NDEB ACJ cheat sheet

Treat the most life-threatening condition first: airway, then uncontrolled bleeding, then swelling compromising the airway, then pain and function.

Red-flag findings mandating urgent referral or emergency care: dysphagia, dyspnea, trismus, floor-of-mouth swelling, fever with facial swelling, paresthesia of the lip or chin, and a nonhealing ulcer over 2 weeks.

Pulpal diagnosis categories: normal, reversible pulpitis (provoked pain, resolves on removal of stimulus), symptomatic irreversible pulpitis (spontaneous or lingering pain), asymptomatic irreversible pulpitis, necrotic, previously treated.

Periapical diagnosis categories: normal, symptomatic apical periodontitis (pain to percussion), asymptomatic apical periodontitis, acute apical abscess (rapid swelling, pain, systemic signs), chronic apical abscess (sinus tract).

Reversible pulpitis is managed by removing the cause (caries, defective restoration, occlusal trauma); irreversible pulpitis and necrotic pulp require root canal treatment or extraction.

A periapical abscess with systemic involvement (fever, malaise, lymphadenopathy, swelling spreading to fascial spaces) requires incision for drainage plus antibiotics and definitive dental treatment; antibiotics alone do not resolve a necrotic pulp.

Antibiotic prophylaxis before invasive dental procedures is indicated for prosthetic heart valve or valve repair with prosthetic material, prior infective endocarditis, certain congenital heart disease, and cardiac transplant with valvulopathy.

Suspected oral malignancy: any ulcer, red or white patch, or swelling persisting beyond 2 weeks without a clear cause requires biopsy or referral; do not treat empirically with antifungals or steroids and reassess later.

Decision rule for sinus communication: a tooth with periapical radiolucency extending to the sinus floor, positive sinus tenderness, or a history of recent extraction with air or fluid passage through the socket needs imaging and possible referral before further restorative work.

Risk assessment for caries drives interval and technique: high risk (active lesions, poor plaque control, xerostomia, frequent sugar exposure) warrants fluoride varnish, chlorhexidine or xylitol protocols, and shorter recall intervals.

Periodontal diagnosis requires probing depths, clinical attachment loss, bleeding on probing, and radiographs; staging uses severity (attachment loss) and complexity, grading uses rate of progression (bone loss/age ratio).

A probing depth of 4 mm or more with bleeding indicates active inflammation requiring subgingival debridement; depths of 5 mm or more with attachment loss typically need referral or specialist assessment.

Local anesthesia failure in irreversible pulpitis is common in mandibular molars; supplemental techniques include intraligamentary, intraosseous, and buccal infiltration with articaine, or a Gow-Gates or Vazirani-Akinosi block.

When a restoration fails, decide between repair, replacement, endodontic treatment, crown, or extraction based on remaining tooth structure, ferrule (at least 1.5-2 mm of circumferential dentin), periodontal support, and occlusal load.

Bleeding disorders, anticoagulant use, and liver disease affect surgical planning; check INR for warfarin (procedure generally acceptable at INR 3.5 or below with local hemostatic measures) and use local measures rather than stopping antiplatelets.

Informed consent requires documenting diagnosis, material risks, alternatives including no treatment, and the patient's questions and decision, before the procedure begins.

Trauma triage: avulsed permanent tooth is replanted immediately if clean, handled by the crown, and stored in milk, saline, or saliva; splint flexibly for 2 weeks and refer for root canal treatment if the apex is closed.

Orofacial pain of nonodontogenic origin (temporomandibular disorder, neuropathic pain, sinusitis, referred cardiac pain) should be considered when pulp tests are normal and pain does not fit a dental cause; avoid irreversible treatment on a normal tooth.