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DEN304 - IODC > Emergency Endodontics > Flashcards

Emergency Endodontics Flashcards

1
Q

Types of endo emergency

A 
Pulpitis
Periapical infection 
Cracked tooth 
Mid and post-treatment flare-ups 
Trauma involving the pulp 
Iatrogenic damage involving the pulp
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2
Q

Pulpitis

A

Reversible

Irreversible

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3
Q

Periapical infection

A

Symptomatic acute apical periodontitis

Acute apical abscess

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4
Q

Pulpitis

A

Inflammation of pulp

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5
Q

Reversible pulpitis signs and symptoms

A

Pain brought on by hot, cold, sweet
Short duration – does not linger for long after removal of
the stimulus
Can be very difficult to localise
The tooth may give an exaggerated response to
sensibility testing
Radiographs are generally of normal appearance (no PA
radiolucency)

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6
Q

Reversible pulpitis treatment

A

Remove causative factor
Consider placing temp
Monitor response

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7
Q

RP - instructions

A

Pain will gradually decrease
Take analgesics as required
Paracetamol 2x500mg up to QDS
Ibuprofen 2x400mg up to TDS
Prescribe co-codamol (2x30/500mg QDS) only if very severe pain
Emphasise the need to complete treatment if required
Return if symptoms become more severe

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8
Q

Irreversible pulpitis - signs and symptoms

A 
Spontaneous pain 
Pain persists for hours 
Pain triggered by heat and in later stages relieved by COLD
Kept awake at night 
Tooth can be TTP but not always 
Pain can radiate
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9
Q

Irreversible pulpitis - treatment time permitting

If possible

A 
LA
Access cavity 
Remove pulp tissue 
Coronal 2/3 opening
Determine WL
Chemo mechanical debridement 
Copious irrigation 
Dry canal
Place CaOH into canal 
Place tight seal

Complete RCT at same appt so after DRYING canal, complete obturation and place bacterial seal

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10
Q

Irreversible pulpitis - time not permitting

A 
LA
Access
Removal of pulp tissue 
Copious irrigation 
Dry pulp chamber
Place sedative dressing e.g odontopaste
Place bacterial tight seal 
Complete RCT in next few days
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11
Q

Irreversible pulpitis - hot pulps

A 
Painful and hard to anaesthetise due to infection 
Regional anaesthesia 
Additional sources of innervation 
Multiple anaesthetics 
IL 
IP 
IO 
Inhalational sedation
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12
Q

Irreversible pulpitis treatment if pain does not permit

A

Remove as much pulp tissue as possible and place sedative
Advise analgesics
not place for antibiotics

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13
Q

Irreversible pulpitis - instructions

A 
Pain will gradually decrease
Take analgesics as required
Paracetamol 2x500mg up to QDS
Ibuprofen 2x400mg up to TDS
Prescribe co-codamol (2x30/500mg QDS) only if very severe
pain
Emphasise the need to complete treatment
Return if symptoms become more severe
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14
Q

Symptomatic apical periodontitis - Signs and symptoms

A

TTP
Tender to palpation especially over apices
Swelling and reddening of mucosa
No responses to vitality testing
Pain can be severe esp in function/pressure
CONSTANT and worsening
Several hours

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15
Q

Symptomatic AP - treatment if time permits

A 
Local anaesthetic
Access cavity
Coronal 2/3 opening
Determine working length
Complete chemo-mechanical debridement
Copious irrigation
Dry the canal
Place CaOH into canal
Place bacteria tight seal
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16
Q

Symptomatic AP - treatment if time does not permit

A 
Local anaesthetic
Access cavity
Coronal 2/3 opening
Copious irrigation
Dry the canal
Place CaOH into canal
Place bacteria tight seal
Complete root canal instrumentation in next few days
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17
Q

Symptomatic AP - instructions

A 
Pain will gradually decrease
Take analgesics as required
Paracetamol 2x500mg up to QDS
Ibuprofen 2x400mg up to TDS
Prescribe co-codamol (2x30/500mg QDS) only if very severe
pain
Emphasise the need to complete treatment
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18
Q

Acute apical abscess - signs and symptoms

A 
Swelling
Severe pain esp on pressure 
Feeling of elevation in socket 
Mobility 
Fever, malaise, lymphadenopathy
19
Q

Acute apical abscess - treatment

A 
Attempt drainage through tooth 
LA
Access
Drain pus via cavity - use diamond bur to reduce vibrations 
If no pus occurs then explore canal 
Copious irrigation 
Dry canal
Place CaOH
Place tight seal 
Complete RCT when patient able
20
Q

Acute apical abscess - treatment when drainage through tooth is inadequate and fluctuant swelling present

A 
LA - spray swelling with EC and place topical 
Incise swelling VERTICALLY 
Aspirate pus
Copious irrigation 
Leave to continue to drain and heal 
Complete RCT when patient is able
21
Q

Are antibiotics required?

A

Only when signs of spreading infection - diffuse swelling/trismus
Systemic involvement
Patient is medically compromised

22
Q

Acute apical abscess - instructions to patient

A

Return to the dentist (or attend A&E) if:
The swelling progresses
Difficulty opening mouth
They start to feel unwell
Any difficulty swallowing/breathing
Return for completion of treatment as soon as possible
following resolution of symptoms

23
Q

Cracked tooth syndrome
Most commonly affects
Signs and symptoms

Fracture line usually

A

2nd premolars and first molars
Pain on chewing, cold sensitivity and hot sensitivity , difficult to localise pain
Mesial –> distal

24
Q

Cracked tooth syndrome - diagnosis

A 
Ask the patient to bite on a cottonwool roll, wood stick, or fracture
detector (tooth slooth)
Pain on release of pressure is the
most reliable aid and most
expressive clinical finding
Visual detection of crack
(fibreoptic, staining)
Radiographs are of little value for
detection
25
Q

Cracked tooth syndrome - treatment

If no pulpitis

If signs of irreversible pulpitis

If fracture line extends below alveolar crest

A

Stabilise tooth with adhesive restoration / partial or full coverage crown

Consider using copper or orthodontic band to stabilise tooth to aid diagnosis/provide immediate relief/protection

Endodontic tx followed by full crown

Extraction

26
Q

Vertical root fractures - features

A

Deep but narrow perio pocket following path of fracture

J-shaped lesion

27
Q

Mid and post treatment flare ups can be caused by

A

Recent restorative treatment

Recent endodontic treatment - mid/post treatment

28
Q

Recent restorative treatment causing flare up - plan - what to assess

A

Risk of symptoms related to depth and amount of tooth structure removed and pulpal condition
Assess symptoms and diagnose
Consider monitoring and recommending analgesics, adjusting occlusion, placing sedative dressing and desensitising agent

29
Q

When do endodontic flare ups occur?

Cause

A

Mid or post tx

Bacterial contamination/change in flora
Poor RD
Unsatisfactory temp 
Inappropriate intracanal medication 
Entry of debris into periodontium 
Missed canals 
Overfill of root filling
30
Q

Mid and post treatment flare-ups - signs and symptoms

A

Similar to acute apical periodontitis
Tender to percussion
Tender to palpation especially over the apices
Swelling and reddening of the surrounding mucosa
Pain can be severe especially in function or
pressure
Can be CONSTANT and worsening
Can be present for several hours

31
Q

Mid and post treatment flare ups - Phoenix abscess

A

When a non-vital tooth flares-up when it has
previously been asymptomatic
Probably due to alteration in the internal environment
of the root canal space during instrumentation
Bacterial flora is altered and causes symptoms

32
Q

Management of mid treatment flare ups - what to assess

A

Assess need to re-open root canal
Provide analgesic advice

Follow procedure and ascertain reason for flare up
Leave CaOH well condensed

33
Q

Advice to patients on Mid treatment flare ups

A

Return if symptoms get worse
Take analgesics as required
Abs not indicated

34
Q

Management of post-treatment flare ups

Is treatment possible?

What to advise patient

A

Often due to bacterial contamination at the apex or
overfill of material
Difficult to treat as the root filling is in situ and often
also the definitive restoration
Usually best to monitor symptoms and reassure patient
that they should resolve with time
Advise appropriate analgesics
There is no indication for antibiotics unless the
previously identified criteria are present

35
Q

Trauma involving pulp can result from

A

Complicated crown fracture

History of trauma and exposed pulp and pain

36
Q

Treatment of pulp-involving trauma

A

Preserve pulp vitality by pulp capping/partial pulpotomy in young people to secure root development

Endodontics for older patients with closed apices

37
Q

Pulp capping indication and process

A 
Injury recent 
LA
Isolate 
Clean 
Disinfect 
CaOH over exposed area
Seal exposed dentine with GIC/composite 
Restore with composite
38
Q

Partial pulpotomy process

A

Local anaesthetic
Isolate with rubber dam
Clean with water, saline or chlorhexidine
Perform pulpotomy to a depth of 2mm with a clean, round
diamond bur under water spray
Place a saline moistened cotton pellet over the pulp until
bleeding has stopped
Apply pulp-capping material (either MTA, biodentine or
calcium hydroxide) over exposed pulp tissue
Seal exposed dentine with GIC or composite
Restore remaining tooth with composite

39
Q

Follow up of pulp trauma

Which treatment is preferred? and why?

If tooth becomes non-vital, what is the treatment indicated?

A

Partial pulpotomy should normally be preferred over
pulp-capping due to slightly better long-term
outcomes
Follow-up
Clinical and radiographic follow-up at 6-8 weeks and 1
year
Prognosis
Depends on extent of initial injury, time before
intervention and stage of root development
If the tooth becomes non-vital, then endodontic
treatment is indicated

40
Q

Iatrogenic damage involving pulp - two types

A

Carious
Non-carious
Affects chance of subsequent tx maintaining vitality

41
Q

Iatrogenic damage involving pulp - non carious exposure

A

Over prepping indirect restoration
Pulp capping
Good prognosis

42
Q

Iatrogenic damage involving pulp - carious exposure

A

Depends on extent of caries
Endo if symptoms of pulpitis exist
Leave affected dentine over pulp and place bacteria tight restoration
Attempt pulp cap or Partial pulpotomy

43
Q

Pulp-cap versus partial pulpotomy

Why is pulp capping more destructive?

A

Partial pulpotomy is preferred in this situation as it
removes the superficially and potentially infected layer
of the pulp
Surrounding dentine is also removed to create a well
defined space for the pulp-capping material to be placed
Follow the procedure a s described previously
It is essential to stop the bleeding from the pulp before
placing the pulp-capping material
If bleeding cannot be stopped, proceed to endodontic
treatment

DEN304 - IODC (58 decks)

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