An insight into Endodontic Emergencies

1. MANAGEMENT OF ENDODONTIC EMERGENCIES

2. An Endodontic emergency is defined as an
“An unscheduled visit associated with pain or swelling ensuring from
pulpoperiapical pathosis requiring immediate diagnosis and treatment”.
DEFINITON

4. • MANAGEMENT OF ENDODONTIC EMERGENCIES CAN BE DIVIDED INTO
FOLLOWING STEPS
MANAGEMENT
PROPER
ATTITUDE
ACCURATE
DIAGNOSIS
PROFOUND
ANESTHESIA
EFFECTIVE
TREATMENT

5. HISTORY
• Dental and medical history
• Patient should be asked about the nature of pain
-where?
-when?
-Describe
-Under any circumstance?
-Relieving factors?
-Previous dental history?

6. REVERSIBLE PULPITIS
• PULP- exposed to irritant
-Reversible
CAUSES:
GINGIVAL RECESSION
EXPOSED CERVICAL DENTIN
DEFECTIVE
RESTORATION
EXPOSED DENTIN

7. TREATMENT OPTIONS: Prevention
INDIRECT PULP CAPPING Reduce the high points
DESENSITIZING
TOOTHPASTE
DIAGNOSIS
1)Pain
2)Visual examination and history
3)Radiographs
4)Percussion test
5)Vitality test

8. IRREVERSIBLE PULPITIS
The pulp has been irreversibly damaged beyond repair
SIGNS: PATIENT HISTORY REVEALS
SPONTANEOUS PAIN LASTS FOR HOURS
WORSEN AT NIGHT
AGGRAVATED BY HOT
&RELIEVED BY COLD STIMULI
DIFFICULT TO LOCALIZE
TENDER ON PERCUSSION
EXPOSURE OF DENTIN
DEFECTIVE
RESTORATION

9. RADIOGRAPHICALLY
TREATMENT PLAN: ROOT CANAL TREATMENT
WIDENING OF PDL SPACE
DIAGNOSIS:
1)Visual examination
2)Radiograph
3)Percussion
4)Vitality tests.

10. ACUTE APICAL PERIODONTITIS
• Occurs before alveolar bone is resorbed.
• SIGNS AND SYMPTOMS
-Tooth feeling elevated in the socket.
-Inability to chew
-Tender on percussion
RADIOGRAPHIC FINDING
Appear normal or
widenimg of PDL space
CAUSATIVE FACTORS:
-Occlusal trauma
-Irreversible pulpitis
TREATMENT:
-Removal of causative factors
-Occlusion should be relieved
-heavy dose of anesthesia required
-Prescribe analgesics and antiinflammatory drugs

11. DENTIN HYPERSENSITIVITY
• Short,sharp pain arising from exposed dentin.
• Age: 20-50 yrs with peak 20-40 yrs
• Gender: Females common.
• Most common site-Buccal cervical area of tooth
• Teeth- canine & 1 st premolars
• ETIOLOGY:
-- Gingival recession
--Acids
--Poor oral hygine
--Improper tooth brushing,
--Premature occlusal contacts
-if it is a sharp transitory pain,
-if there is gingival recession present,
- if there are no defects in restorations or
other potential causes identified during the
examination, and
-if eliminating a potential trigger prevents
the pain,
then dentin hypersensitivity is a likely
cause
PEOPLE AT RISK
-Overenthusiastic brushers
-Periodontal treated patients
-Bulimics
-People with xerostomia
-High-acid food/drink consumers
-Older people exhibiting gingival recession
-Chewing ‘smokeless’ or ‘snuff’ tobacco

12. MANAGEMENT
• Two principle treatment options are
1)Plug the dentinal tubules preventing the fluid flow
2)Desensitize the nerve ,making it less responsive to stimulation
-At home desensitizing therapy: toothpastes, mouthwashes and chewing gums.
-“at-home” desensitizing therapy should be reviewed after every 3–4 weeks. If
there is no relief in DH, “in-office” therapy should be initiated.
The in-office desensitizing agents can be classified as the materials which undergo
a setting reaction (glass ionomer cement, composites) and which do not
undergo a setting reaction (varnishes, oxalates).

13. PERIAPICAL ABSCESS
-NECROTIC PULP- Infection reach the periapical area
-With or without swelling
SIGNS AND SYMPTOMS:
RADIOGRAPHICALLY
NONVITAL TOOTH MOBILITY
TENDER ON
PERCUSSION
SWELLING
WIDENING OF PDL SPACE PERIAPICAL RADIOLUCENCY
IN CHRONIC CASES

14. PERIAPICAL ABSCESS
WITHOUT
SWELLING
WITH
SWELLING
ROOT CANAL TREATMENT
ROOT CANAL DRAINAGE
& RCT
INCISION,DRAINAGE
& RCT

15. CRACKED TOOTH SYNDROME
-The term was first used by Dr. Cameron in 1964
-Also known as ‘cracked cusp syndrome’ or ‘split tooth syndrome’ refers to the
situation where a tooth is incompletely cracked but no part of it is broken off .
-commonly affects: LOWER BACK TEETH – as it absorbs most of the forces of
chewing.
SIGNS & SYMPTOMS:
Sharp Pain on
mastication
SENTIVITY TO HOT
AND COLD
DIFFICULT TO
LOCALIZE
CHRONIC CRACKS :
CHARACTERIZED BY DULL PAIN SWELLING

16. TYPES OF CRACKED TEETH

20. HOT TOOTH
• Difficult to anesthetize.
• MOST COMMONLY SEEN IN:
-Sites of recent or defective restoration
-Recent trauma
-Mandibular molars.
-Patient with Anxiety
Tx: supplementary intraligamentary
Intraosseous injections.

21. AVULSION
• INCIDENCE: 3% of all dental injuries.
• True dental emergency.
• Cause: sports and autombile accidents.
• See for any debris or contaminants
• Record the time of avulsion
IMMEDIATE TREATMENT:
NO MOBILITY
SPLINTING
NOT NEEDED
MOBILITY
SPLINTING
-Splinting should left for 1 to 2 weeks
-Antibiotic course

25. OCCLUSION
HIGH FILLINGS
Tx: proper burnishing
,carving & polishing
OVER ERUPTED 3rd MOLAR
Can also cause pain
Check for high points with
articulating paper
Reduce the high points

26. PERIOPERATIVE EMERGENCIES (FLARE-UP)
Flare up can be defined as occurance of pain or swelling after initiation of endodontic
treatment.
CAUSES
OVER INSTRUMENTATION
INCOMPLETE REMOVAL
OF PULP TISSUE
OVER OBTURATION
EXTRUSION OF SEALER
AGGRESSIVE IRRIGATION
HYPEROCCLUSION
PROCEDURAL ERRORS
ROOT FRACTURE

27. TREATMENT
REPRAPARATION & CLEANING
OF CANAL
IF SWELLING DRAINAGE
ANALGESICS
PERIAPICAL SURGERY FOR
PERSISTENT CASES

28. HYPOCHLORITE ACCIDENT
• Happens when Sodium hypochlorite extruded beyond the apex
CAUSES:
FORCEFUL INJECTION
OF Naocl
IRRIGATING A TOOTH WITH
LARGE APICAL FORAMEN
SYMPTOMS:
-Severe immediate pain
-Swelling
-Profuse bleeding
MANAGEMENT:
-Immediate aspiration
-Cold pack
-Regional block anesthesia administered.
-monitor for half an hour
-Antibiotics and Analgesics
-HOMECARE INSTRUCTIONS:
-Cold and warm compress

29. • PREVENTION:
-Bend the needle at centre
-Never bind the needle in the canal
-oscillate the needle in and out
-Express the irrigant slowly

30. HYDROGEN PEROXIDE AS A CAUSE OF IATROGENIC
SUBCUTANEOUS CERVICOFACIAL EMPHYSEMA
• Hydrogen peroxide 3%
• Facial swelling,tenderness and crepitation.
• Radiograph: Normal
• Prophylactic antimicrobial therapy.
• Emphysema will recover on its own within a week

31. ASPIRATION/INGESTION OF ENDODONTIC INSTRUMENTS
• Happens only when rubber dam is not in place.
• High power suction with rubber ram helps in prevention of aspiration.
• Grossman (1955) had stated that if an instrument is swallowed by the
patient,the dentist is likely to be confronted lawsuite

32. POST OBTURATION EMERGENCIES
CAUSES:
-Overfilling/ Underfilling
-obturating a tooth with concurrent pain present
-High restoration
-Root fracture
TREATMENT:
-Prescribe Analgesics.
-If symptomatic, Apical surgery

33. THANK YOU