09 Treating Endodontic Emergencies Flashcards
how often do ppl experience a toothache?
12% of US population experiences a toothache within a 6 month timeframe
which pulp diagnosis requires emergency treatment?
symptomatic irreversible pulpitis
which pulp diagnosis requires NO emergency treatment?
- normal pulp
- reversible pulpitis
- asymptomatic irreversible pulpitis
what are the characteristics of irreversible pulpitis
- thermal sensitivity
- symptomatic apical periodontitis may or may not be present
- no swelling
- anesthesia problems common, particularly in mandibular teeth
when a patient has anesthesia problems, where is it common?
mandibular teeth (in irreversible pulpitis)
treatment options for toothache
- pulpotomy
- gross pulpal debridement
- partial pulpectomy
- total pulpectomy
- complete endodontic therapy
pulpotomy
removal of coronal pulp
partial pulpectomy
removal of coronal pulp and pulp from main canal
gross pulpal debridement
removal of pulp from all canals without canal shaping (usually without a working length radiograph)
total pulpectomy
complete cleaning and partial or complete shaping
options for treatment of a single rooted tooth
- gross pulpal debridement
- total pulpectomy
- complete endodontic therapy
treatment for a multi-rooted tooth without SAP (symptomatic apical periodontitis)
- pulpotomy
- partial pulpectomy
- gross pulpal debridement
- complete pulpectomy
- complete endodontic therapy
pulpotomy in a multi-rooted tooth without SAP
- 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
treatment of multi-rooted tooth with SAP
- gross pulpal debridement
- complete pulpectomy
- complete endodontic therapy
Necrotic pulp diagnoses with no emergency treatment required
- Asymptomatic apical periodontitis
- Chronic apical abscess
necrotic pulp diagnoses with emergency treatment required
- symptomatic apical periodontitis
- Acute apical abscess
Treatment options necrotic/SAP
- Gross pulpal debridement
- complete pulpectomy
- complete endodontic therapy
Single vs. multiple appointments for necrotic teeth
- 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
example of adjuncts to txt
- interappointment medicaments
- antibiotics
- analgesics
- incision and drainage
- occlusal reduction
- trephination
interappointment medicaments
- do not reduce pain
- bacteriocidal
- break down residual pulp tissue
historical medicaments
- formocresol
- camphorated parachlorophenol
- Eugenol
Formocresol
- 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)
calcium hydroxide
- effective antibacterial
- high pH
- must be mixed with liquid to maximize antibacterial effect
- must remain in tooth for a minimum of 1 week
Ultracal XS
- 35% calcium hydroxide
- 2% Barium Sulfate
- Methylcellulose
- USED AT VCU
anitbiotics, when not to use:
- do not use when treating vital teeth
- will NOT reduce pain
when to use antibiotics
- high fever
- malaise
- cellulitis
- trismus
- persistent and progressive infections
- immunologically compromised patients
what are the primary antibiotics for endodontics?
- Pen VK, 500 mg, Q6h 7 days
- amoxicillin 500 mg, Q8h 7 days
- Clindamycin 300 mg, Q6h 7days
loading dose for antibiotics
-a loading dose of 2 times the maintenance dose is recommended when treating orofacial infections
analgesics (pain killers), non narcotics
NSAIDs, Acetaminophen
analgesics (pain killers), narcotics
- Codeine
- Hydrocodone
- oxycodone
flexible analgesic strategy
-uses single analgesics or combination of analgesics to relieve pain
what analgesics would be used for mild pain?
- 400-600 mg Ibuprofen every 6 hours
- 650 mg Aspirin every 6 hours
- 650 mg Acetaminophen every 6 hours
analgesics for moderate pain
600 mg Ibuprofen and 650 mg Acetaminophen alternating every 3 hours (or taken together)
analgesics for severe pain
- 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
I and D stands for:
Incision and Drainage
-Incise swelling, Drain through tooth
when to do occlusal reduction
- studies are inconclusive
- reduce occlusion only if tooth is symptomatic to percussion
Trephination
- 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
Temporary restorations
- place cotton pellet over the canals
- must be a MINIMUM of 3.5 mm to seal tooth
- never leave the tooth open
temporary restoration materials
- IRM
- cavit
- Triage (fuji)
Cavit
temp restoration material
- easy to use, no mixing
- Do not use in vital teeth (hydrophilic)
Fuji triage glass ionomer
- pink glass ionomer
- expensive
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.
B, swelling is usually present (this is false)
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 direct pulp cap
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.
T, F
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
b acute apical abscess
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.
both are false
T/F Interappointment medicaments have been shown to reduce pain.
false
T/F Formocresol has been shown to be both mutagenic and carcinogenic.
T
What type of interappointment calcium hydroxide paste is used in the VCU Undergraduate Endodontic Clinic?
Ultracal XS
An antibiotic is indicated for an emergency endodontic patient who is allergic to penicillin. Which antibiotic should be prescribed?
Clindamycin
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.
T, F (maximun daily dose is 3000 mg)
