| FUNCTIONS OF IRRIGATING SOLUTIONS: Reducing ____ between the instrument and dentine | friction |
| FUNCTIONS OF IRRIGATING SOLUTIONS:Improving the _______of the files | cutting effectiveness |
| FUNCTIONS OF IRRIGATING SOLUTIONS: Dissolving ___ remnants | organic tissue |
| FUNCTIONS OF IRRIGATING SOLUTIONS:Cooling both the ____ and ___-, | file and tooth |
| FUNCTIONS OF IRRIGATING SOLUTIONS: ____ effect and an ____ effect. | Washing; antimicrobial |
| FUNCTIONS OF IRRIGATING SOLUTIONS:Irrigation is also the only way to have a _____ on areas of the root canal wall not touched by mechanical instrumentation | positive impact |
| what are the areas of the root canal not touched by mechanical instrumentation | lateral canal |
| CLASSIFICATION OF IRRIGATING SOLUTIONS | antimicrobial, chelating solutions, Combinations /antibacterial and chelating solutions combined,Solutions with detergent, bacteriostatic solutions, and bactericidal solutions |
| MECHANICAL OBJECTIVES OF USING ENDODONTIC IRRIGANTS | Rinse out debris and lubricate the canal |
| Soften and dissolve organic and inorganic tissues | SOLVENT |
| CHEMICAL OBJECTIVES OF USING ENDODONTIC IRRIGANTS | Soften and dissolve organic and inorganic tissues. (Not all); Prevent the formation of a smear layer during instrumentation; Dissolve smear layer once it has formed. |
| BIOLOGIC OBJECTIVES OF USING ENDODONTIC IRRIGANTS | Related to their antiseptic and nontoxic properties |
| PROPERTIES OF AN IDEAL IRRIGATING SOLUTION:Disinfect the _____ system | root canal |
| PROPERTIES OF AN IDEAL IRRIGATING SOLUTION: Should be a biocompatible __________capable of physically flushing debris. | bactericidal agent, tissue solvent, lubricant, and smear layer remover |
| PROPERTIES OF AN IDEAL IRRIGATING SOLUTION:Penetrate ____and its ____ | dentin; tubules |
| PROPERTIES OF AN IDEAL IRRIGATING SOLUTION:With ______ but without affecting the physical properties of the dentin | sustained effect |
| PROPERTIES OF AN IDEAL IRRIGATING SOLUTION:Non-______, non-____, non-____ | antigenic, toxic, carcinogenic |
| TRUE OR FALSE: Irrigating solutions must always be confined to the canal during use to avoid harmful effects to the periapical tissues | TRUE |
| TRUE OR FALSE: Any materials used to achieve all the aims mentioned in root canal will have the same effect in the periapical tissues - use the material at a concentration that is low enough to achieve the aims, yet high enough to avoid periapical irritation | FALSE |
| TRUE OR FALSE: There is not just one solution available that will achieve all of the mentioned aims | TRUE |
| TRUE OR FALSE: inorganic solvents are not as effective as organic solvents | FALSE |
| TRUE OR FALSE: it is necessary to use 2 SOLUTIONS to achieve all of these aims | TRUE |
| Example of 2 solutions used together (ABBOT endo manual) | 17% ethylene diamine tetraacetic acid with cetrimide (EDTAC) and 1% sodium hypovhlorite (NaOCI) |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: very important irrigant but often misguided as they possess no antimicrobial properties and thus have to be used with other irrigants | LOCAL ANAESTHETIC, SALINE/ DISTILLED WATER |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: The most common irrigating solution used in endodontics; For cases with nooks and cranies na hindi mareach sa instrumentation | SODIUM HYPOCHLORITE |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: Antimicrobial and proteolytic agent, excellent organic tissue solvent, and lubricant with fairly quick effects. | SODIUM HYPOCHLORITE |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: An oxidizing agent and a hydrolyzing agent | SODIUM HYPOCHLORITE |
| Commercial sodium hypochlorite solutions are strongly ____and ____ and typically have nominal concentrations of 10-14% available chlorine | alkaline; hypertonic |
| SODIUM HYPOCHLORITE MOA(Saponification reaction): Acts as an organic and fat solvent that degrades fatty acids and transforms them into _____ and ____, reducing the surface tension of the remaining solution | fatty acid salts (soap); glycerol (alcohol) |
| SODIUM HYPOCHLORITE MOA(Neutralization reaction): Neutralizes amino acids by forming water and salt. With the exit of hydroxyl ions, the pH is ____ | reduced |
| SODIUM HYPOCHLORITE MOA: When chlorine dissolves in water and it is in contact with organic matter, it forms ______ | hypochlorous acid |
| It is a weak acid with the chemical formula HCIO that acts as an oxidizer | hypochlorous acid |
| Hypochlorous acid (HOCI - / and hypochlorite ions (OCI - ) lead to ____ and ____ | amino acid degradation; hydrolysis |
| SODIUM HYPOCHLORITE MOA: Acts as a solvent, releasing chlorine that combines with protein amino groups (NH) to form chloramines (chloramination reaction). | Solvent action |
| SODIUM HYPOCHLORITE MOA: PH | > 11 |
| SODIUM HYPOCHLORITE MOA: The antimicrobial effectiveness of sodium hypochlorite, based on its high pH (_____action), - similar to the mechanism of action of calcium hydroxide | hydroxyl ion |
| SODIUM HYPOCHLORITE MOA: impede cell metabolism | Chloramines |
| SODIUM HYPOCHLORITE MOA: is a strong oxidant and inhibits essential bacterial enzymes by reversible oxidation of SH groups /sulfhydryl group). | chlorine |
| SODIUM HYPOCHLORITE MOA: The high pH interferes in _________________due to irreversible enzymatic inhibition, biosynthetic alterations in cellular metabolism, and phospholipid degradation observed in lipidic peroxidation | cytoplasmic membrane integrity |
| NaOCI can be used in a concentration that ranges from ________ | 0.5 to 6 % |
| SODIUM HYPOCHLORITE: In vivo study - showed the most effective irrigation regimen for removing E. Coli is ___ for ___min, other concentrations are not as effective | 5.25%; 40 |
| the tissue-dissolving effect of sodium hypochlorite is directly related to the ____ | concentration |
| SODIUM HYPOCHLORITE(CONCENTRATION): if use is for antibacterial, the concentration should be | higher |
| SODIUM HYPOCHLORITE(CONCENTRATION): if use is for flushing, the concentration should be | lower |
| SODIUM HYPOCHLORITE(CONCENTRATION): if used for pulp extirpation, concentration is | higher |
| SODIUM HYPOCHLORITE(CONCENTRATION): high concentrations should also be used when you have problems with constant ___ in culture tests | positive results |
| SODIUM HYPOCHLORITE: more critical for disinfection than its concentration | Volume |
| SODIUM HYPOCHLORITE: Frequent exchange with fresh NaOCl is important and the use of _____of irrigant compensates for the low concentration | large amount |
| SODIUM HYPOCHLORITE: The chlorine ion, which is responsible for the dissolving and antibacterial capacity of NaOCI, is unstable and consumed rapidly during the ____of tissue dissolution, probably within __ min, which provides another reason for continuous replenishment | first phase; 2 |
| SODIUM HYPOCHLORITE: bacterial killing in__ min when __ NaOCl is used, while higher concentrations will need only 30 s to do the same job | 30; 0.5% |
| The dentin is composed of ___ organic material by weight | 22% |
| what is the organic material found in dentin | type 1 collagen |
| SODIUM HYPOCHLORITE: The depth of NaOCl penetration varied between _________, and it depends on concentration, time, and temperature | 77 and 300 um |
| SODIUM HYPOCHLORITE: Clegg et al. demonstrated that __% NaOCl was the only agent capable of both physically removing artificial biofilm and killing bacteria | 6 |
| TRUE OR FALSE: There was a dose-dependent effect of NaOCl against bacteria, as higher concentrations were more antibacterial | TRUE |
| SODIUM HYPOCHLORITE(EFFECT ON BIOFILM): ____ NaOC showed absence of biofilm | 3% and 6% |
| SODIUM HYPOCHLORITE(EFFECT ON BIOFILM): ___ NaOCl showed disruption of biofilm | 1% |
| SODIUM HYPOCHLORITE(EFFECT ON BIOFILM): 2% CHX showed ____biofilm | intact |
| SODIUM HYPOCHLORITE: active component of the sodium hypochlorite is a chemical substance that is elaborated by neutrophils in the process of phagocytosis | Hypochlorous acid |
| SODIUM HYPOCHLORITE: When hypersensitivity to NaOCl is suspected or confirmed, ____ should not be used either because of its chlorine content | chlorhexidine |
| SODIUM HYPOCHLORITE(toxicity): secondary infection may occur after __ hrs | 8 |
| Treatment of NaOCL accidents | palliative, observation, antibiotics and analgesics, referral |
| SODIUM HYPOCHLORITE(HOW TO PREVENT TOXICITY?): irrigating needles should be placed _____of the WL | short |
| SODIUM HYPOCHLORITE(HOW TO PREVENT TOXICITY?): Fit _____ in the canal | loosely |
| SODIUM HYPOCHLORITE(HOW TO PREVENT TOXICITY?): Solution must be injected using ___ flow rate | gentle |
| SODIUM HYPOCHLORITE(HOW TO PREVENT TOXICITY?): Constantly move the needle _____ in the canal - prevents wedging of the needle in the canal - provides better irrigation | up and down |
| SODIUM HYPOCHLORITE(HOW TO PREVENT TOXICITY?): reduce the possibility of forcing solutions into the periapical tissues | side venting tips |
| SODIUM HYPOCHLORITE: When NaOCl is used as a final rinse, ___________ may be altered | bonding of the sealer to the dentin |
| SODIUM HYPOCHLORITE(CLINICAL RECOMMENDATION): Concentrations between ____ should be used during the whole cleaning and shaping procedure | 2.5 and 6 % |
| SODIUM HYPOCHLORITE(CLINICAL RECOMMENDATION): Pulp chamber should be used as a ___of fresh irrigant | reservoir |
| SODIUM HYPOCHLORITE(AAE): Sodium hypochlorite is generally not utilized in its _____ in a clinical setting | most active form |
| SODIUM HYPOCHLORITE(AAE): For proper antimicrobial property, it must be prepared ___ just before use. | freshly |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:Used as an antiseptic mouthwash | CHORHEXIDINE GLUCONATE (CHX) |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: Broad spectrum (bacteriostatic); Sustained action; Low toxicity; Does not dissolve organic and inorganic substances; Cannot remove smear layer. | CHORHEXIDINE GLUCONATE (CHX) |
| CHORHEXIDINE GLUCONATE (CHX):ph | strongly basic |
| CHORHEXIDINE GLUCONATE (CHX):molecule with a pH between ____ | 5.5 and 7 |
| CHORHEXIDINE GLUCONATE (CHX):At high concentrations, CHX acts as a ___ and exerts its ____effect by damaging the cell membrane and causes precipitation of the cytoplasm | detergent; bactericidal |
| CHORHEXIDINE GLUCONATE (CHX):At low concentrations, CHX is ____, causing low-molecular weight substances (ie., potassium and phosphorous) to leak out from the cell membrane without the cell being permanently damaged | bacteriostatic |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:easily soluble in water and is very stable | CHX digluconate salt |
| CHORHEXIDINE GLUCONATE (CHX): Due to the ____ nature of the CHX molecule, it can be absorbed by anionic substrates such as the oral mucosa and tooth structure | cationic |
| CHORHEXIDINE GLUCONATE (CHX):Readily adsorbed onto ____ and ____ | hydroxyapatite; teeth |
| TRUE OR FALSE: Studies have shown that the uptake of CHX onto the teeth is irreversible. | FALSE |
| CHORHEXIDINE GLUCONATE (CHX):This reversible reaction of uptake and release of CHX leads to substantive antimicrobial activity and is referred to as ____ | substantivity |
| CHORHEXIDINE GLUCONATE (CHX):At low concentrations of ______ only as a constant monolayer of CHX is absorbed on the tooth surface, | 0.005%-0.01% |
| CHORHEXIDINE GLUCONATE (CHX): at higher concentrations, a _____ of CHX is formed on the surface, providing a ____of CHX which can rapidly release the excess into the environment as the concentration of CHX in the surrounding environment decreases | multilayer; reservoir |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: you can use when during recalls there is positive to percussion and your objective here is to flush the medicaments in the canal | CHORHEXIDINE GLUCONATE (CHX) |
| CHORHEXIDINE GLUCONATE (CHX): Because of its broad-spectrum ________ (MMP)-inhibitory effect, CHX may significantly improve resin-dentin bond stability | matrix metalloproteinase |
| CHORHEXIDINE GLUCONATE (CHX): allergic reactions | rare |
| CHORHEXIDINE GLUCONATE (CHX):The sensitization rate has been reported in several studies to be approximately __. | 2% |
| CHORHEXIDINE GLUCONATE (CHX): some allergic reactions such as ________ have been reported following direct contact to mucosal tissue or open wounds | anaphylaxis, contact dermatitis, and urticaria |
| The limitations of using CHX as a primary and sole endodontic irrigant are the following: | the inability to dissolve organic matter, No action on smear layer, Minor effect on biofilm disruption |
| The clinical recommendation to use CHX during endodontic treatment include: | Teeth with open apices or perforation where there is a risk to extrude NaOCl; maximal antimicrobial effect is desirable as a final rinse after EDTA |
| Used to remove inorganic portion of the smear layer | DECALCIFYING/CHELATING AGENTS |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: Used for irrigation of the root canal and for removal of the smear layer, Similar to EDTA | Citric Acid |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:It has been recommended as an irrigant in techniques such as photoactivated disinfection | Citric Acid |
| CITRIC ACID: concentrations | 1-50% |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: an aminopolycarboxylic acid, and a colorless, water-soluble solid; little or no antibacterial effect | Ethylenediaminetetraacetic Acid (EDTA) |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:often suggested as an irrigant because it can chelate and remove the mineralized portion of the smear layer | Ethylenediaminetetraacetic Acid (EDTA) |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:Its prominence as a chelating agent arises from its ability to sequester di and tri-cationic metal ions such as Ca 2+ and Fe 3+. | Ethylenediaminetetraacetic Acid (EDTA) |
| Ethylenediaminetetraacetic Acid (EDTA): On direct exposure for extended time, EDTA extracts bacterial surface proteins by combining with ____ from the cell membrane which can eventually lead to bacterial death | metal ions |
| Ethylenediaminetetraacetic Acid (EDTA): Chelators such as EDTA form a stable complex with ___. When all available ions have been bound, equilibrium is formed and no further dissolution takes place; therefore, EDTA is ____ | calcium; self-limiting |
| Ethylenediaminetetraacetic Acid (EDTA): EDTA alone normally cannot remove the smear layer effectively; a _____component, such as NaOCl, must be added to remove the organic components of the smear layer | proteolytic |
| Ethylenediaminetetraacetic Acid (EDTA): Normally used in a concentration of ___ and can remove the smear layer when in direct contact with the root canal wall for less than __ min | 17%; 1 |
| TRUE OR FALSE: In addition to their cleaning ability, chelators may detach biofilms adhering to root canal walls | TRUE |
| TRUE OR FALSE: EDTA irrigant proved to be highly superior to saline in reducing intracanal microbiota despite the fact that its antiseptic capacity is relatively limited | TRUE |
| Ethylenediaminetetraacetic Acid (EDTA): It exerts its strongest effect when used synergistically with ___ | NaOCl |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:root canal debridement and lubrication; moderate activity; used in conjunction with chemical irrigants | normal saline |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:used as a last rinse to flush out any leftover chemical irrigant | normal saline |
| normal saline concentration | 0.90% |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: poisonous, ineffective in removing smear layers, corrosive, it may result in discolouration, and pungent odour. | SODIUM HYPOCHLORITE |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS:The sealer's connection to the dentin will be compromised if used as a final rinse | SODIUM HYPOCHLORITE |
| article: The percentage of NaOCl to be used during the entire cleaning and shaping treatment is recommended to be between ________ | 2.5 and 6%. |
| increase the effectiveness of the NaOCl solution; reduces the shelf life of the solution to less than a week | 1% sodium bicarbonate (buffering agent) |
| sodium hypochlorite contains __ free chlorine | 5% |
| sodium hypochlorite releases OCL form at ph of ___ | 12 |
| sodium hypochlorite dissolves necrotic tissue because of its strong alkaline nature (pH ___) | 12 |
| two most reactive forms of chlorine in an aqueous solution at body temperature | Hypochlorite (OCl-) and hypochlorous acid (HCl-) |
| NAOCl:pH of water is less than 7.6 in aqueous solution | hypochlorite |
| NAOCl:pH of water is more than 7.6 in aqueous solution | hypochlorous acid |
| When the concentration of the sodium hypochlorite solution is ____, its toxicity, antibacterial action and ability to dissolve tissues are all reduced | reduced |
| When the volume of an irrigant is ____, the chances of drastically reducing bacteria colonies in the root canal are more | increased |
| NaOCl at ___ has the same tissue-dissolving ability as a 5.25% solution at 20°C, according to the results of this study | 45°C |
| TRUE OR FALSE: heated low-density NaOCl solutions have higher systemic toxicity than unheated, higher-concentration NaOCl solutions | FALSE |
| common intracanal medicamanet fr CHX | CaOH |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: effective against Gram-positive and -negative bacteria, spores of bacteria, lipophilic viruses, yeast, and fungi; effects are much reduced when organic matter is present; incapable of removing biofilms and other organic debris | CHORHEXIDINE GLUCONATE (CHX) |
| CHORHEXIDINE GLUCONATE (CHX) concentration for mouthwash | 0.1-0.2% |
| CHORHEXIDINE GLUCONATE (CHX) concentration for irrigation | 2% |
| in lower quantities, CHX is | bacteriostatic |
| in higher quantitis, CHX is | bactericidal |
| TRUE OR FALSE: research showed that effects of CHX may last from 72hours to 12 weeks. | TRUE |
| TRUE OR FALSE: Antibacterial effectiveness is decreased by heating the CHX solution at a low concentration, while toxicity is reduced. | FALSE |
| IRRIGATING SOLUTIONS USED IN ENDODONTICS: may be used to disinfect gutta percha | CHORHEXIDINE GLUCONATE (CHX) |
| CITRIC ACID: Using ___ CA as a final irrigation solution offered good results for removing smear layers | 10% |
