NDECC cheat sheet

Pulpal diagnosis categories: normal, reversible pulpitis, symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis, previously treated, previously initiated therapy.

Periapical diagnosis categories: normal, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, chronic apical abscess, condensing osteitis.

Diagnostic tests: cold test (refrigerant spray) assesses pulp vitality; EPT confirms vitality but is unreliable in calcified or recently traumatized teeth; percussion and palpation assess periapical inflammation.

Sinus tract tracing with gutta-percha followed by radiograph identifies the source tooth when the tract is of endodontic origin.

Radiographic findings lag behind histologic change; a periapical radiolucency indicates bone loss of cortical integrity, not the onset of disease.

Cracked tooth: sharp pain on release of biting (rebound pain), localized probing depth, and bite test with a cotton roll or Tooth Slooth aid identification.

Odontogenic vs non-odontogenic pain: odontogenic pain localizes, is provoked by thermal or percussion stimuli, and responds to local anesthesia; neuropathic pain does not cross the midline and is not anesthetized by local infiltration.

Caries risk assessment uses lesion activity, plaque control, fluoride exposure, diet frequency, salivary flow, and prior caries experience rather than lesion count alone.

Sequence complex care: emergency and disease control, then structural (endodontic, periodontal, surgical), then functional (prosthodontic, orthodontic), then maintenance.

Tooth restorability depends on remaining sound tooth structure, ferrule of at least 1.5-2 mm of circumferential dentin, periodontal support, crown-root ratio, and endodontic prognosis.

Crown-root ratio: 1:1 or better is favorable; 2:1 is reduced but acceptable; worse than 2:1 indicates questionable long-term prognosis.

Furcation involvement (Glickman I-IV) worsens prognosis; Grade III and IV have poor long-term retention without regenerative or resective therapy.

Informed consent requires disclosure of diagnosis, treatment options including no treatment, material risks, benefits, and alternatives, documented before care.

Medical risk stratification: ASA I healthy, ASA II mild systemic disease, ASA III severe disease not incapacitating, ASA IV incapacitating threat to life; ASA III-IV often requires medical consultation.

Anticoagulant management: most routine dental procedures can proceed with local hemostatic measures; INR above therapeutic range or dual therapy warrants physician consultation.

Prognosis statements should be expressed as survival or success probabilities tied to defined criteria and time frames, not as guarantees.

Working length: determine with apex locator and confirm radiographically; apical terminus generally 0.5-1.0 mm short of the radiographic apex.

Canal preparation: crown-down technique reduces ledging and transportation; recapitulation and copious irrigation with sodium hypochlorite (0.5-5.25%) dissolve organic tissue and disinfect.

Sodium hypochlorite accident presents with sudden severe pain, immediate swelling, and tissue necrosis; manage with irrigation cessation, saline rinse, and supportive care.

Irrigation with EDTA (17%) removes the smear layer; final rinse sequence typically NaOCl then EDTA then NaOCl.

Access cavity design follows the projected pulp chamber outline; straight-line access reduces instrument separation and improves disinfection.

Post-endodontic restoration: anterior teeth with minimal loss may use composite; posterior teeth with cuspal loss generally need cuspal coverage to resist fracture.

Cuspal coverage indications: loss of marginal ridge integrity, cracks, endodontically treated posterior teeth, and wide isthmus preparations.

Adhesive dentistry: enamel etching with phosphoric acid improves bond durability; dentin bonding benefits from ethanol wet bonding or selective enamel etch with universal adhesives.

2017 World Workshop classification uses staging (severity and complexity) and grading (progression rate) with Stage I-IV and Grade A-C.

Stage I: interdental CAL 1-2 mm, bone loss coronal third under 15%; Stage II: CAL 3-4 mm, bone loss 15-33%; Stage III: CAL 5 mm or more, bone loss extending to middle third, tooth loss 4 or fewer; Stage IV: advanced with tooth loss 5 or more and complex rehabilitation needs.

Grade A: no bone loss over 5 years or bone loss/age under 0.25; Grade B: 0.25-1.0; Grade C: above 1.0 or rapid progression patterns.

Pocket probing depth 4 mm or less with no bleeding indicates stability; 4 mm with bleeding indicates risk; 5 mm or more indicates active therapy need.

Scaling and root planing is the initial therapy for Stage I-III; re-evaluation occurs at 6-8 weeks before deciding on surgery.

Systemic risk factors modifying periodontitis: uncontrolled diabetes (HbA1c above 7%), smoking, and medication-influenced conditions such as phenytoin, nifedipine, and cyclosporine for gingival overgrowth.

Regenerative therapy indications: intrabony defects of 3 mm or more, Class II furcation, and no-through-and-through involvement; guided tissue regeneration uses barrier membranes.

Maintenance interval: 3 months for high-risk patients, 3-6 months for moderate, 6-12 months for low risk, based on risk assessment.

Third molar extraction difficulty indicators: angulation, depth (Pell-Gregory Class A/B/C), relationship to ramus (Class I/II/III), root morphology, and bone density.

Inferior alveolar nerve injury risk increases with roots overlapping the canal, lingual angulation, and deep impaction; cone beam CT clarifies the relationship.

Dry socket (alveolar osteitis) presents 2-4 days post-extraction with severe throbbing pain and empty socket; risk reduced by atraumatic technique and avoiding smoking.

Post-extraction bleeding management: pressure pack, sutures, hemostatic agents (oxidized cellulose, gelatin sponge, tranexamic acid rinse), and evaluation of coagulopathy.

Oral potentially malignant disorders: leukoplakia, erythroplakia, oral submucous fibrosis, actinic cheilitis, and lichen planus; erythroplakia has the highest malignant transformation risk.

Oral cancer red flags: non-healing ulcer over 2 weeks, induration, fixity to deeper tissues, paresthesia, and cervical lymphadenopathy warrant biopsy or referral.

Bisphosphonate-related osteonecrosis of the jaw: exposed bone over 8 weeks in a patient on antiresorptive therapy without radiation history; prevention includes avoiding elective extractions during high-risk periods.

Local anesthesia maximum doses: lidocaine 2% with 1:100,000 epinephrine 7 mg/kg (about 500 mg adult); articaine 4% 7 mg/kg; mepivacaine 3% 6.6 mg/kg; bupivacaine 0.5% 1.3 mg/kg.

Complete denture occlusion: bilateral balanced occlusion in eccentric positions reduces tipping and improves stability; monoplane occlusion may be used with severe ridge resorption.

Posterior palatal seal provides retention and seals the maxillary denture; it lies at the junction of the movable and immovable tissues near the vibrating line.

Neutral zone concept: teeth arranged where the tongue and cheeks exert balanced forces, improving stability in resorbed ridges.

Fixed partial denture abutment selection: crown-root ratio, periodontal support, alignment, and span length determine feasibility; long spans increase flexure and require rigid connectors.

Implant survival vs success: survival is presence of the implant; success criteria include bone loss under 0.2 mm annually after the first year and no mobility or pain.

Occlusal scheme for implant-supported restorations: mutually protected occlusion with light centric contacts and no working or non-working interferences on implants.

Removable partial denture design: use rests to direct forces along the long axis, minimize torque with rigid major connectors, and plan for rotational path when abutments are tilted.

Vertical dimension of occlusion is assessed by closest speaking space (about 1-2 mm), freeway space (2-4 mm), and facial appearance; loss of VDO causes angular cheilitis and commissure drooping.

Dental age estimation: mixed dentition eruption sequence (mandibular central incisor, first molar, maxillary central incisor, lateral incisor, then canines and premolars); Demirjian method uses panoramic tooth mineralization stages.

Class II malocclusion division 1 has proclined maxillary incisors; division 2 has retroclined central incisors with deep overbite.

Angle classification: Class I mesiobuccal cusp of maxillary first molar in the buccal groove; Class II in the buccal groove mesial to it; Class III distal to it.

Cephalometric norms: SNA about 82 degrees, SNB about 80 degrees, ANB 2-4 degrees; increased ANB suggests skeletal Class II.

Growth modification timing: maxillary expansion before the midpalatal suture fuses (before puberty), functional appliances during the pubertal growth spurt, and Class III protraction early.

Pediatric behavior guidance: tell-show-do, positive reinforcement, and voice control; protective stabilization and sedation require documented consent and are last-resort options.

First permanent molar caries prevention includes sealants on occlusal surfaces with deep pits and fissures; sealants are contraindicated in cavitated lesions.

Space maintenance: a space maintainer is indicated when a primary tooth is lost prematurely and arch length loss is anticipated before eruption of the successor.

Core ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and confidentiality; autonomy governs informed refusal of treatment.

Informed consent elements: diagnosis, nature of proposed treatment, risks and benefits, alternatives including no treatment, and consequences of refusal.

Minors and consent: a parent or legal guardian consents; emancipated minors may consent under state law; emergency treatment may proceed under implied consent.

Mandatory reporting obligations include suspected child abuse or neglect, and in many jurisdictions elder abuse and certain communicable diseases.

Conflict of interest disclosure: financial interests in products or referral arrangements must be disclosed to patients and avoided where they bias recommendations.

Boundary violations: sexual or romantic relationships with patients and treating family members without appropriate safeguards are generally prohibited by codes of ethics.

HIPAA permits disclosure for treatment, payment, and operations; minimum necessary standard applies, and patients may request restrictions and accounting of disclosures.

Error disclosure: adverse events should be disclosed promptly and honestly, with documentation of the discussion and follow-up plan.

Hand hygiene: soap and water for 40-60 seconds when hands are visibly soiled or after contact with spores (C. difficile); alcohol-based rub for 20-30 seconds otherwise.

Personal protective equipment: gloves, masks, eye protection, and gowns; gloves are single-use and not washed; masks are changed between patients or when moist.

Sterilization: steam autoclave at 121 degrees C at 15 psi for 15-20 minutes or 132 degrees C for 4 minutes; biological spore testing weekly.

High-level disinfection is required for semicritical items such as endoscopes; critical items (surgical instruments, scalers) require sterilization.

Surface barriers or intermediate-level disinfectants (EPA-registered hospital disinfectant with tuberculocidal claim) are used between patients for clinical contact surfaces.

Sharps safety: do not recap needles by hand; use the one-handed scoop technique or a needle recapping device; place sharps in puncture-resistant containers at point of use.

Occupational exposure: wash the site with soap and water, flush mucous membranes, report immediately, and follow post-exposure prophylaxis protocols for HIV and hepatitis B.

Nitrous oxide and waste anesthetic gas: scavenging systems and room ventilation reduce occupational exposure; monitor for leaks and limit exposure time.

Evidence hierarchy: systematic reviews and meta-analyses of randomized trials at the top, then randomized controlled trials, cohort studies, case-control studies, case series, and expert opinion.

PICO framework: Population, Intervention, Comparator, Outcome, used to formulate an answerable clinical question.

Sensitivity is the proportion of true positives detected; specificity is the proportion of true negatives detected; both are properties of the test, independent of prevalence.

Positive predictive value depends on prevalence: higher prevalence increases PPV; lower prevalence decreases PPV even with the same sensitivity and specificity.

Number needed to treat (NNT) equals 1 divided by absolute risk reduction; number needed to harm equals 1 divided by absolute risk increase.

Confidence intervals describe the range likely containing the true effect; if a 95% CI for a risk ratio crosses 1.0, the result is not statistically significant at the 0.05 level.

Bias types: selection, information, confounding, and publication bias; randomization and blinding reduce selection and information bias.

Levels of clinical recommendations combine evidence quality with strength of effect; strong recommendations require high-quality evidence or a large benefit-harm ratio.