Endodontics
Course Review
Enoch Ng, DDS 2014
Endo Emergencies
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85% of patients requesting emergency dental pain have pulpal or apical disease – require endo
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Pain and/or swelling, disrupts daily activities, not relieved by analgesics
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Acute – few hours/days duration
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Requires immediate diagnosis and treatment
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Microbial, mechanical, chemical irritant that damages pulpal/apical tissues causing inflammation or cell death
Caries, deep/defective restorations, trauma
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Increased tissue pressure in low compliance environment (dental pulp)
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Chemical mediators of inflammation – vasoactive amines, arachidonic acid, acid metabolites, cytokines
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Can occur before (pre-treatment), during (interappointment/flare up), or after (post-obturation) NSRCT
Recognizing Emergencies
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True emergency – needs unscheduled office visit for immediate diagnosis and treatment, cannot be postponed
because of severity
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Questions to Ask
Disturbs sleep, eating, working, concentrating on daily activities
Face/gums look/feel swollen
Difficulty swallowing
Length of time problem has bothered patient
Intake of pain medication and its effectiveness
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Clinical Presentations
Asymptomatic or Symptomatic irreversible pulpitis with normal apical tissues
Symptomatic irreversible pulpitis with symptomatic apical periodontitis
Necrotic/previously treated pulp with symptomatic acute periodontitis
Necrotic/previously treated pulp with acute apical abscess (vestibular/facial swelling)
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Critical urgency – visit can be rescheduled for mutual convenience of patient and dentist
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Symptomatic irreversible pulpitis (with or without apical diagnosis) that can be managed with analgesics
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Necrotic/previously treated pulp with mild symptomatic apical periodontitis
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Necrotic pulp with chronic apical abscess
Treatment Goals
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Obtain accurate diagnosis
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Physical condition
Facial swelling, lymphadenopathy, fever, malaise, difficulty breathing
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Medical/dental history
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Subjective exam
Spontaneity, intensity, duration of pain
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Objective exam
Pulpal and apical assessment
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Goals of treatment
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Eliminate bacteria, reduce concentration of inflammatory mediators (NSRCT or extraction)
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Release pressure of exudate/swelling via incision/drainage
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Rules for treating emergencies
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Never begin treatment until diagnosis is certain
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Better to provide no treatment than the wrong treatment
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When in doubt, refer case for further evaluation
