Emergency Endo Flashcards
When may emergency endo need to be carried out?
Pulpitis Periapical infection Cracked tooth Trauma involving pulp Iatrogenic damage of pulp
Symptoms of reversible pulpitis?
Pain - hot, cold, sweet
Pain doesn’t linger
Not spontaneous
How do special tests of reversible pulpits respond?
Exaggerated response sensibility
PA normal
Tx reversible pulpitis?
Remove causative factor
Temporary restoration
Montior
What advice give pt w/ reversible pulpitis?
Pain should decrease
Analgesia as required
Return symptoms severe
What analgesia advcie?
2 x 500mg paracetamol QDS
2 x 400mg ibuprofen TDS
Symptoms for irreversible pulpitis?
Spontaneous pain
Pain lingers
Keep aware at night
Radiating pain
Tx irreverisble pulpitis?
Extipation
Completion RCT
How extipate a tooth?
Access –> remove pulp tissue –> irrigation –> dry –> sedative dressing
Examples sedative dressing?
Ledermix
Odontopaste
What hot pulp?
Tooth w/ pulpitis which is very painful and difficult to anaesthesie
How tx teeth w/ hot pulps
Consider regional anaesthesia Additional source innervation Multiple anaesthetic - lido + articaine Infra-ligamentary Intra-pulpal
What need intra-ligamentatry?
Need shorter needle and cartridge - protect cartrdige shattering under high pressure
What is intra-osseous anaestehsia?
Drill bone so can inject anaestheisa into medullary bone - profound but wear off quickly as area vascular
What to do if can’t gain anaesthesia?
Remove much pulp tissue as poss and place sedative dressing
Advise analgesia
NO PLACE FOR AB IN PULPITIS
Symptoms acute apical periodontitis?
Extreme pain from PA infection = TTP, tender palpation, swelling and redness mucosa
What see acute apical abscess?
Swelling Severe pain on pressure Tooth feel elevated Mobility Systemic features
How tx a tooth w/ acute apical abscess?
Access cavity to drain pus - if no pus explore canal to encourage pus discharge
What to do if suspect acute apical abscess but no drainage occur and swelling still present?
Drain swelling - leave drain
Should ab be given for apical abscess?
Sign spreading infection - diffuse swelling, trismus
Sign systemic involvement
Instruction pt w/ apical abscess?
Pt A&E if diff opening mouth, unwell, diff swallow or breathing
How temporise tooth?
Calcium hydroxide paste
Sponge pellet
Intermediate filling - IRM/GIC
Symptoms cracked tooth?
Pain on chewing
Sensitivity hot and cold
Pain difficult to locate
See fracture line
How dx cracked tooth?
Ask pt bite cotton wool roll/ tooth sloot - pain on release of pressure most reliable aid
Are radiograph useful in cracked tooth?
No
How tx cracked tooth?
Rule out pulpitis
If no pulpitis stabilise tooth w/ adhesive restoration/ crown
If irreverisible RCT followed crown
How provide temporary tx of cracked tooth?
Orthodontic band
When would cracked tooth be unrestorable?
Fracture line extend below alevolar crest
How detect vertical root fracture?
Deep periodontal pocket following fracture
J shaped lesion radiograph
What assess if have endo flare up mid/post tx?
Is it a recent restoration
Is it recent endodontics
What assess if suspect pain from recent restoration?
Measure depth and amount tooth structure removed
Symptoms - what is diagnosis
Restoration: leakage, occlusion
Tx of pain from recent restoration?
Monitor and analgesia
Adjust occlusion
Place sedative dressing
Why get endo pain mid or post tx?
Usually due bacterial contamination
What phoenix abscess?
Non-vital tooth flares up when previously been asymptomatic
Manage mid-tx flare ups?
Can re-open: follow conventional procedure
Advice to pt who has mid-tx flare up?
Return if symptoms get worse
Sympotms unlikely effect outcome endo proceudre
Analgesia
No ab
Management post-endo pain?
Challenging
Often due bacterial contamination
Best monitor prior XLA/re-tx
How tx trauma involving pulp?
Depends if open or closed apex
How tx complicated root fracture in open apex?
Presever vitality w/ pulp cap/ partial pulpotomy
When should pulp cap be attempted?
Small injury which is recent - smaller risk contaminastion
How provide pulp cap?
LA –> dam –> clean w/ NaOCl –> apply pulp cap –> seal exposed dentien and restore
Material for pulp cap?
Calcium hydroxide
Biodentine/MTA
How provide partial pulptomy?
Remove pulp depth 2mm w/ round diamond
Place saline pellet to stop bleeding
Apply pulp cap material
Seal
How can iatrogenic damage of pulp be divided?
Non-carious exposure
Carious exposure
Manage non-carious pulp exposure?
Pulp-cap placed
Manage carious exposure?
Depends size and pt symptoms
If exposure has soft caries/ pt symptoms pulpitis - endo
Why is partial pulptomy preferred?
Remove superfical and potentially infected layer of pulp
What must do prior placing pulp-cap material?
Stop bleeding
