Managment of Endo Pain

Question 1

What is an endodontic emergency?

Answer 1

Pain or swelling caused by inflammation/ infection of the pulpal/ periapical tissues.

Question 2

What are the 2 common causes of endodontic emergencies?

Answer 2

• Caries
• Deep/ defective restorations.

Question 3

What is the indicated dose of ibuprofen for pain? (+ maximum dose).

Answer 3

2 x 200mg tablets up to 4 times a day
- MAXIMUM DOSE 2.4g.

Question 4

What is the indicated dose of paracetamol for pain? (+ maximum dose).

Answer 4

2 x500mg tablets up to 4 times daily.
- MAXIMUM DOSE 4g.

Question 5

What are the 3 antibiotics indicated for the treatment of dental infection?

Answer 5

Amoxicillin, metronidazole, phenomethylpenicillin.

Question 6

Dose of amoxicillin for dental infection

Answer 6

1 x 500mg capsules 3 times daily.

Question 7

Dose of metronidazole for dental infection

Answer 7

1 x 400mg tablet 3 times daily.

Question 8

Dose of phenoxymethylpenicillin for dental infection.

Answer 8

2 x 250mg tablets 4 times daily.

Question 9

What is dentine hypersensitivity

Answer 9

• EXAGERRATED RESPONSE to application of stimulus to dentine, cannot be ascribed to any other defect or pathology.

Question 10

What are stimuli of dentine hypersensitivity

Answer 10

Cold, air, hypertonic solution

Question 11

What nerves are activated during dentine hypersensitivity and how (physiological process).

Answer 11

• SHORT, SHARP pain.
• Rapid fluid flow in dentinal tubules  HYDRODYNAMIC ACTIVATION OF ALPHA DELTA FIBERS.

Question 12

What is the treatment for dentine hypersensitivity?

Answer 12

DESENSITIZING AGENTS.
- Disturb the transmission of nerve impulses. (potassium nitrate)
- Block dentinal tubules (FLUORIDES, OXALATES, VARNISHES, ADHESIVE SYSTEMS, BIOGLASS, CASEIN-PHOSPHOPEPTIDE, LAZER)

Question 13

What is used to disturb the transmission of nerve impulses for dentine hypersensitivity?

Answer 13

Potassium nitrate.

Question 14

What is felt during reversible pulpitis? Stimuli?

Answer 14

• Sharp pain that lasts a few seconds.
• Stimuli: cold, sweet, sour, salty.

Question 15

What causes reversible pulpitis (4):

Answer 15

• Caries into dentine.
• Worn/ broken down teeth.
• Defective restoration.
• Recent dental treatment.

Question 16

Is reversible pulpitis a dental emergency?

Answer 16

NO

Question 17

Treatment of reversible pulpitis?

Answer 17

• Caries removal + restoration/ dressing to cover dentine.
• Review periodically via SENSITIVITY testing (may heal BUT may not heal develop irreversible pulpitis and become necrotic).

Question 18

What is irreversible pulpitis?

Answer 18

Inflammation of the pulp continues (from reversible), leading to SEVERE inflammation that will NOT resolve even if cause is removed. Pulp will slowly or quickly become necrotic.

Question 19

Irreversible pulpitis symptoms?

Answer 19

Can be asymptomatic or more often SYMPTOMATIC

Question 20

What are the symptoms felt during irreversible pulpitis (4)?

Answer 20

• Spontaneous/ intermittent pain.
• Pain that lasts for minutes or hours.
• Triggered by cold/hot (extreme temp).
• Difficult to localize early on.

Question 21

What is the typical treatment for irreversible pulpitis? (3)

Answer 21

• Remove cause of infection + RCT.
• If emergency carry out PULPOTOMY.
• Extraction

Question 22

What is the interapointment dressing after the 1st stage of RCT (cleaning and shaping)

Answer 22

Non setting calcium hydroxide

Question 23

What is the dressing for emergency pulpotomy?

Answer 23

Ledermix or Odontopaste

Question 24

Symptoms of advanced symptomatic pulpitis (5)?

Answer 24

• Excruciating acute pain.
• Momentarily relieved by cold.
• Often TTP as inflammation has extended periapicaly.
• Reacts violently to heat.
• Radiograph will show thickening of PDL.

Question 25

when is emergency pulpotomy indicated?

Answer 25

• Done when insufficient time to completely prepare canal  Apical remnants of inflamed pulp can be acutely painful when RCT is continued.

Question 26

Same steps as normal pulpotomy BUT

Answer 26

• Seal with odontopaste/ leddermix.
• Apply Coltosol.
• Temporary GIC dressing.

Question 27

In which patients are leddermix and odontopaste contraindicated?

Answer 27

• Pregnant women/ nursing women.
• Clindamicyn allergy.

Question 28

Do we prescribe antibiotics for acute symptomatic pulpitis?

Answer 28

NO AS THIS IS INFLAMMATION AND NOT INFECTION

Question 29

What are 2 causes of symptomatic periapical periodontitis?

Answer 29

• Bacteria/ toxins from INFECTED + NECROTIC PULP  inflammatory response in the periapical tissues, leading to BONE RESORPTION.
• OVERINSTRUMENTATION during RCT that pushes debris beyond the apex.

Question 30

What are 2 symptoms of symptomatic periapical periodontitis?

Answer 30

• Pain on biting.
• Radiolucent area around the apex.

Question 31

3 causes of tissue swelling?

Answer 31

• Acute periapical abscess.
• Inter appointment flare-up.
• Post-endodontic complication.