2. It is defined as a condition
associated with pain/swelling
which requires immediate
diagnosis and treatment
3 types:
Pre-treatment
Intra appointment
Post-obturation
6. ANAESTHESIA
• The pain management is the most critical factor which affects
the prognosis of the treatment.
• To obtain an adequate anaesthesia of inflamed tissues is the
challenge. Maxillary anaesthesia is easier to obtain by giving
infiltration or block injections in the buccal or palatal region.
• For adequate pulpal anaesthesia in the mandible, inferior
alveolar, lingual and long buccal injections are preferred.
• If anaesthesia is required in the lower premolars, canine and
incisor, then other alternative techniques such as mental nerve
block, periodontal ligament injection, intraosseous anaesthesia
and intrapulpal injection are given
7. DENTIN HYPERSENSITIVITY
It is defined as sharp, short pain arising from exposed dentin in
response to stimuli typically thermal, chemical, tactile or osmotic
and which can’t be ascribed to any other form of dental defect or
pathology.
Treatment
Two main treatment options are plug the dentinal tubules
preventing the fluid flow and desensitize the nerve.
Etiology The primary underlying cause for dentin hypersensitivity
is exposed dentinal tubules which can occur by two processes- by
loss of enamel or by loss of covering periodontal structures.
8. ACUTE REVERSIBLE PULPITIS:-[Hyperemia]
• DEFINITION: It is a mild to moderate inflammatory condition of the pulp
caused by noxious stimuli in which the pulp is capable of returning to the
uninflamed state following removal of the stimulus
• It is characterized by sharp pain lasting for a moment, more often brought on
by cold than hot food or beverages. The patient can identify the tooth.
Momentary pain that subsides on removal of stimulus.
• Symptoms: A.R.P. is characterized by: •Sharp pain lasting for a moment.
•Shooting pain lasting for short-duration. •Pain brought on by cold beverages
and sweets. •Clinically – the patient can identify the tooth by pointing to it.
• ETIOLOGY:- 1.Caries Lesions which are close to pulp can cause mild to
moderate sensitivity to patients. Treatment Caries excavation and placing a
sedative cement like dycal and zinc oxide eugenol (IPC). 2.Recent restoration
which has a premature contact point. Treatment Recontouring or removal of
high points.
9. • Recurrent caries -> under an old restorations. Treatment Remove all caries
and replace with a sedative cement.
• Thermal shock from preparing a cavity with a dull bur or keeping the bur in
contact with the tooth for a long time can cause acute reversible pulpitis
which exaggerates on placing a metallic restoration over the tooth.
3.Persistent pain and severe sensitivity after cavity preparation Suggesting
chemical leakage. Treatment Removal of restoration and placing sedative
cement like ZOE.
• TREATMENT:- The best Rx is prevention. In a recently restored tooth,
occlusion is adjusted. In cases of marginal leakage or secondary caries ,the
old restorations are removed and replaced with sedative cement. Pain
usually disappears with in several days ,if it persists then pulp has to be
extirpated
• Prognosis: The prognosis is favourable if early removal of irritant is achieved
,otherwise the condition may develop into irreversible pulpitis
10. ACUTE IRREVERSIBLE PULPITIS
DEFINITION: It is a persistent inflammatory condition of the pulp, symptomatic
or asymptomatic, caused by a noxious stimulus. Acute Irreversible Pulpitis
exhibits pain usually caused by hot or cold stimulus
Symptoms: Pain lasts for minutes to hours. •It is spontaneous. •It often
continues even when the cause is removed. •Pain is present even on bending
over. •Patient complains of disturbed sleep. •Pain is experienced on sudden
temperature change. •On taking sweets or acidic foodstuff. •From packing of
food into cavity/food impaction.
Causes: •The most common cause of irreversible pulpitis is bacterial
involvement of pulp through caries. •Reversible pulpitis may also deteriorate
into irreversible pulpitis. In irreversible pulpitis the pulp may be Vital Non-vital
11. MANAGEMENT:
• Profound anaesthesia of the affected teeth
• Preparation of access cavity
• Extirpation of the pulp from the chamber
• Thorough irrigation and debriment
• Placement of intra canal medicaments
• Appropriate analgesics therapy and antibiotics
12. ACUTE APICAL PERIODONTITIS:-
DEFINITION:- It is a painful inflammation of periodontium as a result of trauma, irritation or
infection through root canal whether the pulp is vital or non vital.
CAUSES:- caries,Occlusal trauma Wedging of foreign objects Blow to tooth Over
instrumentation or over filling Symptoms: Pain & tenderness of the tooth,sometimes the
tooth may be extruded.
TREATMENT:- Vital tooth--------symptomatic Rct
Management of Non vital tooth Profound anaesthesia of the involved tooth Preparation of
the access cavity Total extirpation of pulp in pulp chamber Determination of working length
Total extirpation of the pulp Bio-mechanical preparation Thorough irrigation Placement of
sedative dressing folllowed by closed dressing Relieve occlusion if indicated Prescribe
analgesics to reduce pain
13. ACUTE ALVEOLAR ABSCESS:
Also called as: Acute periapical abscess. Phoenix abscess.
DEFINITION: It is a localized collection of pus in the alveolar bone at the root
apex following pulp death with extension of infection through apical foramen
into periapical tissues.
Causes (Non-vital pulp) •Bacterial involvement. •H/O trauma. •Mechanical or
chemical irritation. The acute episode may result from: a)PULPITIS that
progressively developed into pulp necrosis affecting the periapical tissues.
b)ACUTE EXACERBATION of a chronic periapical lesion c)ENDO-PERIO lesion
when the periodontal abscess secondarily affects the pulp through the lateral
canals or deep infrabony pockets. 38
SYMPTOMS There are local reactions like: •Tenderness of tooth. •Severe
throbbing pain. •Swelling. •Sinus tract.
Systemic reactions are: •Elevated temperature. •Malaise. •Nausea. •Dizziness.
•Lack of sleep
14. TREATMENT
• The main treatment is biphasic in nature i.e. I – Debridement of canals. II
– Drainage of abscess. The emergency treatment of acute alveolar
abscess differs from acute irreversible pulpitis, as the pulp is necrotic,
local anaesthesia is not required and frequently contraindicated. Forcing
anaesthetic solution into an acutely infected and swollen area may
increase pain and may spread infection.
• “BLOCK MAY BE USED IN SUCH CASES” Most of the pain that occurs
during access cavity preparation is caused by tooth movement resulting
from vibration of the bur, therefore, one should stabilize tooth with
finger pressure so that the pain is reduced. Treatment procedure follows
as: •Access cavity preparation. •Profuse irrigation avoiding forcing of any
solution or debris into the periapical tissue. •In most cases PURULENT
EXUDATE escapes into the chamber and indicates that root canal is
patent and draining. •If drainage does not occur, the apical constriction
is purposefully violated and enlarged to a minimum of 20/25 no.
instrument to allow for exudate to drain because in most cases the apical
constriction may prevent the drainage
15.
16. EMERGENCIES DURING TREATMENT
Endodontic emergencies can occur during the course of treatment. Most emergencies
are reactive phenomenon to pressure and chemical mediators created as a result of
inflammatory response in periradicular tissues. According to Grossman The emergencies
can be due to: •Instrumentation beyond the root apex causing trauma to periradicular
tissue. •When debris and microorganisms are pushed beyond the apical foramen which
can cause an infectious reaction. •Chemical irritants like - Irrigating solution. - Intracanal
medicament
•Incomplete debridement of all root canals. •Lost or depressed access cavity seals
leading to recontamination. •Overfilled root canals with subsequent periapical
inflammation. The inflammation in the peri-radicular tissue is induced as a result of
release of substances such as vasoactive amines, kinins and arachadonic acid
metabolites.
17. FLARE UPS:
• Irritants within the pulp system. • Operator controlled or iatrogenic factors. • Host
factors. • General systemic factors which are related to Flare-up. Patients can accept that
pain may continue to a lesser extent when they come to the dental office for emergency
treatment. What is difficult for patients to comprehend is when they enter the office
having little or no pain before therapy but then encounter an explosive flare-up after the
treatment is done.
Therefore PREVENTION OF FLARE-UPS can be done by: • The most important preventive
measure is preparing the patient to accept some discomfort which should subside in a
day or two i.e. psychological preparation of patients. • Using long acting anaesthetic
solution. • Complete cleaning and shaping of root canals. • Administration of
appropriate analgesics, prophylactic analgesics before next appointment reduces the
incidence of discomfort and flare-ups.
18. FRACTURE OF TEETH
If it occurs during treatment,then one should go for extraction of the tooth
RECENTLY PLACED RESTORATIONS
CAN CAUSE DISCOMFORT DUE TO HGH FILLINGS,MARGINAL LEAKAGE,INADEQUATE
PULP PROTECTION,GALVANISM,CHEMICAL IRRITANTS
HYPOCHLORITE ACCIDENT
Another very important but rare emergency is due to expelling of an irrigant such as
NaOCl beyond the apex. This happens only by locking the needle of the irrigating
syringe in the canal and forcefully injecting the irrigant. • Within minutes the patient
feels SUDDEN EXTREME PAIN. • SWELLING within minutes. •eccymosis, Profuse,
prolonged BLEEDING through the root canal. This bleeding is the body’s reaction to the
irrigant. Remove the toxic fluid with high volume evacuation to encourage further
drainage from periradicular tissue.
19. Treatment:
ice packs •Allow the bleeding to continue. If the body rids itself of toxic fluid
healing may be faster. •If the treated tooth is pulpless consider prescribing an
antibiotic and an analgesic for 5 and 3 days respectively. •Since this may be
hypersensitive reaction consider prescribing an antihistaminic
TISSUE EMPHYSEMA
Collection of gas or air in tisssue spaces
When, blast of air is directed towards open root canals
Treatment-antibiotics,heat application to reduce inflammation,medical attention is
required if it is serious
20.
21. VERTICAL ROOT FRACTURE
May occur during bio-mechanical preparation,obturation, or during post
Preparation. It results from wedging forces within the canal. It leads to
Fatigue and fracture.
CLINICAL FEATURES:
• Commonly occurs in facio-lingual plane.
• Sudden crunching sound accompanied by pain
• Susceptibility increases by excessive dentin
removal during canal preparation
PREVENTION:
• Avoid wedging forces and weakening the canal wall.
TREATMENT:
• Mostly extraction
• In multirooted tooth,root resection or hemisection can be tried.
22. INADEQUATE CANAL PREPARATION:
OVERINSTRUMENTATION:
• Excessive instrumentation beyond the apical constriction violates the
Periodontal ligament and the alveolar bone.
• Leads to overfilling which causes pain and discomfort to the patient.
• It is recognised when haemorrhage is evident in the apical portion of the
canal
TREATMENT:
• Re-establish the working length
• Filling an apical barrier which includes materials like
Dentinal chips,calcium hydroxide powder,
Hydroxy apatite and MTA.
PREVENTION:
• Use a good radiograph
• Use sound reference points
• Using stable instrument stops
23. OVERFILLING OF ROOT CANALS
Overfilling of the root canals is filling more than 2mm beyond the apex of the root.
ETIOLOGY:
• Over instrumentation of the root canal
• Inadequate determination of working length
• Incompletely formed root apex
• Inflammatory apical root resorption
• Improper use of reference points
SIGNIFIANCE:
• Over filling may cause foreign giant cell reaction and may act as foreign body which may
Support the formation of biofilms.
• Over instrumentation often precedes overfilling which poses risk of forcing infected root
Canal contents into the peri radicular tissues thereby impairing the healing process
