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5th - APD > Emergency Endo > Flashcards

Emergency Endo Flashcards

1
Q

When may emergency endo need to be carried out?

A 
Pulpitis
Periapical infection
Cracked tooth 
Trauma involving pulp
Iatrogenic damage of pulp
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2
Q

Symptoms of reversible pulpitis?

A

Pain - hot, cold, sweet
Pain doesn’t linger
Not spontaneous

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3
Q

How do special tests of reversible pulpits respond?

A

Exaggerated response sensibility

PA normal

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4
Q

Tx reversible pulpitis?

A

Remove causative factor
Temporary restoration
Montior

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5
Q

What advice give pt w/ reversible pulpitis?

A

Pain should decrease
Analgesia as required
Return symptoms severe

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6
Q

What analgesia advcie?

A

2 x 500mg paracetamol QDS

2 x 400mg ibuprofen TDS

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7
Q

Symptoms for irreversible pulpitis?

A

Spontaneous pain
Pain lingers
Keep aware at night
Radiating pain

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8
Q

Tx irreverisble pulpitis?

A

Extipation

Completion RCT

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9
Q

How extipate a tooth?

A

Access –> remove pulp tissue –> irrigation –> dry –> sedative dressing

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10
Q

Examples sedative dressing?

A

Ledermix

Odontopaste

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11
Q

What hot pulp?

A

Tooth w/ pulpitis which is very painful and difficult to anaesthesie

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12
Q

How tx teeth w/ hot pulps

A 
Consider regional anaesthesia
Additional source innervation 
Multiple anaesthetic - lido + articaine 
Infra-ligamentary 
Intra-pulpal
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13
Q

What need intra-ligamentatry?

A

Need shorter needle and cartridge - protect cartrdige shattering under high pressure

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14
Q

What is intra-osseous anaestehsia?

A

Drill bone so can inject anaestheisa into medullary bone - profound but wear off quickly as area vascular

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15
Q

What to do if can’t gain anaesthesia?

A

Remove much pulp tissue as poss and place sedative dressing
Advise analgesia
NO PLACE FOR AB IN PULPITIS

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16
Q

Symptoms acute apical periodontitis?

A

Extreme pain from PA infection = TTP, tender palpation, swelling and redness mucosa

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17
Q

What see acute apical abscess?

A 
Swelling
Severe pain on pressure
Tooth feel elevated 
Mobility
Systemic features
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18
Q

How tx a tooth w/ acute apical abscess?

A

Access cavity to drain pus - if no pus explore canal to encourage pus discharge

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19
Q

What to do if suspect acute apical abscess but no drainage occur and swelling still present?

A

Drain swelling - leave drain

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20
Q

Should ab be given for apical abscess?

A

Sign spreading infection - diffuse swelling, trismus

Sign systemic involvement

21
Q

Instruction pt w/ apical abscess?

A

Pt A&E if diff opening mouth, unwell, diff swallow or breathing

22
Q

How temporise tooth?

A

Calcium hydroxide paste
Sponge pellet
Intermediate filling - IRM/GIC

23
Q

Symptoms cracked tooth?

A

Pain on chewing
Sensitivity hot and cold
Pain difficult to locate
See fracture line

24
Q

How dx cracked tooth?

A

Ask pt bite cotton wool roll/ tooth sloot - pain on release of pressure most reliable aid

25
Q

Are radiograph useful in cracked tooth?

A

No

26
Q

How tx cracked tooth?

A

Rule out pulpitis
If no pulpitis stabilise tooth w/ adhesive restoration/ crown
If irreverisible RCT followed crown

27
Q

How provide temporary tx of cracked tooth?

A

Orthodontic band

28
Q

When would cracked tooth be unrestorable?

A

Fracture line extend below alevolar crest

29
Q

How detect vertical root fracture?

A

Deep periodontal pocket following fracture

J shaped lesion radiograph

30
Q

What assess if have endo flare up mid/post tx?

A

Is it a recent restoration

Is it recent endodontics

31
Q

What assess if suspect pain from recent restoration?

A

Measure depth and amount tooth structure removed
Symptoms - what is diagnosis
Restoration: leakage, occlusion

32
Q

Tx of pain from recent restoration?

A

Monitor and analgesia
Adjust occlusion
Place sedative dressing

33
Q

Why get endo pain mid or post tx?

A

Usually due bacterial contamination

34
Q

What phoenix abscess?

A

Non-vital tooth flares up when previously been asymptomatic

35
Q

Manage mid-tx flare ups?

A

Can re-open: follow conventional procedure

36
Q

Advice to pt who has mid-tx flare up?

A

Return if symptoms get worse
Sympotms unlikely effect outcome endo proceudre
Analgesia
No ab

37
Q

Management post-endo pain?

A

Challenging
Often due bacterial contamination
Best monitor prior XLA/re-tx

38
Q

How tx trauma involving pulp?

A

Depends if open or closed apex

39
Q

How tx complicated root fracture in open apex?

A

Presever vitality w/ pulp cap/ partial pulpotomy

40
Q

When should pulp cap be attempted?

A

Small injury which is recent - smaller risk contaminastion

41
Q

How provide pulp cap?

A

LA –> dam –> clean w/ NaOCl –> apply pulp cap –> seal exposed dentien and restore

42
Q

Material for pulp cap?

A

Calcium hydroxide

Biodentine/MTA

43
Q

How provide partial pulptomy?

A

Remove pulp depth 2mm w/ round diamond
Place saline pellet to stop bleeding
Apply pulp cap material
Seal

44
Q

How can iatrogenic damage of pulp be divided?

A

Non-carious exposure

Carious exposure

45
Q

Manage non-carious pulp exposure?

A

Pulp-cap placed

46
Q

Manage carious exposure?

A

Depends size and pt symptoms

If exposure has soft caries/ pt symptoms pulpitis - endo

47
Q

Why is partial pulptomy preferred?

A

Remove superfical and potentially infected layer of pulp

48
Q

What must do prior placing pulp-cap material?

A

Stop bleeding

5th - APD (8 decks)

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