Management of Endo Emergencies Flashcards
use of pulpotomy
immature tooth more
- want to have apexogenesis
used in sympotomatic irreversible pulpitits as emergency treatment
hyperplastic pulpitis aka
pulp polyp
describe pulp necrosis
may still have pain due to the C fibers response
- even though not responding to the cold
due to caries, trauma, perio disease
circumfrenterial spread of inflammation
can follow reversible pulpitis if etiology is not removed
peri-apical status will dictate treatment (in regards to emergency treatment)
emergency treatment likely depends upon?
the peri-apical / peri-radicular diagnosis of the tooth
symptomatic peri-radicular periodontitis
inflammation in the pulp has extended through the apical foramen into the pero-radicular area
EXCLUDES the occlusal trauma and periodontal abscess
can you do pulpotomomy with apical symptoms?
NO - so it is contra-indicated in symptomatic peri-radicular periodontitist
intra-cranial medicament usually
calcium hydroxide
secondary acute peri-radicular eriodontitis
main causes?
secondary to the RCT
- overextension of endodontic instruments into peri-apical area
- extrusion of fluids, tissue, bacteria (bacterial products) into peri-apical area
secondary acute peri-radicular eriodontitis presents?
likely history of RCT 1-2 days prior to therapy
spontaneous or continous pain
pain to chewing, percussion, palpation,
‘feels like tooth is higher than the adjacent teeth’
’ feels like pressure is building up in my jaw
- is there a swelling?
secondary acute peri-radicular eriodontitis emergency treatment?
- occlusal adjustemnt
- investigate presence of additional canals
- intra-canal corticosteroid paste
- seal the access cavity again
- trephination of buccal cortical plate
symptomatic peri-radicular periodontitis is presentation of
one presentation of chronic peri-radicular periodontitis with developing symptoms
- spontaneous pain
- pain to chewing/ brushing
describe acute peri-radicular abscess as it presents and associated with?
advanced acute periradicular periodontitis
decreased host resistance
increased virulence of bacteria
a “true” infection
pain present with acute peri-radicular abscess ? what do you need to consider
maybe – pain fibers located in the periosteum
look at the dental history
- history of pain?
acute peri-radicular abscess systemic symptoms
fever/ lymphadenopathy/ sweating/ chills. GI disturbance
patient can feel and look sick
acute peri-radicular abscess emergency treatemnt
management of odontogenic infections
which one is a true infection
acute peri-radicular abscess
management of odontogenic infections breaks down into?
Patient health
anatomical features
microbial factors
with infection in the middle
- diagram with all these surrounding / influencing the infection
spread of odontogenic infection
through path of least resistance
- anatomic position in relation to the B and L cortical plates
relationship of apex of tooth to closest muscle attachment
incision and drainage is what type of treatment?
surgical phase
what does IAD do?
- decrease number of bacteria
- reduces tissue pressure
- alleviates pain
- improves circulation in area - prevents spread of infection
- alters oxidation - reduction potential in tissue
- accelerates healing and prevents spread of infection
avoid what in IAD
‘needle-track’ infections
anesthesia in IAD?
use regional blocks or infiltration
decontamination uses what in IAD?
betadine scrub
describe incision in IAD?
incision of HEALTHY TISSUE
- most dependent area
- subperiosteal
- 1/2 - 3/4 in lneght
’ rule of index finger’
describe blunt dissection
part of IAD
- curved hemostat
- insert closed with beaks unblocked
- open beaks to separate tissues
- extend into adjacent spaces
describe insertion of drain?
use sterile penrose tubing
suture to healthy tissue
allow to remain in place for 2-7 days
when can you do endodontic therapy with IAD?
at time of surgical phase
- while the drain is in place
removal of drain
24 hours after cleansing and shaping of root canal system
after resolution of infection
employ antibiotic therapy when?
in a compromised host resistance
there has been systemic involvment
fascial space involvment
inadequate surgical drainage
guidelines for antibiotic therapy
- select an antibiotic with an ANEROBIC SPECTRUM
- use larger doses for shorter periods of time
- collect specimens prior to intiation of antibiotics
- if available - utalize gram stain results to select intital antibiotic
if no gram stain or culture and sensitivity results available what antibiotic should you use?
enicillin is antibiotic of choice
- acts on gram + and - and anerobic cocci
describe penicillin use
first choice
spectrum is gram+/- aerobic cocci and most anaerobic rods
dosage
- 1-2 gram loading dose
- 500 mg every 6 hours for 5-7 days
prescribe clindamycin when?
allergic to penicillin or when it has been 48 hours and pt. does not respond to the penicillin tx
spectra and dosage of clindamycin
specrta
- gram - anaerobic rods
gram + aerobic streptococci
dosage
- 600 mg loading dose
150-300 mg every 6 hours for 5-7 days
clindamycin can increase risk of? associated with which risk?
pseudomembranous colitis
pseudomembranous colitis
overgrowth of C.diff – which is gram + spore forming anaerobic rod
growth is inhibited by lactobacillus, porphyromonas, peptostreptococcus
approx. 5% of healthy aduts carry C. diff in their intestines
20% of adults in hospitals are C. diff asymptomatic carriers
pt’s more at risk for pseudomembranous colitis
elderly, inpatient in hospital, immunosuppressed
pseudomembranous colitis most associated with which drug
- cephalosporin
- ampicillin
- clindamycin
c. difficile produces?
Toxin a - entertoxin
toxin b- cytotoxin
out-patient vs in-patient use of antibiotics results in pseudomembranous colitis
outpatient –> 1 in 3 of 100,000
IN PATIENT AT HIGHER RISK
in patient –> 1-10 of 1,000 inpatient
3 forms of pseudomembranous colitis
- antibiotic associated diarrhea without colitis
- not caused by overgrowth of C. diff - antibiotic associated without pseudomembrane formation
- so get no produciton of toxins - antibiotic associated collitis with produciton of pseudomembranes
antibiotic therapy can interfere with which drugs?
oral contraceptives
metronidazole use?
indications/ spectrum
- all anaerobic gram - rods
- anerobic gram + cocci
if after a day and a half we can switch to this and add this to the regime instead of giving clindamycin
dosage
- 500 mg every 6 hours for 5-7 days
NSAID analgesics
is use PRN?
ibuprofen (motrin)
- one tablet one hour pre-operative
- one tablet every 6 hours
NOT PRN
use of applied heat?
intra-oral warm rinses
reversible pulpitis emergency treatment
occlusal adjustment
or if faulty restoratino
- remove and replace with temporay
- zinc oxide eugenol based restoration
emergency treatment for symptomatic irreversible pulpitis
pulpotomy - when can (immature tooth and open apex) - apexogensis
or pulpectomy
USE NSAIDS
internal resoprtion falls under what category
asymptomatic irreversible pulpitis
hyperplastic pulpitis associated with
pulp poly
- asymptomatic irreversible pulpitis
