10 - Endodontic Emergencies Flashcards
90% of dental pain is ___ origin
pulpo-periradicular
what is the purpose of emergency treatment
to provide fast, effective, relief
what are examples of ODONTOGENIC pain
- pulpal origin
- periodontal
- pericornitis (but this one is not endo problem)
what are examples of non-odontogenic origin?
- TMJ
- sinus
- cardiac
- neurologic
- psychogenic
how to diagnose a hot tooth? (4 questions)
- which tooth
- pulpal or periapical? can be both.
- is condition reversible or irreversible?
- always attempt to reproduce patient symptoms
where is pain coming from in endo emergencies?
pulp, periradicular tissues, or both?
what is experienced in pain from PULP ONLY?
- spontaneous pain/ pain to hot and cold
- pain often not localized
- try to reproduce patient symptoms cold/hot/air
- not percussion tender (since no PDL)
- no radiographic signs
periradicular pain will manifest itself by what?
sensitivity to chewing, precussion, and palpation
what are symptoms of IRREVERSIBLE condition
cold test has prolonged pain for several seconds
what are symptoms of REVERSIBLE condition
pain from cold test, but it goes away
what is this:
Pain is stimulated (tooth OK unless hot/cold applied)
Pain is quick, sharp and of short duration
No percussion sensitivity unless it’s related to hyper-occlusion
Often seen after new restorations
Check occlusion
reversible pulpitis
treatment for reversible pulpitis
identify and eliminate cause (e.g., excavate caries, place sedative filling, adjust occlusion, etc.)
what are painful kinds of pulpal/periradicular pathology?
Symptomatic Irreversible Pulpitis
Symptomatic Irreversible Pulpitits with Symptomatic Apical Periodontitis (SIPSAP)
Partial Pulpal Necrosis
Pulpal Necrosis with Symptomatic Apical Periodontitis
Pulpal Necrosis with Acute Apical Abscess
what is it:
Pain is spontaneous
When stimulated pain will linger on
Pain is often diffuse and difficult to localize
Cannot see on radiographs
symptomatic irreversible pulpitis
how to treat posterior teeth symptomatic irreversible pulpitis in emergency?
Canal debridement
Ca(OH)2
Cotton
Place temporary Filling (not Cavit)
how to treat anterior teeth w/ syptomatic irreversibly pulpitis in emergency
Canal debridement
If pulp is well organized, can do a pulpectomy with a barbed broach
Ca(OH)2
Cotton
Place a temporary Filling
why do we place cotton in emergency treatment?
so you have access to it again if you run out of time and need to access another day
what is this:
Same as symptomatic irreversible pulpitis but is also sensitive to percussion (Due to PDL being involved)
symptomatic irreversible pulpitis w/ symptomatic apical periodontitis
how to treat SIPSAP
Canal debridement
Ca(OH)2
Temporary fill
Adjust occlusion (Could use supportive therapy too)
In SIPSAP, when does temp sensitivity resolve? chewing sensitivity?
Temp sensitivity resolves immediately but sensitivity to chewing may persist 2-3 days
what is this:
Usually severe non-localized pain
Sometimes tender to percussion
Pulp tests often inconclusive, response to vitality tests often delayed
Look for etiology: caries, large fillings, old crowns etc.
Patient usually has diffuse pain (hard to localize toothache)
partial necrosis
how to treat pulpal necrosis
Canal debridement
Irrigate NaOCl
Ca(OH)2
Cotton
Temporary Filling
what is this:
No response to cold or EPT
Might or might not have spontaneous pain (when pulp is necrotic pain is from peri-radicular tissues such as PDL)
Pain to percussion
pulpal necrosis w/ symptomatic apical periodontitis
how to treat pulpal necrosis w/ symptomatic apical periodontitis?
Canal debridement
Irrigate with NaOCI
Ca(OH)2
Cotton
Place temporary fill (like GI)
how does pulpal necrosis w/ symptomatic apical periodontitis pain last after tx?
pain may persist for 2 or 3 days, requires supportive therapy
what is this:
No response to cold or EPT
Spontaneous and percussion/palpation pain
SWELLING
pulpal necrosis w/ acute apical abscess
how to treat ABSCESS in tooth w/ pulpal necrosis w/ AAA
establish drainage
through tooth
incision and drainage
how to treat TOOTH w/ pulpal necrosis with AAA
clean and irrigate canal
Ca(OH)2
cotton
temporary fill
how can you tell if pulpal necrosis w/ AAA is endo or perio?
Swelling with vital pulp indicates abscess of periodontal origin (no rct indicated)
Look for presence of calculus
Usually periodontal disease is more generalized
signs and symptoms of PN w/ AAA
Swelling
Spontaneous pain
Pain to percussion/palpation
No response to vitality tests
X-ray varies from wide PDL to large (phoenix abscess, recrudescent
if xray shows a PHOENIX ABSCESS, what is it
pulpal necrosis with AAA
where does swelling from AAA appear?
localized usually in buccal vestibule
diffuse and invade facial spaces(cellulitis)
what are systemic symptoms for pulpal necrosis with AAA
fever, malaise, regional lymphadenopathy
adjunct therapy for pulpal necrosis with AAA
Systemic antibiotics for 7-10 days, especially in cases of systemic involvement
* Amoxicillin or clindamycin (for penicillin allergy)
* Augment works well too, just expensive!
Analgesic medication (Like tylenol)
Never use a steroid like decadron in cases of acute apical abscess
can you use steroids in AAA?
NO
what is a canal debridement in endo emergencies?
Removes pulp tissue from pulp chamber and coronal 1/3 of canal (if possible)
Access cavity preparation
Gates Glidden drill #3 in canals. Do not force if canal is tight (you will block canal)
Place sterile cotton pellet
Temporary filing
what is a pulpectomy in endo emergencies
Removes pulp tissue from canal
Can use barbed broach in large canals if pulp tissue is intact
what is supportive therapy
Anti-inflammatory drug may be used for cases that need this (Ex: Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis)
NSAIDS; ibuprofen, naproxen, etc.
Steroids: Decadron (do not give if tooth is abscessed) (Ex: don’t use this with cellulitis)
can you use steroids for abscessed tooth
no
