InUrnational Endodontic JoumaUi992)2S,

169-172

Undergraduate Curriculum Guidelines for Endodontoiogy EUROPEAN SOCIETY OF ENDODONTOLOGY

Introduction Endodontoiogy is that branch of dental science concerned with the study of the form, function and health of, injuries to and diseases of the dental pulp and periradicular region, and their treatment. The aetiology and diagnosis of dental pain and disease are integral parts of endodontic practice.

Definition of terms The terms used in these guidelines indicate the relative weight that is attached to each statement.

Student -a student at the completion of the undergraduate dental course. Uncomplicated treatment —treatment of a fully developed tooth with normal root canal(s), visible on the radiograph over its entire length, with a curvature of < 15° from the axis of the roots, and where the access from the pulp chamber to the canal is not obstructed by restorative materials and cements that are diEBcult to remove, and whicb has not been damaged by iatrogenic procedtires or pathological resorption.

Verbs —must—indicates an imperative need and an essential or indispensable item, i,e, mandatory. —should—indicates the recommended manner for obtaining the standard, i.e. highly desirable.

Levels of knowledge —understanding—adequate knowledge vritb the ability to apply. —familiarity—basic knowledge and a recognition of general principles achieved through orientation.

Level of skill —proficient—^level of skill attciined when a particular activity is accomplished with repeated quality.

Endodontic specialist —a colleague at a university endodontic clinic (in countries where no recognized specialty in endodontics exists). Correspondence; Dr P. R. Wesseiink. Department of Cariology and Endodontoiogy. ACTA, Louwesweg 1, 1066 EA Amsterdam, The Netherlands.

Overview The endodontic curriculum must consist of didactic and laboratory instruction on fundamental principles. In addition, it must include endodontic instruction on the treatment of patients and clinical experience, under close supervision of experienced faculty. Optimally, this should be supplemented by seminars and advanced clinical experience. Primary educational goals The undergraduate endodontic curriculum should include the anatomy, embryology, histology and physiology of tbe dentine-pulp complex, and must prepare the student to: (a) diagnose diseases of the pulp and periradicular tissues; (b) identify and determine aetiological factors responsible for pulpal and periradicular diseases; (c) identify and use appropriate measures to prevent diseases of the pulp and periradicular tissues; (d) identify, on the basis of diagnosis and aetiology, factors tbat may affect progress of the proposed treatment; (e) select cases for eitber treatment or referral based on knowledge, experience and complexity; 169

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(f) provide care that is proper and consistent with knowledge, experience, and ability on cases selected for treatment; (g) identify the need for appropriate adjunctive procedures subsequent to endodontic treatment; (h) determine a reasonable prognosis for cases selected for treatment; (i) evaluate the completed endodontic procedures.

—removal of carious dentine and, where indicated, indirect pulp capping; —direct pulp capping; —(partial) pulpotomy; —desensitization of dentine; —protective liners and bases; —cracked tootb. (ii) Diagnosis and treatment planning

Core content

The student must be able to undertake:

The core curriculum in endodontoiogy Includes the theory and practice of the following;

(a) Diagnosis

(i) preventive endodontics and vital pulp therapy; (ii) diagnosis and treatment planning for endodontics; (iii) emergency root canal procedures; (iv) root canal treatment; (v) evaluation ofthe treatment result; (vi) treatment of failures and surgical endodontics; (vii) restoration of endodontically treated teeth; (viii) bleaching of endodontically treated teeth; (ix) adjunctive treatment. Specific behavioural objectives (i) Preventive endodontics and vital pulp therapy (a) Diagnosis The student must recognize local and systemic conditions that affect the dental pulp and understand the relationship between pulpal health, endodontic treatment and the following factors; —dental caries and previous operative treatment of dental caries; —erosion, abrasion, attrition; —anomalous defects; —genetic factors and defects; —-periodontal diseases and procedures; —systemic disease and medical treatment; —restorative, orthodontic and surgical procedures; —management of cracked tooth; —traumatology. (b) Treatment The student must be proficient in preventing or managing pulpal disorders and performing appropriate treatment where indicated for vital pulp therapy;

—^identify the patient's chief complaint; —conduct a systemic visual and tactile clinical extraand intraoral examination using a mirror, explore, periodontal probe and radiographs; —determine the relationship between the general and oral health status ofthe patient; —interpret the significance ofthe patient's symptoms, examination of findings and clinical test resuits to identify diseases of the pulp and periradicular tissues. In addition, the student must understand and be proficient in performing tbe following diagnostic tests: —percussion; —mobility; —occlusal analysis; —pulpal sensibility; —sinus tract exploration; —transillumination; —test cavity preparation; —selective anaesthesia; —to be able to differentiate between pulpal and/or periradicular pain and orofacial pain of other origins and to be able to differentiate between periradicular lesions on radiographic examination of pulpal origin, non-pulpal origin and normal anatomical landmarks and to be able to diagnose between the following clinical situations; —normal pulp; —different forms of pulpitis; —^pulp necrosis; —internal and external root resorption; —calcific degeneration; —different forms of apical periodontitis; —periapical exacerbation; —endodontic treatment failures; —combined endodontic-periodontal lesions;

ESE Undergraduate Curriculum Guidelines —complicated and uncomplicated crown fractures, crown and root, and root fractures; —subluxation, intrusion, extrusion, lateral luxation; —avulsion.

(b) Treatment Based on the results of examination and testing procedures, the student must be able to provide appropriate treatment in the following clinical situations; —different forms of pulpitis; —pulp necrosis; —apical periodontitis; —complicated and uncomplicated crown fractures, crown and root, and root fractures; —subluxation, intrusion, extrusion, lateral luxation; —avulsion; —periapical exacerbation; —endodontic treatment failures; —combined endodontic-periodontal lesions.

(iii) Emergency root canal treatment The student must be able to perform the appropriate emergency treatments for the relief of preoperative, interappointment and postoperative symptoms associated with pulpal and periradicular diseeises by: —pulpotomy; —pulpectomy; —drainage; —supportive therapy, as in prescribing analgesics or when indicated, antibiotic therapy and antiinfiammatory therapy.

(iv) Root canal treatment The student must be able to perform endodontic treatment on uncomplicated single and multirooted teeth and must be familiar witb problems encountered in endodontic therapy on complicated single and multirooted teeth.

(a) Technical procedures —provide adequate anaesthesia and/or analgesia for the procedure;

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—prepare the tooth and the field of operation for aseptic treatment and protection of the pharynx, including application of rubber dam; —prepare access cavity; —irrigate root canal system; —determine root canal length; —clean and shape the root canal system; —^place interappointment dressings in the pulp cavity; —^place and remove temporary restoration; —obturate root canal system; —prepare radicular tootb structure for post and core and final restoration, —give appropriate postoperative instructions concerning discomfort, pain and swelling.

(b) Procedural errors The student should be able to identify and avoid procedural errors during endodontic treatment. Having identified any of the following procedural errors, the student must be able to determine the effect on prognosis and the appropriate procedure for correction. The student must be able to discuss the situation witb the patient and be familiar with the next treatment steps to be taken so that a decision can be made on when to refer for special treatment to an 'endodontic specialist'; —shelf or ledge in the root canal; —perforation of crown or root; —extrusion of irrigating agents out of the root canal system; —overextension of root canal filling; —incomplete obturation; —fractured instrument in the canal; —obstruction of tbe root canal by restorative material or dentine filings; —vertical fracture ofthe root during condensation.

(v) Evaluation ofthe treatment result The student must be able to determine whether endodontic treatment has been successful or not by the following clinical criteria; —presence and/or absence of an intact periodontal ligament space or lamina dura; —change in size or appearance of periradicular lesions; —presence or absence of external and/or internal root resorption; —spontaneous pain; —pain on biting and/or percussion;

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—tenderness of soft tissue to palpation; —presence or absence of soft tissue sweUing; —presence or absence of a sinus tract; —presence or absence of mobility. In addition, the student must, on the basis of the examination, pulp testing and radiographic interpretation, be able to consult, when necessary, with an 'endodontic specialist' to determine the probable cause of failure and communicate the findings to the patient.

(viii) Bleaching of endodontically treated teeth The student must be able to perform and understand the following procedures; —recognize those teeth which are amenable to bleaching after endodontic treatment; —perform the appropriate procedure; —understand the types of tissue damage which may occur in the use of bleaching procedures. (ix) Adjunctive treatment

(vi j Treatment of failures and surgical endodontics The student must be familiar with the diagnostic and technical procedures involved in treatment of failures and surgical endodontics. (a) The student must be able to recognize the need for non-surgical, surgical or combined treatment, after consulting an endodontic specialist when necessetry, in; —cases where root canal treatment has not been initiated; —cases where failure of previous root canal treatment is observed, (b) The student must be familiar with; —apical curettage, apica! root resection, retrograde filling and other endodontic surgical techniques; —appropriate postsurgical instructions to the patient concerning bleeding, pain, swelling, diet, time of sutiu-e removal and complications such as haematoma, tissue discoloration and infection.

In cases in which subgingival fracture, perforation or caries are present, the student should be familiar with the kinds of procedures which would permit sufficient tooth exposure for rubber dam placement and restoration. The student must also be familiar with the indications and availability ofthe following procedures; —hemisection; —root amputation; —apexification; —intentional replantation; —crown lengthening and forced eruption procedures.

Faculty Endodontics must be taught by skilled and experienced staff. When possible faculty should have advanced training in endodontology and ideally devote their universityappointment time fully to endodontology. An adequate faculty-to-student ratio is necessary to implement these guidelines effectively.

(vii) Restoration of endodontically treated teeth

Reference The student must be able to recognize the type of restoration required including suitable post(s) and canal(s).

AMERICAN

ASSOQATION

OF DENTAL

SCHOOLS

(1986)

Curriculum

guidelines for endodontics./ournaio/nenta/Education, 5 0 , 1 9 0 - 1 9 4 .

Undergraduate curriculum guidelines for endodontology. European Society of Endodontology.

InUrnational Endodontic JoumaUi992)2S, 169-172 Undergraduate Curriculum Guidelines for Endodontoiogy EUROPEAN SOCIETY OF ENDODONTOLOGY Introduction...
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