Emergency Endodontics Flashcards
Types of endo emergency
Pulpitis Periapical infection Cracked tooth Mid and post-treatment flare-ups Trauma involving the pulp Iatrogenic damage involving the pulp
Pulpitis
Reversible
Irreversible
Periapical infection
Symptomatic acute apical periodontitis
Acute apical abscess
Pulpitis
Inflammation of pulp
Reversible pulpitis signs and symptoms
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)
Reversible pulpitis treatment
Remove causative factor
Consider placing temp
Monitor response
RP - instructions
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
Irreversible pulpitis - signs and symptoms
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
Irreversible pulpitis - treatment time permitting
If possible
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
Irreversible pulpitis - time not permitting
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
Irreversible pulpitis - hot pulps
Painful and hard to anaesthetise due to infection Regional anaesthesia Additional sources of innervation Multiple anaesthetics IL IP IO Inhalational sedation
Irreversible pulpitis treatment if pain does not permit
Remove as much pulp tissue as possible and place sedative
Advise analgesics
not place for antibiotics
Irreversible pulpitis - instructions
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
Symptomatic apical periodontitis - Signs and symptoms
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
Symptomatic AP - treatment if time permits
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
Symptomatic AP - treatment if time does not permit
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
Symptomatic AP - instructions
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
Acute apical abscess - signs and symptoms
Swelling Severe pain esp on pressure Feeling of elevation in socket Mobility Fever, malaise, lymphadenopathy
Acute apical abscess - treatment
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
Acute apical abscess - treatment when drainage through tooth is inadequate and fluctuant swelling present
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
Are antibiotics required?
Only when signs of spreading infection - diffuse swelling/trismus
Systemic involvement
Patient is medically compromised
Acute apical abscess - instructions to patient
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
Cracked tooth syndrome
Most commonly affects
Signs and symptoms
Fracture line usually
2nd premolars and first molars
Pain on chewing, cold sensitivity and hot sensitivity , difficult to localise pain
Mesial –> distal
Cracked tooth syndrome - diagnosis
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
