp and resulting in pulpal necrosis. (2) Cracks when left untreated, can propagate into fractures resulting in catastrophic failures and tooth loss, such as in the incidence of a split tooth. (3)
Early in the COVID-19 pandemic, a Sept. 11, 2020, article in USA Today reported that endodontists were seeing twice as many cracked teeth as they did in the prior year. (4) The March 21, 2021, ADA Huddle reported that an ADA Health policy survey had found a rise in stress-related tooth damage linked to pandemic stress. (5) More recently, the JOE published an article comparing the incidence of cracked teeth in a private endodontic practice over three years (2019, 2020, and 2021), showing a significant increase in the incidence of cracked teeth in the 40-60 age group (2020) and males 40-60 and over-60 age groups in 2021. (6) Regardless of direct or indirect causes, the diagnosis of cracked teeth was already highly prevalent before the pandemic and has subsequently and substantially increased since that time. We are at a point where we must include cracked teeth and vertical root fractures in almost every differential diagnosis of tooth pain.
Let us look at the new definitions of cracked teeth and vertical root fractures.
Learning Objectives:
- Discuss the most recent definitions used for longitudinal fractures of teeth.
- Describe the clinical diagnostic features of both cracked teeth and vertical root fractures.
- Describe the radiographic features of both cracked teeth and vertical root fractures.
- Discuss current treatment options for both cracked teeth and vertical root fractures.
- Discuss prognosis for cracked teeth requiring root canal treatment using the Iowa Staging Index.
Keith V. Krell, D.D.S., M.S., M.A.
Dr. Krell received his D.D.S. and M.S. degrees from the University of Iowa in 1981 and 1983, respectively. He earned his M.A. degree in sociology-anthropology in 1975, from the United States International University in San Diego, Calif.
Dr. Krell has been an endodontist for over 43 years. He was a full-time educator for 8 years at the University of Iowa and was in private practice in West Des Moines, Iowa for 29 years until he retired December 31, 2017. He is still an adjunct clinical Professor in the Department of Endodontics at the University of Iowa College of Dentistry. He has lectured nationally and internationally about his research on cracked teeth based on his data base of over 3,000 private practice cases. His complete data base is over 50,000 cases.
Dr. Krell is a Diplomate of the American Board of Endodontics, as well as a past president and past director of the ABE. He is a past president of AAEF (now the Foundation for Endodontics) and finally is past president of the American Association of Endodontists.
Dr. Krell has been married for over 52 years to Diane and they have five grandchildren. He still has research interests in cracked teeth and vertical root fractures.
Disclosure:
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
- Includes Credits
CE Hours: 0.5
Description: When planning endodontic treatment on mandibular teeth, the location of the inferior alveolar nerve (IAN) must be taken into consideration. Failure to properly assess the potential for injury to the IAN may result in sensory disturbances such as paresthesia, anesthesia, or dysesthesia to the chin, lip, or associated anatomic structures and dermatomes. (1,2) These post-traumatic sensory neuropathies can present as a range of symptoms from merely a minor annoyance to devastating life-altering changes which can affect everyday well-being. (3) This is why it is critical for the clinician to carefully assess and manage any pending endodontic treatment in the mandible, particularly when a reasonably careful clinician should have foreseen and thus prevented any undue risk of harm to their patient.
At the conclusion, participants should be able to:
- Discuss the advantages of new imaging technologies in identifying key neurovascular structures and their proximity to the root canal systems of teeth.
- Describe the sequelae of chemical and obturation overfill into neurovascular anatomy and the potential for injury.
- Evaluate surgical versus non-surgical interventions for neurologic injury with outcome expectations.
Alan H. Gluskin, D.D.S.
Alan H. Gluskin DDS is currently Professor, Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific in San Francisco, California. He served as Chairperson of the Endodontic Department for over thirty years. He is at present a Fellow of the International College of Dentists and the American College of Dentists. Dr. Gluskin has served on numerous AAE committees including the Educational Affairs Committee and the Research and Scientific Affairs Committee, as well being General Chair for both AAE10 and AAE18. Dr. Gluskin has just completed his tenure on the Executive Board of Directors of the American Association of Endodontists as Immediate Past President of the AAE. He additionally functions on the editorial boards of the Journal of Endodontics and the International Journal of
Endodontics. Dr. Gluskin is the 2017 recipient of the University of the Pacific’s Eberhardt Teacher-Scholar Award. He is co-editor of the textbooks Decision Making in Dental Treatment Planning and Practical Lessons in Endodontic Treatment.Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
Louis H. Berman, D.D.S., F.A.C.D.
Dr. Berman received his dental degree from the University of Maryland School of Dentistry, and his Certificate in Endodontics from Albert Einstein Medical Center, where he is currently a clinical instructor and guest lecturer. He is also a clinical associate professor of endodontics at the University of Maryland School of Dentistry. He has lectured internationally and published in several peer-reviewed journals, and is a member of the Journal of Endodontics' Scientific Advisory Board. Dr. Berman is the co-author for the chapter on Diagnosis in the ninth, tenth and eleventh editions of Cohen’s Pathways of the Pulp and is the co-editor of the current eleventh edition along with Dr. Kenneth Hargreaves. Dr. Berman is also the senior editor and contributing author of the comprehensive textbook, A Clinical Guide to Dental Traumatology. A Diplomate of the American Board of Endodontics, Dr. Berman has been in full-time private practice for 32 years.
Marcus D. Johnson, DDS
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
- Includes Credits
CE Hours: 0.5
Description:Estimates suggest that pulpal disease may affect up to 30% of the world’s population. When left unchecked, pulpal disease lends itself to a reduced quality of life by means of increased pain, loss of physiologic function and compromised anatomical form of the affected dentition. Scientific literature consistently highlights the undeniable benefits of antibiotic use in treatment of disease control, more specifically odontogenic bacterial infections. However, the value of these drugs in preventing serious health complications is not always congruent with safety; because their use can be undermined by disruptive prescribing practices and behaviors that lead to misuse of antibiotics and their associated adverse effects (1).
At the conclusion, participants should be able to:
- Discuss the clinical and nonclinical indications for proper antibiotic prescribing including dosing and duration.
- List the updated recommendations regarding antibiotic prescribing for patients with a true penicillin allergy.
- Describe which antibiotic has a "black box" label and evaluate the recommended indications of this antibiotic.
Marcus D. Johnson, DDS, MSD
Dr. Marcus Johnson, wanted to be a dentist since age 11. A Rutgers University alum and graduate of New York University Dental School, he advanced his knowledge and training receiving his Certificate of Endodontics from Case Western Reserve University in Cleveland, Ohio while earning his Master’s Degree of Science in Dentistry. Dr. Marcus Johnson is a Diplomate of the American Board of Endodontics. He serves as the directing endodontic attending for the General. Practice Residency at Interfaith Medical Center in Brooklyn and owns and operates a private office, City Endodontics in midtown Manhattan. He values organized dentistry and is active at the local, state and national levels. Currently he is President for the New York State Association of Endodontists, District 2 AAE director the host of the AAE podcast Endovoices.
Speaker Disclosure
In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: Financial Coltene
Marcus D. Johnson, DDS
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
- Includes Credits
CE Hours: 0.5
Description: The newsletter explores the use of cone beam computed tomography in endodontic diagnosis and examines the application of several recommendations from the AAE/AAOMR position statement on the use of CBCT in endodontics.
At the conclusion, participants should be able to:
- Review CBCT technology and its advantages over conventional radiography.
- Apply CBCT imaging in the following cases: diagnosis of pain, vertical root fracture, and treatment resorptive defects
- Apply CBCT in pre-nonsurgical and surgical treatment planning of compromised teeth.
Mohamed I. Fayad, DDS, MS, PhD
Dr. Fayad received his DDS from the College of Dentistry, Cairo University in 1985. He received his MS in 1994 and his PhD in 1996 from the University of Buffalo at New York. He had two years of Advanced Education in General Dentistry at Eastman Dental Center, University of Rochester at New York, and received his certificate of Specialty in Endodontics at the University of Illinois. Currently he is the director of Endodontic research, and a clinical associate Professor in the Endodontic department at College of Dentistry at UIC, dividing his time between teaching, research, intra-and extra-mural continuing education and private practice. He currently serves on the Scientific Advisory and Manuscript Review Panels of the Journal of Endodontics, and Evidence Based Endodontics Journal. He served on the AAE Research and Scientific Affairs Committee and co-chaired AAE/AAOMR committee drafting the joint position statement on CBCT (2015). He has numerous publications and chapters in peer reviewed journals and textbooks (Pathways of the pulp) and (Contemporary surgical Endodontics). He is the co-editor of the CBCT text book (3-D Imaging in Endodontics: A new Era in diagnosis and treatment) by Springer (2016). He is a Diplomate of the American Board of Endodontics.
Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
Mohamed I. Fayad, D.D.S., M.S., Ph.D.
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
- Includes Credits
CE Hours: 0.5
Description:The American Association of Endodontists is dedicated to excellence in endodontics and promoting the highest standards of patient care. This following position statement is intended to define and outline Maxillary Sinusitis of Endodontic Origin (MSEO), deliver guidelines for its diagnosis and appropriate treatment, and provide a standard for all dental and medical practitioners who undertake the responsibility of managing patients with this condition. The relationship between dental infections and sinus disease is widely recognized in both the dental and medical literature. Despite extensive scientific recognition and reported high prevalence, periapical infection manifesting in the maxillary sinus remains under-appreciated and frequently goes undiagnosed by dentists, otolaryngologists, and radiologists alike, with its sequelae often misdiagnosed as sinogenic sinusitis. Recognition of MSEO is critical as failure to identify and properly manage the endodontic source pathology will result in the persistence of sinus disease, the failure of medical sinus therapies, and the potential advancement to more serious or even life-threatening cranio-facial infections.
At the conclusion, participants should be able to:
- Describe a maxillary sinusitis of endodontic origin (MSEO) and how periradicular infection can directly cause a maxillary sinus infection.
- Describe the variety of typical symptoms that a patient may experience with MSEO.
- Recognize and describe the various pathological effects and radiographic presentations of periapical inflammation on the maxillary sinus tissues, including periapical mucositis, periapical osteoperiostitis, and sinus obstruction.
Roderick W. Tataryn, DDS, MS
Dr. Rod Tataryn received his DDS degree in 1989 and Master of Science degree in Endodontics in 1994 from Loma Linda University. He has been in private practice endodontics in Spokane, Washington for 28 years and maintains a faculty position at Loma Linda University School of Dentistry. Dr. Tataryn has served on the Clinical Practice Committee for the American Association of Endodontists, has authored clinical and scientific articles on endodontics, including recent multidisciplinary consensus statements on the diagnosis and management of odontogenic sinusitis. Dr. Tataryn is also a contributing author for several endodontic textbooks including the Sixth and Seventh Editions of "Ingle’s Endodontics", and Torabinejad and Rubinstein's "The Art and Science of Contemporary Surgical Endodontics".
Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
Roderick W. Tataryn, D.D.S.,M.S.
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
