endo emergency Flashcards
what analgesics to give for pain in emergencies
Ibuprofen 400mg TDS/ QDS
if severe pain, supplement w paracetamol 1000mg (synergistic effect w ibuprofen) and then up the ibuporfen dose to 600mg
if NSAIDs contraindicated:
paracetamol 1000mg
if severe pain, supplement with tramadol 50mg TDS or 2 tabs panadeine
what is mx for localised swelling (acute apical abscess)
1) check for systemic involvement (febrile, enlarged LN) -> give antibiotics
- amox 500mg TDS x 5 days
- metronidazole 400mg TDS x 5 days
- if allergic to penicillin, clindamycin 300mg TDS x 5 days
2) profound anesthesia
3) establish drainage
can be either intraoral or extraoral
intraoral:
- direct through canal by chemo mechanical instrumentation
- gentle finger pressure to overlying mucosa
- if no drainage, penetrate apical foramen with small file up to #25
OR
- I&D: incise over most fluctuant point of swelling down to bone with blade #11
- gentle finger pressure to overlying mucosa
for extraoral:
- after incision, need to dissect &open tissue spaces with small sinus forcep to evacuate compartmentalised areas of pus
- finger pressure and suction to evacuate pus
- copious irrigation w warm saline
- suture in dwelling drain to maintain the drainage
4) analgesics
defn of endodontic flare up
AAE glossary of endo terms 2020
acute exacerbation of asymptomatic pulpal and/or periradicular pathosis, after initiation/ continuation of RCT
what are the factors affecting tissue reactions that might cause flare ups
IRRITANTS WITHIN PULP SYSTEM
1) microbes
- some gram -ve anaerobic bacteria is closely associated with asymptomatic AP or acute apical abscess (eg Pg, Tf)
2) others
- microbial by products
- necrotic pulp tissue
- other noxious substances
IATROGENIC FACTORS
1) instrumentation
- over instrumentation: apical extrusion of infected debri -> PA Inflammation
- under instrumentation: inadequate debridement and hence change in microbiota/ envt condition
2) others
- breach of aseptic technique/leakage leading to secondary intra radicular infection
- misuse of irrigants (NaOCl extrusion)
- hyperocclusion of TD
HOST FACTORS
- if theres preop pain then higher incidence of flare up
- if theres PA lesion then higher incidence of flare up
- sinus tract has lower incidence of flare up
- systemic factors like allergy got higher incidence of flare up
what are some challenges in emergency cases
1) difficulty in diagnosis
2) differentiation between emergency and urgency
3) difficulty in achieving profound anesthesia (may need supplemental injections)
4) anxiety and pain mx
indications for antibiotics in endodontics
1) prophylaxis for IE
2) high risk of systemic infection/ endocarditis
3) signs of recent extension/ progression of infection
- eg pain/ extension of swelling down side of neck
- cellulitis
4) systemic symptoms
- fever, chills
5) unable to establish appropriate drainage
features of craze line
aka enamel infraction
- confined within enamel
- misindentification and confusion with cracked teeth
- no tx needed (usually asymptomatic)
common presentations of split tooth
- crack from occlusal extends apically
- usually mesio distal
- complete separation at middle or apical 1/3 of root
