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24 Endodontics > 10 - Endodontic Emergencies > Flashcards

10 - Endodontic Emergencies Flashcards

1
Q

90% of dental pain is ___ origin

A

pulpo-periradicular

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2
Q

what is the purpose of emergency treatment

A

to provide fast, effective, relief

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3
Q

what are examples of ODONTOGENIC pain

A
  1. pulpal origin
  2. periodontal
  3. pericornitis (but this one is not endo problem)
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4
Q

what are examples of non-odontogenic origin?

A
  1. TMJ
  2. sinus
  3. cardiac
  4. neurologic
  5. psychogenic
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5
Q

how to diagnose a hot tooth? (4 questions)

A
  1. which tooth
  2. pulpal or periapical? can be both.
  3. is condition reversible or irreversible?
  4. always attempt to reproduce patient symptoms
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6
Q

where is pain coming from in endo emergencies?

A

pulp, periradicular tissues, or both?

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7
Q

what is experienced in pain from PULP ONLY?

A
  1. spontaneous pain/ pain to hot and cold
  2. pain often not localized
  3. try to reproduce patient symptoms cold/hot/air
  4. not percussion tender (since no PDL)
  5. no radiographic signs
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8
Q

periradicular pain will manifest itself by what?

A

sensitivity to chewing, precussion, and palpation

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9
Q

what are symptoms of IRREVERSIBLE condition

A

cold test has prolonged pain for several seconds

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10
Q

what are symptoms of REVERSIBLE condition

A

pain from cold test, but it goes away

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11
Q

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

A

reversible pulpitis

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12
Q

treatment for reversible pulpitis

A

identify and eliminate cause (e.g., excavate caries, place sedative filling, adjust occlusion, etc.)

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13
Q

what are painful kinds of pulpal/periradicular pathology?

A

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

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14
Q

what is it:

Pain is spontaneous
When stimulated pain will linger on
Pain is often diffuse and difficult to localize
Cannot see on radiographs

A

symptomatic irreversible pulpitis

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15
Q

how to treat posterior teeth symptomatic irreversible pulpitis in emergency?

A

Canal debridement
Ca(OH)2
Cotton
Place temporary Filling (not Cavit)

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16
Q

how to treat anterior teeth w/ syptomatic irreversibly pulpitis in emergency

A

Canal debridement
If pulp is well organized, can do a pulpectomy with a barbed broach
Ca(OH)2
Cotton
Place a temporary Filling

17
Q

why do we place cotton in emergency treatment?

A

so you have access to it again if you run out of time and need to access another day

18
Q

what is this:

Same as symptomatic irreversible pulpitis but is also sensitive to percussion (Due to PDL being involved)

A

symptomatic irreversible pulpitis w/ symptomatic apical periodontitis

19
Q

how to treat SIPSAP

A

Canal debridement
Ca(OH)2
Temporary fill
Adjust occlusion (Could use supportive therapy too)

20
Q

In SIPSAP, when does temp sensitivity resolve? chewing sensitivity?

A

Temp sensitivity resolves immediately but sensitivity to chewing may persist 2-3 days

21
Q

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)

A

partial necrosis

22
Q

how to treat pulpal necrosis

A

Canal debridement
Irrigate NaOCl
Ca(OH)2
Cotton
Temporary Filling

23
Q

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

A

pulpal necrosis w/ symptomatic apical periodontitis

24
Q

how to treat pulpal necrosis w/ symptomatic apical periodontitis?

A

Canal debridement
Irrigate with NaOCI
Ca(OH)2
Cotton
Place temporary fill (like GI)

25
Q

how does pulpal necrosis w/ symptomatic apical periodontitis pain last after tx?

A

pain may persist for 2 or 3 days, requires supportive therapy

26
Q

what is this:

No response to cold or EPT
Spontaneous and percussion/palpation pain
SWELLING

A

pulpal necrosis w/ acute apical abscess

27
Q

how to treat ABSCESS in tooth w/ pulpal necrosis w/ AAA

A

establish drainage
through tooth
incision and drainage

28
Q

how to treat TOOTH w/ pulpal necrosis with AAA

A

clean and irrigate canal
Ca(OH)2
cotton
temporary fill

29
Q

how can you tell if pulpal necrosis w/ AAA is endo or perio?

A

Swelling with vital pulp indicates abscess of periodontal origin (no rct indicated)
Look for presence of calculus
Usually periodontal disease is more generalized

30
Q

signs and symptoms of PN w/ AAA

A

Swelling
Spontaneous pain
Pain to percussion/palpation
No response to vitality tests
X-ray varies from wide PDL to large (phoenix abscess, recrudescent

31
Q

if xray shows a PHOENIX ABSCESS, what is it

A

pulpal necrosis with AAA

32
Q

where does swelling from AAA appear?

A

localized usually in buccal vestibule
diffuse and invade facial spaces(cellulitis)

33
Q

what are systemic symptoms for pulpal necrosis with AAA

A

fever, malaise, regional lymphadenopathy

34
Q

adjunct therapy for pulpal necrosis with AAA

A

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

35
Q

can you use steroids in AAA?

A

NO

36
Q

what is a canal debridement in endo emergencies?

A

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

37
Q

what is a pulpectomy in endo emergencies

A

Removes pulp tissue from canal
Can use barbed broach in large canals if pulp tissue is intact

38
Q

what is supportive therapy

A

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)

39
Q

can you use steroids for abscessed tooth

A

no

24 Endodontics (2 decks)

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