EMERGENCY ENDODONTICS Flashcards
endodontic emergency
- pulpitis (reversible and irreversible)
- periapical infection
- cracked tooth
- mid and post treatment flare ups
- trauma involving the pulp
- iatrogenic damage involving the pulp
what is pulpitis
inflammation of the pulp
reversible pulpits symptoms
- pain brought on by hot cold or sweet
- short duration – does not linger for long after removal of the stimulus
- can be difficult to localise
- tooth may give an exaggerate response to sensibility testing
- radiographs generally normal appearance (no PA radiolucency)
tx for reversible pulpitis
- removal of the causal factor eg caries, failed restoration etc
- consider placing a temp restoration such as Zn-Ox/eug (sedative dressing)
- monitor response to treatment
can place biodentine near the pulp, helpful to use in restorations
irreversible pulpitis
- spontaneous pain
- pain persists (hours)
- pain triggered by heat and in the later stages relieved by cold
- kept awake at night
- tooth can be TTP, but not always
- pain can radiate
tx of irreversible pulptis
ideally finish RCT in one session
pulp usually non infective at this point so little bacterial invasion therefore the pulp is almost sterile
how to anaesthetise hot pulp
regional anaesthesia consider additional sources of innervation mulitple anaesthetics intraligamentary anaesthesia intra osseous anaesthesia
periapical periodontitis (symptomatic)
TTP tender to palpation swelling and reddening musosa no repsonces to vitality testing pain can be severe esp in pressure or function can be constant or worsening can present for several hours
tx of periapical periodontitis
RCT
but dont do in one go as canal is not sterile
- will have contamination as the pulp is non vital
abcess
collection of pus
acute apical abcess symptoms
swelling severe pain esp on pressure feeling of tooth elevated in socket mobility may be present pt may experience fever, malaise and lymphadenopahy
tx of acute apical abcess
LA
access cavity to drain
- dont do open drainage as debris will get stuck and infeciton will be worse to treat
when to use antibiotics
abcess with
- signs of spreading infection (diffuse swelling, trismus)
- signs of systemic involvement (fever, malaise, lymphadenopathy)
- certain patients who are severely medically compromise
causes of cracked tooth syndrome
- masticatory incidents
- bruxism
- thermal cycling
symptoms and diagnosis of cracked tooth syndrome
- pain on chewing
- sensitivity to cold and hot fluids
- pain difficult to locate
- fracture usually from mesial to distal
- pain on release on pressure
visial dectection of crack
tx of cracked tooth syndrome
no signs of pulpitis
- stablise tooth with ahdesive restortation or crown
- band
irreversible pulpitis
- endo tx and crown
fracture line below alveolar crest
- extraction
vertical root fracture
Deep but narrow periodontal picket which follows the path of the root fracture
- the fracture may be clinically visible but often hidden under a restoration and the gingivae (probe may drop into it) – could also be a perio endo lesion so look at SS and radiographs
- look for J shaped lesion on radiograph
why may you get mid/post tx flare ups
bacterial contamination/change in bacterial flora
phoenix abcess
When a non vital tooth flares up when it has been previously asymptomatic
- may be due to alteration in the internal environment of the root canal space during instrumentation
- bacteria flora is altered and causes symptoms
tx for pulp problems in young patietns
- important to preserve pulp capping or partial pulpotomy in order to secure further root development
pulp capping- MTA biodentine or CaOH, seal with GIC or composite
partial pulpotomy vs pulp capping
pp better as removed the superficual and potential infected layer of pulp
surrounding dentine also removed to create a well defined space for pulp capping material to be placed
mg of non carious pulp exposrie
pulp capping
clean exposure
signs and symptoms of mid/post flare up of endo tx
- similar to acute apical periodontitis
- TTP
- TTP over apices
- swelling and reddening of mucosa
- pain severe in function or pressure
- can be constant or worsening
- can be present for several hours
