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Endo > 09 Treating Endodontic Emergencies > Flashcards

09 Treating Endodontic Emergencies Flashcards

1
Q

how often do ppl experience a toothache?

A

12% of US population experiences a toothache within a 6 month timeframe

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2
Q

which pulp diagnosis requires emergency treatment?

A

symptomatic irreversible pulpitis

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3
Q

which pulp diagnosis requires NO emergency treatment?

A
  • normal pulp
  • reversible pulpitis
  • asymptomatic irreversible pulpitis
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4
Q

what are the characteristics of irreversible pulpitis

A
  • thermal sensitivity
  • symptomatic apical periodontitis may or may not be present
  • no swelling
  • anesthesia problems common, particularly in mandibular teeth
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5
Q

when a patient has anesthesia problems, where is it common?

A

mandibular teeth (in irreversible pulpitis)

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6
Q

treatment options for toothache

A
  • pulpotomy
  • gross pulpal debridement
  • partial pulpectomy
  • total pulpectomy
  • complete endodontic therapy
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7
Q

pulpotomy

A

removal of coronal pulp

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8
Q

partial pulpectomy

A

removal of coronal pulp and pulp from main canal

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9
Q

gross pulpal debridement

A

removal of pulp from all canals without canal shaping (usually without a working length radiograph)

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10
Q

total pulpectomy

A

complete cleaning and partial or complete shaping

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11
Q

options for treatment of a single rooted tooth

A
  • gross pulpal debridement
  • total pulpectomy
  • complete endodontic therapy
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12
Q

treatment for a multi-rooted tooth without SAP (symptomatic apical periodontitis)

A
  • pulpotomy
  • partial pulpectomy
  • gross pulpal debridement
  • complete pulpectomy
  • complete endodontic therapy
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13
Q

pulpotomy in a multi-rooted tooth without SAP

A
  • excellent option when hemorrhage can be controlled
  • pulp is removed to level of canal orifice
  • NaOCl is used to clean the chamber
  • Calcium hydroxide is placed over pulp in canals
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14
Q

treatment of multi-rooted tooth with SAP

A
  • gross pulpal debridement
  • complete pulpectomy
  • complete endodontic therapy
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15
Q

Necrotic pulp diagnoses with no emergency treatment required

A
  • Asymptomatic apical periodontitis

- Chronic apical abscess

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16
Q

necrotic pulp diagnoses with emergency treatment required

A
  • symptomatic apical periodontitis

- Acute apical abscess

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17
Q

Treatment options necrotic/SAP

A
  • Gross pulpal debridement
  • complete pulpectomy
  • complete endodontic therapy
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18
Q

Single vs. multiple appointments for necrotic teeth

A
  • controversial
  • most new studies show that there is no difference in success if the treatment is done in a single or multiple appointments
  • However, a new study has shown that when two appt txt is done with CaOH as an interappointment medicament there are fewer residual bacteria than when single appt txt is used
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19
Q

example of adjuncts to txt

A
  • interappointment medicaments
  • antibiotics
  • analgesics
  • incision and drainage
  • occlusal reduction
  • trephination
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20
Q

interappointment medicaments

A
  • do not reduce pain
  • bacteriocidal
  • break down residual pulp tissue
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21
Q

historical medicaments

A
  • formocresol
  • camphorated parachlorophenol
  • Eugenol
22
Q

Formocresol

A
  • shown to be mutagenic and carcinogenic
  • can be traced in other parts of the body
  • pungent (it sting the nostrils, but not in a good way)
23
Q

calcium hydroxide

A
  • effective antibacterial
  • high pH
  • must be mixed with liquid to maximize antibacterial effect
  • must remain in tooth for a minimum of 1 week
24
Q

Ultracal XS

A
  • 35% calcium hydroxide
  • 2% Barium Sulfate
  • Methylcellulose
  • USED AT VCU
25
Q

anitbiotics, when not to use:

A
  • do not use when treating vital teeth

- will NOT reduce pain

26
Q

when to use antibiotics

A
  • high fever
  • malaise
  • cellulitis
  • trismus
  • persistent and progressive infections
  • immunologically compromised patients
27
Q

what are the primary antibiotics for endodontics?

A
  • Pen VK, 500 mg, Q6h 7 days
  • amoxicillin 500 mg, Q8h 7 days
  • Clindamycin 300 mg, Q6h 7days
28
Q

loading dose for antibiotics

A

-a loading dose of 2 times the maintenance dose is recommended when treating orofacial infections

29
Q

analgesics (pain killers), non narcotics

A

NSAIDs, Acetaminophen

30
Q

analgesics (pain killers), narcotics

A
  • Codeine
  • Hydrocodone
  • oxycodone
31
Q

flexible analgesic strategy

A

-uses single analgesics or combination of analgesics to relieve pain

32
Q

what analgesics would be used for mild pain?

A
  • 400-600 mg Ibuprofen every 6 hours
  • 650 mg Aspirin every 6 hours
  • 650 mg Acetaminophen every 6 hours
33
Q

analgesics for moderate pain

A

600 mg Ibuprofen and 650 mg Acetaminophen alternating every 3 hours (or taken together)

34
Q

analgesics for severe pain

A
  • 600 mg Ibuprofen and 5-10 mg hydrocodone/325 mg acetaminophen alternating every 3 hours (or together)
  • 325 mg acetaminophen and 5-10 mg hydrocodone/325 mg Acetaminophen every six hours
35
Q

I and D stands for:

A

Incision and Drainage

-Incise swelling, Drain through tooth

36
Q

when to do occlusal reduction

A
  • studies are inconclusive

- reduce occlusion only if tooth is symptomatic to percussion

37
Q

Trephination

A
  • Trephination is the surgical perforation of the cortical plate adjacent or apical to the symptomatic tooth
  • recent studies have shown that trephination is not a beneficial adjunct to reduce pain
38
Q

Temporary restorations

A
  • place cotton pellet over the canals
  • must be a MINIMUM of 3.5 mm to seal tooth
  • never leave the tooth open
39
Q

temporary restoration materials

A
  • IRM
  • cavit
  • Triage (fuji)
40
Q

Cavit

A

temp restoration material

  • easy to use, no mixing
  • Do not use in vital teeth (hydrophilic)
41
Q

Fuji triage glass ionomer

A
  • pink glass ionomer

- expensive

42
Q

Which of the following is NOT a characteristic of symptomatic irreversible pulpitis?
Answer
a.
Thermal sensitivity is usually present.
b.
Swelling is usually present.
c.
Local anesthesia is often diffcult to obtain.
d.
Symptomatic apical periodontitis is often present.

A

B, swelling is usually present (this is false)

43
Q 
A patient presents to your office with a toothache.  Tooth #14 has a carious lesion that extends to the pulp in the area of the mesiobuccal pulp horn.  Your diagnosis is tooth #14 irreversible pulpitis with normal apical tissue. Which of the following emergency treatment options would not be appropriate?
Answer
	a. 	
Direct pulp cap
	b. 	
Pulpotomy
	c. 	
Gross pulpal debridement
	d. 	
Complete endodontic therapy.
A

a direct pulp cap

44
Q

Statement 1: Teeth diagnosed with irreversible pulpitis may or may not have symptomatic apical periodontitis.

Statement 2: Teeth with symptomatic apical periodontitis will always have a periapical radiolucency that is present on a periapical radiograph.

A

T, F

45
Q 
With which of the following diagnoses would you most likely swelling?
Answer
	a. 	
Symptomatic apical periodontitis
	b. 	
Acute apical abscess
	c. 	
Irreversible pulpitis
	d. 	
Asymptomatic apical periodontitis
A

b acute apical abscess

46
Q

Statement 1: Studies have shown that occlusal reduction is a proven adjunct to reduce the pain of symptomatic apical periodontitis.

Statement 2: Studies have shown that trephination is a proven adjunct to reduce the pain of symptomatic apical periodontitis.

A

both are false

47
Q

T/F Interappointment medicaments have been shown to reduce pain.

A

false

48
Q

T/F Formocresol has been shown to be both mutagenic and carcinogenic.

A

T

49
Q

What type of interappointment calcium hydroxide paste is used in the VCU Undergraduate Endodontic Clinic?

A

Ultracal XS

50
Q

An antibiotic is indicated for an emergency endodontic patient who is allergic to penicillin. Which antibiotic should be prescribed?

A

Clindamycin

51
Q

Statement 1: The Flexible Analgesic Strategy uses single analgesics or a combination of analgesics to relieve pain.

Statement 2: When prescribing Acetominophen, the current recommended maximum daily dose is 4000 mg.

A

T, F (maximun daily dose is 3000 mg)

Endo (10 decks)

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