An endodontic emergency is defined as pain and/or swelling caused by inflammation or infection of pulp and/or periradicular tissue necessitating an emergency visit to the dentist for immediate treatment.
The main causative factors responsible for occurrence of endodontic emergencies are:
Pathosis in pulp and periradicular tissues
Traumatic injuries
Recent studies report a 60-82% incidence of endodontic emergencies among all dental emergencies.
Within this group, 20-42% of patients seek care for teeth with symptomatic irreversible pulpitis (SIP) .
Additionally, about 60% of SIP patients also complain of symptomatic apical periodontitis (SAP)
The goal of management of endodontic emergencies is to quickly and effectively manage pain and infections thereby also minimizing the development of persistent pain and the formation of periapical pathology.
Endodontic emergencies include pain and swelling that can occur before, during, or after root canal treatment. Common causes are pulpal and periapical pathosis or traumatic injury. A flare-up during root canal therapy results from irritants left in the root canal system and causes pain, swelling, or both. Management depends on the specific clinical condition but generally involves re-establishing drainage, debriding and irrigating the root canal, and prescribing medications.
Flareups during root canal treatment can be caused by mechanical, chemical or microbial factors. They typically present as pain and swelling within hours or days after a procedure. Preventing flareups involves minimizing debris extrusion, completing treatment in one visit, using intracanal medications, maintaining asepsis and not leaving teeth open between appointments. Management includes incision and drainage if abscess is present, along with analgesics, antibiotics and potential occlusal reduction.
This document discusses the management of endodontic pain. It defines pain and related terms like hyperalgesia. It describes the pathways of pain transmission, including the gate control theory. It discusses factors that affect a patient's pain threshold like fear. It outlines the types of dental pain and the nerves involved in transmitting pain signals. Finally, it discusses various clinical strategies for managing endodontic pain, including pulpotomy, pulpectomy, incision and drainage, and occlusal reduction. It also covers effective medical management using analgesics and anxiolytics.
working length estimation in endodontic Marwa Ahmed
The document discusses methods for determining working length in root canals. It describes both radiographic and non-radiographic methods. Radiographic methods include Grossman's formula, Ingles method, Weine's modification, and use of xeroradiography and radiovisiography. Non-radiographic methods discussed are digital tactile sense, apical periodontal sensitivity, paper point measurement, and use of electronic apex locators. Electronic apex locators are highlighted as an important advancement, with different generations discussed varying in their measurement of resistance, impedance, or frequency. Accuracy and limitations of different methods are also reviewed.
This document provides an overview of single visit endodontics. It discusses the history and increased acceptance of single visit root canals due to advances in technology. The document outlines indications and contraindications for single visit root canals and notes the practice management, patient, and clinician advantages which include reduced stress, cost and number of visits. Guidelines for performing single visit root canals including case selection criteria and pain control methods are also summarized.
The document discusses the management of endodontic pain. It defines pain and describes the various causes of pre-treatment, during treatment, and post-treatment endodontic pain. It outlines strategies for diagnosing the source of pain and discusses both pharmacological and non-pharmacological options for managing different types of endodontic pain, including the use of analgesics, local anesthetics, antibiotics, and steroids. Challenges in achieving pulpal anesthesia for teeth with irreversible pulpitis ("hot tooth") are also covered, along with strategies for improving anesthesia success.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
Non-carious lesions can be caused by various factors like attrition, abrasion, abfraction, erosion, and developmental defects. They are managed through treatments like restoration, controlling parafunctional habits, and addressing underlying causes. Localized enamel hypoplasia can result in pits and defects from interruptions during enamel formation, while hypocalcification makes enamel softer and more stainable. Management involves restoration, bleaching, or preventing further demineralization.
Endodontic emergencies include pain and swelling that can occur before, during, or after root canal treatment. Common causes are pulpal and periapical pathosis or traumatic injury. A flare-up during root canal therapy results from irritants left in the root canal system and causes pain, swelling, or both. Management depends on the specific clinical condition but generally involves re-establishing drainage, debriding and irrigating the root canal, and prescribing medications.
Flareups during root canal treatment can be caused by mechanical, chemical or microbial factors. They typically present as pain and swelling within hours or days after a procedure. Preventing flareups involves minimizing debris extrusion, completing treatment in one visit, using intracanal medications, maintaining asepsis and not leaving teeth open between appointments. Management includes incision and drainage if abscess is present, along with analgesics, antibiotics and potential occlusal reduction.
This document discusses the management of endodontic pain. It defines pain and related terms like hyperalgesia. It describes the pathways of pain transmission, including the gate control theory. It discusses factors that affect a patient's pain threshold like fear. It outlines the types of dental pain and the nerves involved in transmitting pain signals. Finally, it discusses various clinical strategies for managing endodontic pain, including pulpotomy, pulpectomy, incision and drainage, and occlusal reduction. It also covers effective medical management using analgesics and anxiolytics.
working length estimation in endodontic Marwa Ahmed
The document discusses methods for determining working length in root canals. It describes both radiographic and non-radiographic methods. Radiographic methods include Grossman's formula, Ingles method, Weine's modification, and use of xeroradiography and radiovisiography. Non-radiographic methods discussed are digital tactile sense, apical periodontal sensitivity, paper point measurement, and use of electronic apex locators. Electronic apex locators are highlighted as an important advancement, with different generations discussed varying in their measurement of resistance, impedance, or frequency. Accuracy and limitations of different methods are also reviewed.
This document provides an overview of single visit endodontics. It discusses the history and increased acceptance of single visit root canals due to advances in technology. The document outlines indications and contraindications for single visit root canals and notes the practice management, patient, and clinician advantages which include reduced stress, cost and number of visits. Guidelines for performing single visit root canals including case selection criteria and pain control methods are also summarized.
The document discusses the management of endodontic pain. It defines pain and describes the various causes of pre-treatment, during treatment, and post-treatment endodontic pain. It outlines strategies for diagnosing the source of pain and discusses both pharmacological and non-pharmacological options for managing different types of endodontic pain, including the use of analgesics, local anesthetics, antibiotics, and steroids. Challenges in achieving pulpal anesthesia for teeth with irreversible pulpitis ("hot tooth") are also covered, along with strategies for improving anesthesia success.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
Non-carious lesions can be caused by various factors like attrition, abrasion, abfraction, erosion, and developmental defects. They are managed through treatments like restoration, controlling parafunctional habits, and addressing underlying causes. Localized enamel hypoplasia can result in pits and defects from interruptions during enamel formation, while hypocalcification makes enamel softer and more stainable. Management involves restoration, bleaching, or preventing further demineralization.
This document discusses endodontic retreatment. It defines retreatment as removing root canal filling materials from a tooth to clean, shape, and re-obturate the canals. Reasons for retreatment include persistent or reinroduced intraradicular microorganisms, extraradicular infection, foreign body reaction, or true cysts. Evaluation involves clinical examination, radiographs, and assessing for symptoms like pain, swelling or sinus tracts. Success is defined as resolution of symptoms and periapical radiolucency, while failure is persistence or worsening of these signs.
CONSIST OF INDTRODUCTION, PAIN DEFINITION , MECHANISM OF PAIN, THEORIES OF PAIN, PATHOPHYSIOLOGY OF PAIN, THORIES OF DENTIN HYPERSENSTIVITY , TREATMENT
Non-carious cervical lesions are caused by a combination of erosion, abrasion, and abfraction and affect half the population. Erosion is chemical wear from acids like those in citrus fruits and drinks. Abrasion is mechanical wear, like from overly vigorous brushing. Abfraction is stress-related wear from forces like clenching. These lesions are diagnosed through history, examination, and radiographs. Treatment depends on the severity but may include desensitization, restorations using composites or glass ionomers, endodontics, or periodontal procedures.
This document discusses various strategies for managing endodontic pain. It begins by noting that root canals are often perceived as more painful than they actually are based on surveys. It then examines diagnostic considerations for determining the origin and type of pain. Several clinical strategies are outlined for relieving endodontic pain such as pulpotomy, pulpectomy, trephination, incision and drainage, occlusal reduction, and achieving profound anesthesia. Effective pain management involves diagnosing and treating the underlying cause, using a flexible analgesic prescription, pretreating with NSAIDs, and ensuring profound anesthesia. Anxiety management techniques like relaxation therapy, flooding/implosion, and cognitive behavioral therapy are also discussed.
The document discusses focal infection and inflammation in the dental pulp. It describes how microorganisms from infected dental sites can spread through the bloodstream and lymphatic system, potentially causing infection elsewhere. When the pulp becomes inflamed in response to injury or infection, it undergoes degenerative or proliferative changes. The "FISH" study identified four zones of tissue reaction around an infected area: the zone of infection, contamination, irritation, and stimulation. Kronfeld's mountain pass theory applied this concept to explain the inflammatory response in the periapex as a defensive reaction analogous to a military mobilization.
Speed in dentistry refers to the revolutions per minute of rotary cutting instruments like dental burs. The document discusses the history and evolution of rotary cutting instruments from early mechanical drills to modern electric and air-driven dental handpieces. It classifies speeds as low, medium, and high and describes the uses, advantages, and disadvantages of different speed ranges. Recent advances discussed include fibre optic handpieces, specialized cavity-preparation burs, and sonic/ultrasonic instrumentation.
This document classifies dental emergencies into pre-treatment, inter-appointment, and post-appointment emergencies. Pre-treatment emergencies include acute pulpitis, acute pulpitis with apical periodontitis, and pulp necrosis. Inter-appointment emergencies can result from misdiagnosis, missed canals, incomplete removal of pulp tissue, overinstrumentation, irrigation methods, and intracanal medicaments. Post-appointment emergencies involve complications after a root canal procedure. The document provides details on signs, symptoms, and emergency treatments for several common dental conditions.
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
This document provides an overview of endodontics. It defines endodontics as the branch of dentistry concerned with the morphology, physiology, and pathology of the dental pulp and periradicular tissues. The scope of endodontics includes treating diseases of the pulp, such as pulpal inflammation and infection, through both nonsurgical and surgical root canal treatment and periradicular surgery. Pathogenesis is discussed, noting that while physical and chemical factors can induce inflammation, microbial infection is essential for progression of pulpal and periradicular disease. Routes of canal infection and the focal infection theory are also summarized.
This document discusses various materials that have been used for retrograde root canal fillings. It begins by outlining the ideal properties of retrograde filling materials, including good adhesion, biocompatibility, and preventing microorganism leakage. The document then examines the properties and limitations of numerous materials that have been used, including amalgam, zinc oxide-eugenol cements, glass ionomer cement, MTA cement, and various other alternatives. It provides details on the composition, sealing ability, biocompatibility and other characteristics of each material. In conclusion, the document states that MTA cement is currently considered the best material due to its biocompatibility, sealing ability and dimensional stability.
This document discusses various types of dental emergencies that may occur during or after endodontic treatment. It describes three types of pre-treatment, intra-appointment, and post-obturation emergencies. Specific emergencies discussed in detail include acute reversible and irreversible pulpitis, acute apical periodontitis, acute periapical abscess, flare-ups during treatment, instrument separation beyond the apex, and overfilling of the root canal. The document provides descriptions of symptoms, causes, and recommended treatment approaches for resolving each emergency.
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
The document discusses various classifications of tooth resorption. It describes resorption as a multifactorial process involving the loss of tooth structure due to different causes. Several classifications are presented based on anatomical location, etiology, histopathology and other factors. The key mechanisms of resorption including the cells involved, prerequisites for resorption, and the bi-modal process of dissolving inorganic crystal structures and degrading organic collagen are summarized.
The document discusses various endodontic mishaps that can occur during root canal treatment. It describes mishaps related to access preparation, instrumentation, and obturation. Access-related mishaps include treating the wrong tooth, missing canals, damaging existing restorations, perforating the access cavity, and crown fractures. Instrumentation mishaps include ledge formation, perforating the root, and separated instruments. Obturation mishaps include overfilling or underfilling the canal. The document provides details on the causes, recognition, correction, prevention and prognosis of several common endodontic mishaps.
The document discusses strategies for managing teeth with irreversible pulpitis, known as "hot teeth", including supplemental injections like intra-ligamentary (PDL), intra-osseous, articaine buccal infiltration, and intra-pulpal when conventional injections fail to provide anesthesia. It provides details on techniques for different supplemental injections using devices like the Wand or Stabident system and recommends strategies based on tooth location, such as inferior alveolar nerve block plus lingual and intra-osseous for mandibular posterior teeth.
A ferrule is a band of metal that encircles the remaining tooth structure below the crown. It acts to reinforce root-filled teeth. A ferrule should be at least 1.5-2mm in height to provide optimal resistance to fracture. It works by resisting stresses from lever forces during function and wedging forces from tapered posts. A ferrule can be created by the crown itself engaging the tooth (crown ferrule) or be built into a cast metal core (core ferrule).
An endodontic emergency is defined as pain and/or swelling caused by inflammation or infection of the pulp and/or periradicular tissues requiring immediate treatment. Common causes are pulpal pathologies and traumatic injuries. Pain results from chemical mediators and increased fluid pressure causing stimulation of pain receptors. Accurate diagnosis involves dental history, clinical examination including vitality testing and radiographs to determine the source and rapidly provide effective treatment.
Cracked tooth syndrome is an incomplete fracture of tooth structure causing sharp pain on biting. Risk factors include excessive forces, weakened tooth structure, dental materials or rare events. Symptoms are biting pain and sensitivity. Diagnosis involves visual inspection, transillumination, dyes or bands to detect the crack
This document discusses root canal curvatures and methods for determining their degree. It begins with an introduction on the importance of understanding root canal anatomy for successful endodontic treatment. It then covers causes of canal curvatures, various classification systems, and techniques for assessing curvature using periapical radiographs, cone-beam computed tomography, and angular measurement methods. The relationship between curvature degree and ledge formation risk is also addressed, as are canal characteristics often invisible on routine radiographs. The document concludes by emphasizing the challenges of treating severely curved canals and the need for accurate preoperative assessment and proper instrumentation.
This document provides an overview of endodontic surgery. It begins with a brief history of endodontic surgery dating back over 1500 years. It then discusses the definition, rationale, objectives, and indications for endodontic surgery. The document outlines the classification of endodontic surgery and describes various surgical procedures like periradicular surgery, root-end resection, and root-end filling. It provides details on surgical instruments, treatment planning considerations, and techniques for achieving profound local anesthesia. In summary, the document provides a comprehensive review of the principles and procedures involved in endodontic surgery.
An endodontic emergency is a situation requiring immediate treatment due to severe pain and/or swelling. It may involve rescheduling normal appointments. Key factors in diagnosing an emergency include whether the problem is disturbing sleep, eating or concentration. Accurate diagnosis involves determining the cause, such as microbial infection, mechanical trauma or chemical irritants. Non-surgical emergency treatment may involve pulpotomy, pulpectomy or incision and drainage, while surgical treatment includes incision or trephination. Definitive treatment, antibiotics and analgesics are aimed at resolving the underlying etiology and symptoms.
This document discusses endodontic emergencies and their management. It defines endodontic emergencies as unscheduled visits requiring immediate treatment for pain or swelling from pulp or periapical inflammation or infection. Various classifications of endodontic emergencies are presented. Management strategies for different emergencies arising before, during, or after treatment are covered, including pulpectomy or pulpotomy for vital pulps and root canal treatment for non-vital pulps. Clinical challenges in accurately diagnosing the tooth and pulp condition causing a patient's symptoms are also addressed.
This document discusses endodontic retreatment. It defines retreatment as removing root canal filling materials from a tooth to clean, shape, and re-obturate the canals. Reasons for retreatment include persistent or reinroduced intraradicular microorganisms, extraradicular infection, foreign body reaction, or true cysts. Evaluation involves clinical examination, radiographs, and assessing for symptoms like pain, swelling or sinus tracts. Success is defined as resolution of symptoms and periapical radiolucency, while failure is persistence or worsening of these signs.
CONSIST OF INDTRODUCTION, PAIN DEFINITION , MECHANISM OF PAIN, THEORIES OF PAIN, PATHOPHYSIOLOGY OF PAIN, THORIES OF DENTIN HYPERSENSTIVITY , TREATMENT
Non-carious cervical lesions are caused by a combination of erosion, abrasion, and abfraction and affect half the population. Erosion is chemical wear from acids like those in citrus fruits and drinks. Abrasion is mechanical wear, like from overly vigorous brushing. Abfraction is stress-related wear from forces like clenching. These lesions are diagnosed through history, examination, and radiographs. Treatment depends on the severity but may include desensitization, restorations using composites or glass ionomers, endodontics, or periodontal procedures.
This document discusses various strategies for managing endodontic pain. It begins by noting that root canals are often perceived as more painful than they actually are based on surveys. It then examines diagnostic considerations for determining the origin and type of pain. Several clinical strategies are outlined for relieving endodontic pain such as pulpotomy, pulpectomy, trephination, incision and drainage, occlusal reduction, and achieving profound anesthesia. Effective pain management involves diagnosing and treating the underlying cause, using a flexible analgesic prescription, pretreating with NSAIDs, and ensuring profound anesthesia. Anxiety management techniques like relaxation therapy, flooding/implosion, and cognitive behavioral therapy are also discussed.
The document discusses focal infection and inflammation in the dental pulp. It describes how microorganisms from infected dental sites can spread through the bloodstream and lymphatic system, potentially causing infection elsewhere. When the pulp becomes inflamed in response to injury or infection, it undergoes degenerative or proliferative changes. The "FISH" study identified four zones of tissue reaction around an infected area: the zone of infection, contamination, irritation, and stimulation. Kronfeld's mountain pass theory applied this concept to explain the inflammatory response in the periapex as a defensive reaction analogous to a military mobilization.
Speed in dentistry refers to the revolutions per minute of rotary cutting instruments like dental burs. The document discusses the history and evolution of rotary cutting instruments from early mechanical drills to modern electric and air-driven dental handpieces. It classifies speeds as low, medium, and high and describes the uses, advantages, and disadvantages of different speed ranges. Recent advances discussed include fibre optic handpieces, specialized cavity-preparation burs, and sonic/ultrasonic instrumentation.
This document classifies dental emergencies into pre-treatment, inter-appointment, and post-appointment emergencies. Pre-treatment emergencies include acute pulpitis, acute pulpitis with apical periodontitis, and pulp necrosis. Inter-appointment emergencies can result from misdiagnosis, missed canals, incomplete removal of pulp tissue, overinstrumentation, irrigation methods, and intracanal medicaments. Post-appointment emergencies involve complications after a root canal procedure. The document provides details on signs, symptoms, and emergency treatments for several common dental conditions.
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
This document provides an overview of endodontics. It defines endodontics as the branch of dentistry concerned with the morphology, physiology, and pathology of the dental pulp and periradicular tissues. The scope of endodontics includes treating diseases of the pulp, such as pulpal inflammation and infection, through both nonsurgical and surgical root canal treatment and periradicular surgery. Pathogenesis is discussed, noting that while physical and chemical factors can induce inflammation, microbial infection is essential for progression of pulpal and periradicular disease. Routes of canal infection and the focal infection theory are also summarized.
This document discusses various materials that have been used for retrograde root canal fillings. It begins by outlining the ideal properties of retrograde filling materials, including good adhesion, biocompatibility, and preventing microorganism leakage. The document then examines the properties and limitations of numerous materials that have been used, including amalgam, zinc oxide-eugenol cements, glass ionomer cement, MTA cement, and various other alternatives. It provides details on the composition, sealing ability, biocompatibility and other characteristics of each material. In conclusion, the document states that MTA cement is currently considered the best material due to its biocompatibility, sealing ability and dimensional stability.
This document discusses various types of dental emergencies that may occur during or after endodontic treatment. It describes three types of pre-treatment, intra-appointment, and post-obturation emergencies. Specific emergencies discussed in detail include acute reversible and irreversible pulpitis, acute apical periodontitis, acute periapical abscess, flare-ups during treatment, instrument separation beyond the apex, and overfilling of the root canal. The document provides descriptions of symptoms, causes, and recommended treatment approaches for resolving each emergency.
A detailed description about endo perio interrelationship, including introduction, development and etiology, historical aspects, definition, classification, diagnosis, differential diagnosis, management, special consideration in management,controversies prognosis, conclusion.
The document discusses various classifications of tooth resorption. It describes resorption as a multifactorial process involving the loss of tooth structure due to different causes. Several classifications are presented based on anatomical location, etiology, histopathology and other factors. The key mechanisms of resorption including the cells involved, prerequisites for resorption, and the bi-modal process of dissolving inorganic crystal structures and degrading organic collagen are summarized.
The document discusses various endodontic mishaps that can occur during root canal treatment. It describes mishaps related to access preparation, instrumentation, and obturation. Access-related mishaps include treating the wrong tooth, missing canals, damaging existing restorations, perforating the access cavity, and crown fractures. Instrumentation mishaps include ledge formation, perforating the root, and separated instruments. Obturation mishaps include overfilling or underfilling the canal. The document provides details on the causes, recognition, correction, prevention and prognosis of several common endodontic mishaps.
The document discusses strategies for managing teeth with irreversible pulpitis, known as "hot teeth", including supplemental injections like intra-ligamentary (PDL), intra-osseous, articaine buccal infiltration, and intra-pulpal when conventional injections fail to provide anesthesia. It provides details on techniques for different supplemental injections using devices like the Wand or Stabident system and recommends strategies based on tooth location, such as inferior alveolar nerve block plus lingual and intra-osseous for mandibular posterior teeth.
A ferrule is a band of metal that encircles the remaining tooth structure below the crown. It acts to reinforce root-filled teeth. A ferrule should be at least 1.5-2mm in height to provide optimal resistance to fracture. It works by resisting stresses from lever forces during function and wedging forces from tapered posts. A ferrule can be created by the crown itself engaging the tooth (crown ferrule) or be built into a cast metal core (core ferrule).
An endodontic emergency is defined as pain and/or swelling caused by inflammation or infection of the pulp and/or periradicular tissues requiring immediate treatment. Common causes are pulpal pathologies and traumatic injuries. Pain results from chemical mediators and increased fluid pressure causing stimulation of pain receptors. Accurate diagnosis involves dental history, clinical examination including vitality testing and radiographs to determine the source and rapidly provide effective treatment.
Cracked tooth syndrome is an incomplete fracture of tooth structure causing sharp pain on biting. Risk factors include excessive forces, weakened tooth structure, dental materials or rare events. Symptoms are biting pain and sensitivity. Diagnosis involves visual inspection, transillumination, dyes or bands to detect the crack
This document discusses root canal curvatures and methods for determining their degree. It begins with an introduction on the importance of understanding root canal anatomy for successful endodontic treatment. It then covers causes of canal curvatures, various classification systems, and techniques for assessing curvature using periapical radiographs, cone-beam computed tomography, and angular measurement methods. The relationship between curvature degree and ledge formation risk is also addressed, as are canal characteristics often invisible on routine radiographs. The document concludes by emphasizing the challenges of treating severely curved canals and the need for accurate preoperative assessment and proper instrumentation.
This document provides an overview of endodontic surgery. It begins with a brief history of endodontic surgery dating back over 1500 years. It then discusses the definition, rationale, objectives, and indications for endodontic surgery. The document outlines the classification of endodontic surgery and describes various surgical procedures like periradicular surgery, root-end resection, and root-end filling. It provides details on surgical instruments, treatment planning considerations, and techniques for achieving profound local anesthesia. In summary, the document provides a comprehensive review of the principles and procedures involved in endodontic surgery.
An endodontic emergency is a situation requiring immediate treatment due to severe pain and/or swelling. It may involve rescheduling normal appointments. Key factors in diagnosing an emergency include whether the problem is disturbing sleep, eating or concentration. Accurate diagnosis involves determining the cause, such as microbial infection, mechanical trauma or chemical irritants. Non-surgical emergency treatment may involve pulpotomy, pulpectomy or incision and drainage, while surgical treatment includes incision or trephination. Definitive treatment, antibiotics and analgesics are aimed at resolving the underlying etiology and symptoms.
This document discusses endodontic emergencies and their management. It defines endodontic emergencies as unscheduled visits requiring immediate treatment for pain or swelling from pulp or periapical inflammation or infection. Various classifications of endodontic emergencies are presented. Management strategies for different emergencies arising before, during, or after treatment are covered, including pulpectomy or pulpotomy for vital pulps and root canal treatment for non-vital pulps. Clinical challenges in accurately diagnosing the tooth and pulp condition causing a patient's symptoms are also addressed.
The document discusses diseases of the dental pulp, including pulpitis, pulp degeneration, and necrosis. It defines reversible and irreversible pulpitis, and describes their causes, signs, and treatments. Reversible pulpitis can be treated by removing irritants, while irreversible pulpitis may require root canal treatment or extraction. Pulp degeneration includes calcific, atrophic, and fibrous changes. Necrosis is the death of pulp tissue from issues like trauma, infection, or treatment. Necrotic pulp is typically treated with root canal therapy.
The document summarizes different types of pulp diseases. The most common is pulpitis, which is pulp inflammation that can lead to necrosis if left untreated. There are various criteria that make the pulp susceptible to inflammation like a lack of collateral circulation. Causes of pulpitis include bacterial infection from caries, trauma, chemicals from restorative materials, and mechanical irritation. The different types of pulpitis are described based on the extent and severity of inflammation, from reversible focal pulpitis to acute and chronic pulpitis, which can develop into a pulp abscess or chronic hyperplastic pulpitis in some cases. Histological findings and clinical symptoms are provided for each condition.
This document discusses various types of dental emergencies that may occur during or after endodontic treatment. It describes three types of pre-treatment, intra-appointment, and post-obturation emergencies. Specific emergencies discussed in detail include acute reversible and irreversible pulpitis, acute apical periodontitis, acute periapical abscess, flare-ups during treatment, instrument separation beyond the apex, and overfilling of the root canal. The document emphasizes the importance of adequate pain management, prevention of complications, and proper treatment protocols for resolving endodontic emergencies.
This document discusses various pulpal diseases, their causes, symptoms and treatment. It covers reversible and irreversible pulpitis caused by physical, chemical and bacterial factors. It also covers chronic hyperplastic pulpitis, characterized by a fleshy pulpal mass filling the pulp chamber. Internal resorption is discussed as an idiopathic resorptive process in the dentin and root canals, often asymptomatic with a history of trauma. Classification schemes and histopathological features of different pulpal conditions are also presented.
1. Dental pulp diseases include pulpitis, which can be acute or chronic. Acute pulpitis is reversible or irreversible, while chronic pulpitis can be closed or open.
2. Periapical diseases result from pulp necrosis and include acute or chronic apical periodontitis, periapical abscesses, cysts, and osteomyelitis. Chronic apical periodontitis often forms a periapical granuloma.
3. Symptoms, causes, histological features, radiographic features and treatments are described for each condition. Physical, chemical and microbial factors can all contribute to pulp and periapical diseases.
This document discusses different types of periapical abscesses, including acute periapical abscesses, phoenix abscesses, and chronic alveolar abscesses. It describes the etiology, symptoms, diagnosis, and treatment of each. Bacteria entering the pulp through breaks in dentin are the most common cause of these periradicular tissue lesions. Acute periapical abscesses present with rapid onset pain and swelling, while chronic alveolar abscesses are generally asymptomatic but can be detected by sinus tracts or radiographs. Treatment involves drainage, antibiotics if needed, and resolving the pulpal infection through root canal treatment or extraction.
This document discusses diseases of the dental pulp. It begins with an introduction and definitions of key terms like pulp and pulpitis. It then covers the classification, causes, features, histopathology, treatment and prognosis of various pulp conditions like reversible and irreversible pulpitis, acute and chronic pulpitis, pulp polyps, and gangrenous necrosis. It distinguishes between the symptoms and characteristics of different types of pulpitis and pulp conditions. It provides an overview of diagnostic techniques and the typical pathway from normal pulp to pulp necrosis if left untreated.
The document discusses diseases of the dental pulp, including pulpitis and necrosis. It defines the pulp as the formative organ of the tooth that builds dentin. Pulpitis is the most common cause of dental pain and can be reversible or irreversible depending on the severity of inflammation. Untreated pulpitis can lead to necrosis or death of the pulp. Causes include mechanical, thermal, chemical, and bacterial factors. Management involves removal of irritants and root canal treatment if needed.
This document provides an overview of pulp and periapical pathologies. It begins by defining the dental pulp and pulpitis. It then covers causes of pulp disease including physical, chemical, and bacterial factors. It classifies pulp disease and discusses factors affecting the pulp response. It details the pathways of bacterial invasion of the pulp and describes different types of reversible and irreversible pulpitis. It also discusses chronic hyperplastic pulpitis, gangrenous necrosis of the pulp, and diseases of the periapical tissues like acute and chronic apical periodontitis and periapical abscess.
- Diseases of the pulp and periapical tissues can result from caries, trauma, or other injuries that lead to inflammation and necrosis. This summary will discuss pulpitis, periapical diseases, and osteomyelitis.
- Pulpitis can be focal/reversible, acute, or chronic and results from inflammation of the pulp in response to injuries or irritants. Acute pulpitis causes severe pain while chronic pulpitis may be asymptomatic.
- Periapical diseases like apical periodontitis, periapical granulomas, cysts, and abscesses occur when inflammation spreads from the pulp through the root canals into surrounding tissues. Left untreated, periapical abscesses
The document provides an overview of periapical diseases and their classification. It begins with an introduction to periapical diseases and their causes. The document then classifies periapical diseases into symptomatic and asymptomatic categories. Within each category, it describes specific conditions such as symptomatic apical periodontitis, acute alveolar abscess, chronic alveolar abscess, radicular cyst, and condensing osteitis. For each condition, it discusses causes, symptoms, diagnosis, differential diagnosis, and treatment. The document provides a comprehensive review of different periapical diseases and conditions that can affect the tissues around the root apex.
Deep carious lesions penetrate deep into the dentin and can potentially expose the pulp, causing pulpitis if left untreated. There are five zones of carious dentin, ranging from normal dentin to infected dentin teeming with bacteria. Pulpitis can be reversible or irreversible, depending on the severity of inflammation. For deep lesions near the pulp, indirect pulp capping involves removing infected dentin while leaving behind affected dentin to avoid exposure. For direct exposures, pulp capping places a biocompatible material over the exposure site to promote healing and maintain vitality. Factors like remaining dentin thickness, exposure size, and patient age influence the success of pulp capping procedures.
This document discusses the management of tooth pulp. It describes the pulp as the formative organ that builds dentin during tooth development and after eruption. It also discusses patient history, clinical exam, categories of pulp pathology, types of pulpal pain, and techniques for managing deep carious lesions, including indirect pulp capping, direct pulp capping, and using corticosteroid-antibiotic pastes. The goal of pulp capping techniques is to protect the pulp from bacterial contamination if exposed and encourage reparative dentin formation.
This presentation offers a comprehensive review of the clinical management and evidence-based approaches to endodontic emergencies. Delve into the diagnostic criteria, pathophysiology, and treatment modalities for a spectrum of endodontic conditions, including acute pulpitis, apical abscesses, and traumatic dental injuries. Utilizing the latest research and case studies, the presentation will explore key decision-making frameworks and surgical vs non-surgical interventions to optimize patient outcomes. Designed for dental professionals, postgraduate students, and researchers, this presentation aims to elevate the standard of care in the management of endodontic emergencies
This document discusses various endodontic emergencies, including:
- Hot tooth caused by irreversible pulpitis, which requires immediate pain relief. Bupivacaine is recommended for injection.
- Dentin hypersensitivity caused by exposed dentin, which can be treated by plugging dentinal tubules or desensitizing nerves.
- Acute apical periodontitis presenting with tooth discomfort on biting, which is usually treated with symptomatic relief for vital teeth or root canal treatment for non-vital teeth.
- Acute periapical abscess seen as swelling and pain, sometimes requiring incision and drainage along with root canal treatment and antibiotics.
This document provides information on various types of pulpal and periapical diseases. It discusses the etiology, signs and symptoms, pathogenesis, diagnosis, and treatment of different conditions including acute and chronic apical periodontitis, apical abscesses, granulomas, cysts, condensing osteitis, and root resorption. Microorganisms commonly associated with these diseases include streptococcus, peptostreptococcus, and provotella. Diagnosis involves clinical examination, vitality testing, and radiographic examination to identify features such as bone loss, lesions, or sinus tracts.
Similar to Endodontic emergencies and mid term flare ups (20)
Restorative procedures require adequate isolation of the operating field for best results.
A clean and dry field is comfortable both for the patient and the operator.
It provides better access and visibility, improving the efficiency of the operator.
The properties of many dental materials are improved in the absence of moisture.
Isolation collects the materials from operating site and also prevents their aspiration.
Isolation also often permits the dentist to carry out extended operations if desired.
Goals of isolation:
Moisture control
Retraction and access
Harm prevention . Safe and aseptic operating field
Prevent accidental swallowing of restorative materials and instruments
Mineral trioxide aggregate, described in 1993, is an aggregate of mineral oxides added to “trioxides” of tricalcium silicate, tricalcium aluminate, and tricalcium oxide silicate oxide.
It was patented by Mahmoud Torabinejad and Dean White, and described it as the tooth filling material comprising of Portland cement ( TYPE 1)
hydraulic type of cement
Biodentine, a tricalcium silicate based dental material was introduced by Septodont in the year 2010known as “dentine in a capsule”
The product was synthesized de novo and was free from the impurities present in the derivatives of portland cement like MTA.
It helps in achieving biomimetic mineralisation within the depths of a carious cavity
Microorganisms cause virtually all pathoses of the pulp and periapical tissues.
Once bacterial invasion of pulp tissues has taken place, both non-specific inflammation and specific immunologic response of the host have a profound effect on the progress of the disease.
Endodontic infection develops in root canals devoid of host defenses,
pulp necrosis (as a sequel to caries, trauma, periodontal disease,or iatrogenic operative procedures)
or pulp removal for treatment.
Biofilm-induced oral diseases.
ROUTES OF ROOT CANAL INFECTION
Caries
• Trauma-induced fractures
• Cracks
• Restorative procedures
• Scaling and root planing
• Attrition
• Abrasion
• Gaps in the cementoenamel junction
at the cervical root surface
• Dentinal tubules
• Direct pulp exposure
• Periodontal disease
• Anachoresis
Mechanisms of Microbial Pathogenicity and Virulence Factors
Pathogenicity : The ability of a microorganism to cause disease.
Virulence: Degree of pathogenicity of a microorganism.
Some microorganisms routinely cause disease in a given host and are called primary pathogens.
Other microorganisms cause disease only when host defenses are impaired and are called opportunistic pathogens by changing the balance of the host–bacteria relationship.
Bacterial strategies that contribute to pathogenicity include the ability to coaggregate and form biofilms.
In the pathogenesis of primary apical periodontitis
Bacteria in caries lesions form authentic biofilms adhered to dentin.
Diffusion of bacterial products through dentinal tubules induces pulpal inflammation
After pulp exposure, the exposed pulp tissue is in direct contact with bacteria and their products
and responds with severe inflammation. Some tissue invasion by bacteria may also occur.
Bacteria in the battlefront have to survive the attack from the host defenses and at the same time acquire nutrients to keep themselves alive.
In this bacteria–pulp clash, the latter invariably is “defeated” and becomes necrotic, so bacteria move forward and “occupy the territory”—that is, they colonize the necrotic tissue.
These events advance through tissue compartments, coalesce, and move toward the apical part of the canal until virtually the entire root canal is necrotic and infected.
At this stage, involved bacteria can be regarded as the early root canal colonizers or pioneer species (play an important role in the initiation of the apical periodontitis disease process, modify the environment, making it conducive to the establishment of other bacterial groups)
General anaesthetics (GAs) are drugs which produce reversible loss of all sensation and consciousness.
The cardinal features of general anaesthesia are:
• Loss of all sensation, especially pain.
• Sleep (unconsciousness) and amnesia
• Immobility and muscle relaxation
• Abolition of somatic and autonomic reflexes.
GA was absent until the mid 1800’s
Original discoverer of GA
-Crawford long, physician from Gerogia(1842),
ETHER ANESTHESIA
. NITROUS OXIDE
- Horace wells(1844)
. GASEOUS ETHER by William T.G. Morton(1846)
. CHLOROFORM introduced by
- James simpson (1847)
METHODS OF ADMINISTRATION OF INHALATIONAL GENERAL ANAESTHETICS
OPEN METHOD: This is a simple method of administering a volatile anaesthetic.
A simple mask covered with six to ten layers of gauze, which does not fit the contour of the face is held on the face and an anaesthetic like ether, or ethyl chloride is poured on it in drops. The anaesthetic vapour, diluted with air, is inhaled through the gap between the mask and the face.
SEMI-OPEN METHOD: This method is similar to open method but the dilution with air is prevented by using either a well-fitting mask like Ogston’s mask or layers of gauze between face and the mask. A small carbon dioxide build-up occurs with this method.
SEMI-CLOSED METHOD: This method allows some rebreathing of the anaesthetic drug with the help of a reservoir but in addition, part of the volume of each succeeding inspiration is a new portion from an anaesthetic mixture. This method involves accumulation and rebreathing of carbon dioxide.
• CLOSED METHOD: This method employs the chemical agent soda lime to absorb the carbon dioxide present in the expired air. It requires the use of a special apparatus but is particularly useful when the anaesthetic agent is potentially explosive
STAGES OF ANAESTHESIA
Guedel, in 1920 outlined the four stages of general anaesthesia :
• Stage I: Stage of analgesia
• Stage II: Stage of delirium
• Stage III: Stage of surgical anaesthesia
• Stage IV: Stage of respiratory paralysis
Inadequate anaesthesia is indicated by:
Signs of ANS overactivity, such as tachycardia, rise of BP, sweating and lacrimation.
Grimacing;
Other muscle activity.
Surgical anaesthesia is indicated by:
Loss of eyelash (lid) reflex
Development of rhythmic respiration.
Deep anaesthesia is suggested by :
Depression of respiration.
Hypotension
Asystole
Temporomandibular joint anatomy and functionDR POOJA
diarthrodial joint
The masticatory system is the functional unit of the body primarily responsible for chewing, speaking and swallowing. Components also play a major role in tasting and breathing.
The system is made up of bones, joints, ligaments, teeth and muscles.
In addition ,there is an intricate neurologic controlling system that regulates and coordinates all these structural components.
The Temporomandibular joint (TMJ) is formed by the articulation between the articular eminence and the anterior part of the glenoid fossa of the squamous part of temporal bone above and the condylar head of the mandible below.
The TMJ contains a fibrous intraarticular disk that is interposed between the articular surface and functions as a shock absorber.
The TMJ is a compound joint that can be classified by anatomic type as well as by function.
Anatomically the TMJ is a diarthrodial joint, which is a discontinuous articulation of two bones permitting freedom of movement that is dictated by associated muscles and limited by ligaments.
It is also a synovial joint, lined on its inner aspect by a synovial membrane, which secretes synovial fluid. The fluid acts as a joint lubricant and supplies the metabolic and nutritional needs of the non-vascularized internal joint structures.
Functionally the TMJ is a compound joint, composed of four articulating surfaces:
articular facets of the temporal bone
articular facets of the mandibular condyle
superior surface of the articular disk
inferior surface of the articular disk.
The articular disk divides the joint into two compartments. The lower compartment permits hinge motion or rotation and hence is termed ginglymoid.
The superior compartment permits sliding (or translatory) movements and is therefore called arthrodial. Hence the temporomandibular joint as a whole can be termed ginglymoarthrodial.
SYNONYMS
Craniomandibular joint/ articulation
Mandibular joint
Bicondylar joint
Modified ball and socket joint
Compound joint
Diarthroidal joint
oral mucosa
The term mucous membrane is used to describe the moist lining of the gastrointestinal tract, nasal passages, and other body cavities that communicate with the exterior. In the oral cavity this lining is referred to as the oral mucous membrane, or oral mucosa. At the lips the oral mucosa is continuous with the skin; at the pharynx the oral mucosa is continuous with the mucosa lining the rest of the gut. Thus the oral mucosa is located anatomically between skin and gastrointestinal mucosa and shows some of the properties of each.
CLASSIFICATION
The classification based on these functional criteria, divides the oral mucosa into three major types:
1. Masticatory mucosa 25% (gingiva and hard palate)
2. Lining or reflecting mucosa 60% (lip, cheek, vestibular fornix, alveolar mucosa, floor of mouth and soft palate)
3. Specialized mucosa 10% (dorsum of the tongue and taste buds)
Based on keratinization:
KERATINIZED MUCOSA—
MASTICATORY MUCOSA
VERMILLION BORDER OF LIPS
NON KERATINIZED MUCOSA–
LINING MUCOSA
SPECIALIZED MUCOSA
DEVELOPMENT OF ORAL MUCOSA
The epithelium of the oral cavity is derived from both the ectoderm and the endoderm. The anterior part of the oral cavity is lined by the epithelium derived from the ectoderm.
By 13–20 weeks differences between keratinized and nonkeratinized mucosa becomes apparent. Keratohyaline granules in the keratinized mucosa and region specific cytokeratin appear.
Lingual papillae appear early at about 7th week; the circumvallate and foliate papillae appear earlier than filiform papillae, which can be recognized by 10–12 weeks.
FUNCTIONS OF ORAL MUCOSA
DEFENSE
1.Effective barrier for the entry of the microorganisms.
2.The oral mucosa is impermeable to bacterial toxins. It also secretes antibodies and has an efficient humoral and cell mediated immunity.
LUBRICATION
The secretion of salivary glands keeps the oral cavity moist and thus prevents the mucosa from drying and cracking thereby ensuring an intact oral epithelium.
A moist oral cavity helps in speech, mastication, swallowing and in the perception of taste.
SENSORY
The oral mucosa is sensitive to touch, pressure, pain and temperature.
The sensation of taste is a unique sensation, felt only in the anterior 2/3rd of the dorsum of the tongue.
Swallowing, gagging, retching and salivating reflexes are initiated by receptors in the oral mucosa.
Touch sensations in the soft palate results in gag reflex
PROTECTION
The oral mucosa protects the deeper tissues from mechanical forces resulting from mastication and from abrasive nature of foodstuffs.
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
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Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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Recent Trends
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2. CONTENTS
• Introduction
• Classifications
• Different Types Of Endodontic Emergencies And
Their Management
1.PRETREATMENT ENDODONTIC
EMERGENCIES
(i) Cracked tooth syndrome
(ii) Symptomatic reversible pulpitis
(iii) Symptomatic irreversible pulpitis
(iv) Symptomatic apical periodontitis
(v) Acute exacerbation of asymptomatic
apical periodontitis (phoenix abscess)
(vi) Acute alveolar abscess
3. CONTENTS
2. DURING TREATMENT
(a) Hot tooth
(b) Endodontic flare-ups
(c) Hypochlorite accident
(d) Air emphysema
(e) Aspiration/ ingestion of instruments
(f) Perforation
3. AFTER TREATMENT
(a) Postobturation pain
(b) Vertical root fracture (VRF)
• CONCLUSION
4. An endodontic emergency is defined as
pain and/or swelling caused by
inflammation or infection of pulp and/or
periradicular tissue necessitating an
emergency visit to the dentist for
immediate treatment.
The main causative factors responsible for occurrence of
endodontic emergencies are:
Pathosis in pulp and periradicular tissues
Traumatic injuries
Grossman endodontic practice 13th edi chapter 7, pg 146
5. Recent studies report a 60-82% incidence of endodontic emergencies
among all dental emergencies.
Within this group, 20-42% of patients seek care for teeth with
symptomatic irreversible pulpitis (SIP) .
Additionally, about 60% of SIP patients also complain of
symptomatic apical periodontitis (SAP)
The goal of management of endodontic emergencies is to quickly and
effectively manage pain and infections thereby also minimizing the
development of persistent pain and the formation of periapical
pathology
Management of endodntic emergencies. www.aae.org Fall 2017
14. • ‘Cuspal fracture odontalgia’
was first used by Gibbs in
1954
• ‘Cracked tooth syndrome’ or
‘Cracked cusp syndrome’.
coined by Cameron in 1964.
• Also called-
Split tooth syndrome , or
Green-stick fracture
BRITISH DENTAL JOURNAL VOLUME 208 NO. 11
JUN 12 2010. Cracked tooth syndrome. Part 1. Cracked
tooth syndrome. Part 1: aetiology and diagnosis S. Banerji
15. • Crack tooth syndrome is defined as
“incomplete tooth fracture extending through
body of the tooth causing pain of idiopathic
origin.”
• Most distinct clinical Features:
»Rebound pain
»Sharp pain on eating or drinking
hot/sugary substances
TEXTBOOK OF ENDODONTICS;
NISHA GARG
16. Inconsistent ability to localise affected tooth
Sensitivity to cold thermal stimuli; in some cases hyper-
reactivity to hot/sugary stimuli may also occur
Pain may be elicited by lateral cusp pressure, as evoked by ‘bite
tests’ and tooth grinding. Pain at initiation or release of biting
pressure
Fracture lines may be seen clinically (sometimes upon
removal of the restoration), aided by magnification, dyes or
transillumination
Positive response to vitality tests; exaggerated
response to cold thermal stimuli
Sudden sharp pain on release of
bite: rebound pain SIGNS &
SYMPTOMS
BRITISH DENTAL JOURNAL VOLUME 208 NO. 11
JUN 12 2010. Cracked tooth syndrome. Part 1. Cracked
tooth syndrome. Part 1: aetiology and diagnosis S. Banerji
17. Lynch et al. have subdivided the
causes of cracks into four major
causative categories, hence:
Restorative procedures
Occlusal factors
Developmental conditions , and
Miscellaneous factors
BRITISH DENTAL JOURNAL VOLUME 208 NO. 11
JUN 12 2010. Cracked tooth syndrome. Part 1. Cracked
tooth syndrome. Part 1: aetiology and diagnosis S. Banerji
18. When the fractured portions of the
tooth move independently of each other,
it causes sudden movement of fluid
present in the dentinal tubules.
This causes activation of myelinated A-
type fibers within the dental pulp and
results in acute pain.
Hypersensitivity to cold may occur due
to the seepage of toxic irritants through
the crack.
This leakage of toxic irritants cause the
release of neuropeptides, and a
concomitant lowering in the pain
threshold of unmyelinated C-type fibers
within the dental pulp.
the symptoms are caused by the
alternating stretching and
compressing of the odontoblast
processes located within the crack
Int J Appl Basic Med Rest.2015 Sep-Dec; 5(3): 164–168. Cracked tooth syndrome: Overview of literature Shamimul Hasan
THEORIES
ASSOCIATED
WITH CTS
20. • FIBRE OPTIC LIGHT:
transillumination of fracture line
• DYE: such as gentian violet or
methylene blue
• Use Of Wooden Sticks, Cotton
Rolls, rubber plungers of
anaesthetic carpules suspended from
a length of floss.
• The Tooth slooth is placed either
between the cusps of a tooth or onto
the cusp tip and the patient is asked to
close together.
• Pain on biting or release on the
specific cusp identifies the
offending/involved cusp
BRITISH DENTAL JOURNAL VOLUME 208 NO. 11 JUN
12 2010. Cracked tooth syndrome. Part 2: restorative
options for the management of cracked tooth syndrome S.
Banerji
21.
22. TREATMENT
URGENT CARE!!
• Immediate reduction of
occlusal contacts by
selective grinding of tooth
at the site of crack or its
antagonists
TEXTBOOK OF ENDODONTICS;
NISHA GARG
25. 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
• 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
Cohen pathways of pulp
26. CAUSES
1. Trauma-disturbed occlusal relationship
2. Thermal shock- too long contact of bur during cavity preparation or
overheating due to polishing of a filling.
3. Excessive dehydration-chloroform or alcohol
4. Galvanic shock-fresh amalgam filling in contact with gold
restoration
5. Chemical irritation-sweet of sour food stuff or irritation of silicate
or self cure acrylic
MANAGEMENT
1. Removal of the cause.
2. Recontouring of recently placed restoration which causes pain.
3. Removal of the restoration and replacing it with the sedative
dressing if painful symptoms still persist following the tooth
preparation.
4. Relieving the occlusion.
28. DEFINITION: It is a persistent inflammatory condition of the pulp,
symptomatic or asymptomatic, caused by a noxious stimulus.
SYMPTOMS:
• Pain lasts for minutes to hours.
• 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.
Cohen pathways of pulp
29. PAIN –
• sharp, piercing, or shooting in nature,
• it may be intermittent, continues depending on degree of pulp
involvement, related to external stimuli
• Later stages- bowing, gnawing & throbbing
• Pain-increased by heat relieved by cold
CAUSES-
• Bacterial involvement of pulp through caries. Other factors-chemical ,
thermal, mechanical
MANAGEMENT-
• Vital pulp According to Grossman, the preferable emergency
treatment is ‘PULPECTOMY’ - complete removal of the pulp and
placement of an intracanal medicament to act as a disinfectant or
obtundent.
Cohen pathways of pulp
31. • Defined as a painful inflammation of the periodontium as a result
of trauma, irritation, or infection through the root canal,
regardless of whether the pulp is vital or nonvital.
• Pressure on tooth (Occlusion/percussion) is transmitted to the fluid
which pushes on nerve endings in the periodontal ligament.
• It is characterized by:
Tooth may be elevated out of its socket because of the build up in
fluid pressure in the periodontal ligament.
Discomfort to biting or chewing.
Sensitivity to percussion is a hallmark diagnostic test.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
32. • Radiographic examination may show a thickened periodontal
ligament or a small area of rarefaction if a pulp less tooth is
involved and it may show normal periradicular structures if a vital
pulp is present in the tooth
TREATMENT:
• Adjustment of high points (in hyperocclusion cases) and removal of
irritants (in case of nonvital infected pulp) is the immediate line of
management.
• Root canal treatment
Management of endodontic emergencies chapter 2, Cohen pathways of pulp 10th edition
34. • It is a localized collection of pus in the alveolar bone at
the root apex of a tooth following death of the pulp,
with extension of the infection through the apical
foramen into the periradicular tissues.
SYMPTOMS:
tenderness of the tooth, relieved by
continued slight pressure on the
extruded tooth to push it back into
the alveolus.
severe, throbbing pain, with
attendant swelling of the overlying
soft tissue.
Management of endodontic emergencies chapter 2,
Cohen pathways of pulp 10th edition
35. • the pain may subside or cease entirely while the adjacent tissue
continues to swell.
• If left unattended, chronic apical abscess sinus tract
(opening in the labial or buccal mucosa)
• It may further progress on to osteitis, periostitis, cellulitis, or
osteomyelitis.
• Systemic features such as fever and malaise may also be present.
a radiograph may help
determine the tooth affected by
showing a cavity, a defective
restoration, thickened
periodontal ligament space, or
evidence of breakdown of bone
in the region of the root apex.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
36. Management
Biphasic treatment:
a. Pulp debridement
b. Incision and drainage
• Do not leave tooth open between appointments.
• In case of localized infections, antibiotics provide
no additional benefit.
• In case of systemic features, antibiotics should
be given.
• Relieve the tooth out of occlusion in cases of
hyperocclusion.
• To control postoperative pain, NSAIDs should be
prescribed.
• Speed of recovery will rely on canal debridement.
LA is contraindicated in such cases
because of following reasons:
1. Pain caused by injection in distended
area.
2. Chances of dissemination of virulent
organisms.
3. Ineffectiveness of local anesthetics.
Acutely inflamed tissue has a localized
pH that is acidic inspite of the body's
natural buffering action.
Local anesthetics are effective in tissues
with a more alkaline pH and, as a result,
are ineffective when injected into
acutely inflamed tissue.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
37. Nonvital infected tooth with active drainage from the periapical area through the
canal.
A, Access opened and draining for 1 minute.
B, Drainage after 2 minutes.
C, Canal space dried after 3 minutes.
Management of endodontic emergencies chapter 2, Cohen pathways of pulp 10th edition
38. Pulpal Necrosis With Acute
Apical Abscess
1977 preferred to leave the
tooth open, with instrumentation extending
beyond the apex
to help facilitate drainage through the canals.
Until 1977 preferred to leave the tooth open, with
instrumentation extending beyond the apex to help
facilitate drainage through the canals.
there is currently a trend toward not leaving teeth open
for drainage.
another trend: when treatment is done in more than one
visit, most endodontists will use calcium hydroxide as an
intracanal medicament.
Care should be taken not to allow necrotic debris to be
pushed beyond the apex, because this has been shown to
promote more posttreatment discomfort
Trephination
In the absence of swelling, trephination is the surgical perforation of the alveolar
cortical plate to release from between the cortical plates the accumulated tissue
exudate that causes pain.
No Swelling
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
39. Pulpal Necrosis With Acute
Apical Abscess
Swelling may be controlled by establishing drainage
through the root canal or by incising the fluctuant
swelling.
When the swelling is localized, the preferred avenue is
drainage through the root canal. Complete canal
debridement and disinfection are paramount to success
presence of persistent swelling, gentle finger pressure
to the mucosa overlying the swelling may help facilitate
drainage
Incision for Drainage
Swelling
Management of endodontic emergencies chapter 2, Cohen
pathways of pulp 10th edition
40. • A non functional swelling can be converted to a soft fluctuant
state by rinsing with warm saline solution 3-5 min at a time
repeated every hour.
Irrigants used in treating acute abscess
• Initial stages sterile water and saline/ (NaOCl clumping debris)
• When the patency through the apex is maintained, sodium hypochlorite
may be used for further canal preparation.
• For further appointments, an alternating solutions of sodium hypochlorite
and hydrogen peroxide is recommended
Textbook of endodontics 4th edition chapter 10 Management of acute emergencies and traumatic dental injuries
K Gulabivala, Y-L Ng
41. (10) Pre-op buccal abscess
over tooth No. 14.
(11) Buccal incision made with
No. 15 scalpel.
(12) Purulence draining from incised fluctuant abscess.
(13) Curved hemostat used to open incised site.
(14) Monoject (Medtronic)
syringe used to irrigate inside
incision site.
Textbook of endodontics 4th edition chapter 10 Management of acute emergencies
and traumatic dental injuries K Gulabivala, Y-L Ng
42. A, Localized fluctuant abscess as a result of
periradicular pathosis after trauma.
B, Radiographic appearance. C, Drainage was
spontaneous when the tooth was opened. D,
Christmas tree–shaped rubber drain placed after
soft tissue incision.
Different shapes of rubber drains. From
left to right: I drain, Christmas tree
drain, T drain, and Penrose drain with
oblique cuts. These designs are self-
retentive and do not require suturing to
the incision margins.
Endodontic
Principles &
Practise 4th Edi.
Torabinejad &
Walton
44. • It is an acute inflammatory reaction superimposed on an existing
chronic apical periodontitis.
• Also c/d: Exacerbating apical periodontitis , PHOENIX
ABSCESS.
CAUSES:
• noxious stimulus from a diseased pulp can cause acute inflammatory
response in dormant lesions.
• Lowering of body s defenses due to influx of bacterial toxins from the
root canal or,
• irritation during root canal instrumentation triggers acute
inflammatory response.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
45. tender on palpation
tooth gets elevated from its socket and becomes sensitive.
The mucosa over radicular area may appear red and swollen and is
sensitive to palpation.
Lack of response to vitality tests
a tooth may respond to the electric pulp test because of fluid in the
root canal or in a multirooted tooth.
Well-defined periradicular lesion evident in a
case of acute exacerbation of chronic
periodontitis.
48. CROWN FRACTURE
• Uncomplicated crown fracture can be
defined as fracture of the enamel only or
enamel and dentin without pulp exposure
Treatment:
• Reattachment of the separated enamel-
dentin fragment or conservative restoration
with composite resin
Management of endodontic
emergencies chapter 2, Cohen
pathways of pulp 10th edition
49. • CROWN FRACTURE INVOLVING PULP
• crown fractures involving enamel, dentin & pulp are called
‘complicated crown” fractures by Andreasen & class 3 by Ellis.
• Degree of pulp exposure--- pinpoint exposure to total unroofing of
coronal pulp.
TREATMENT:
• Treatment options for complicated crown fracture are
(1) Vital pulp therapy, comprising pulp capping, partial pulpotomy, or
full pulpotomy;
(2) Pulpectomy.
Choice of treatment depends on the stage of development of the
tooth, the time between trauma and treatment, concomitant
periodontal injury, and restorative treatment plan.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
50. ROOT FRACTURE
• < 3% of all dental injuries
• Since root fractures are usually oblique (facial to
palatal) , one periapical radiograph may easily miss its
presence.
• It is imperative to take at least three angled
radiographs (45, 90, 110 degrees)
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
51. Radiographs showing the importance of different vertical angulations
for diagnosis of root fracture.
Radiographic technique
used for suspected root
fractures. At least two
angulations are made: the
conventional (90 degree)
view and a steep vertical (45
degree) view.
Principles & practise of endodontics 3rd edit, walton & torabinejad
52. • Re-approximation of the two segments done by releasing the coronal
segment from the bone by gently pulling it slightly downward
with finger pressure or extraction forceps, and then once it is
loose, rotate it back to its original position
• The traditionally recommended splinting protocol has been changed
from 2 to 4 months with rigid splinting to a semirigid splint to
adjacent teeth for 2 to 4 weeks.
Textbook of endodontics 4th edition chapter 10 Management of acute emergencies and traumatic dental injuries
K Gulabivala, Y-L Ng
53. Healing with calcified tissue. Radiographically, the fracture line is
discernible, but the fragments are in close contact
Healing with interproximal connective tissue. Radiographically,
the fragments appear separated by a narrow radiolucent line, and the fractured
edges appear rounded
Healing with interproximal bone and connective tissue.
Radiographically, the fragments are separated by a distinct bony ridge
Interproximal inflammatory tissue without healing.
Radiographically a widening of the fracture line and/or developing radiolucency
corresponding to the fracture line becomes apparent
Management of endodontic emergencies chapter 2, Cohen pathways of pulp 10th edition
55. Types of luxation injury:
1. Concussion implies no displacement, normal mobility, and
sensitivity to percussion.
2. Subluxation implies sensitivity to percussion, increased mobility,
and no displacement.
3. Lateral luxation implies displacement labially, lingually, distally,
or incisally.
4. Extrusive luxation implies displacement in a coronal direction.
5. Intrusive luxation implies displacement in an apical direction into
the alveolus.
Management of endodontic emergencies chapter 2, Cohen pathways of
pulp 10th edition
56. • Initial treatment : avoid use of the tooth.
• serious luxation: slight occlusal adjustment OR repositioning
(reduction) and splinting (stabilization) for 2 to 6 weeks.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
57. Avulsion of permanent teeth:
theory to practice
• Avulsion is defined as complete displacement of a tooth from the
socket.
• Tooth avulsion results in attachment damage and pulp necrosis.
• The tooth is “separated” from the socket mainly due to tearing of
the periodontal ligament that leaves viable periodontal ligament
cells on most of the root surface.
• The incidence is < 3% of all dental injuries
Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of
Permanent Teeth Dental Traumatology 2012;28:88-96
58. When the patient arrives:
1. The tooth is placed in a cup of physiologic saline.
2. The area of injury is radiographed, looking for evidence of alveolar
fracture.
3. The avulsion site is examined carefully for any loose bone fragments
that may be removed.
4. The socket is gently irrigated with saline to remove contaminated
coagulum.
5. In the cup of saline, the tooth is grasped with extraction forceps by the
crown to avoid handling the root.
6. The tooth is examined for debris, which, if present, is gently removed
with gauze moistened with saline.
REPLANTATION WITHIN 1 HOUR OF AVULSION.
Principles & practise of endodontics 3rd edit,
walton & torabinejad
59. 7. The tooth is replaced into the socket; after partial insertion using the
forceps, gentle finger pressure is used or the patient bites on gauze
until the tooth is seated.
8. Proper alignment is checked, and hyperocclusion is corrected. Soft
tissue lacerations are tightly sutured, particularly cervically.
9. The tooth is stabilized for 1 to 2 weeks with a splint
10. It has been suggested that antibiotics be prescribed in the same
dosage as that used for mild to moderate oral infections,
A tetanus booster injection is recommended if the last one was
administered more than 5 years previously
11. Supportive care is given; a soft diet and mild analgesics are
suggested as needed.
• Root canal treatment is indicated for mature teeth and should be
done optimally after 1 week and before the splint is removed
Principles & practise of endodontics 3rd edit,
walton & torabinejad
60. • Debris and pieces of soft tissue adhering to the root surface are
removed.
• The tooth is soaked in a 2.4% solution of sodium fluoride
(acidulated to pH 5.5) for 5 to 20 minutes.
• The pulp is extirpated, and the canal is cleaned, shaped, and filled
while the tooth is held in a fluoride-soaked piece of gauze. Often the
procedure can be accomplished from an apical direction if the root is
immature.
• The alveolar socket is carefully suctioned to remove the blood clot.
The socket is irrigated with saline. Anesthesia may be necessary first.
• The tooth is gently replanted into the socket, checking for proper
alignment and occlusal contact.
• The tooth is splinted for 3 to 6 weeks
REPLANTATION AFTER 1 HOUR
Principles & practise of endodontics 3rd edit,
walton & torabinejad
61.
62.
63.
64.
65. Replantation of a tooth with closed apex within 1 hour of avulsion in a 14-year-old boy. A, The avulsed
central incisor was brought to the dentist in a cup of milk. B, Clinical appearance of the avulsion site.
C, A wire-composite splint is used after repositioning the tooth. D, Radiographic examination after
splinting. The roots appear short, probably due to history of previous trauma to the anterior teeth. E,
Calcium hydroxide is placed in the root canal 8 days later and left in place for 2 months. F-G, Clinical
and radiographic appearance at 2 months follow-up control. Root canal treatment with gutta-percha
66. I. healing with a normal periodontal ligament. Clinically the tooth exhibits a
normal position and mobility. Radiographically the periodontal ligament
space is evident and displays no signs of bone or root resorption
II. healing with surface resorption. The resorptive process is self-limiting, and
clinically the tooth is normal. The resorptive defects are usually not evident
radiographically
III. healing with ankylosis or replacement resorption. It is characterized by
osteoclastic activity and resorption of the root followed by deposition of bone
into the defect. Clinically the tooth is immobile and percussion elicits a clearly
different sound compared with normal teeth. The radiographic appearance is
consistent with the replacement of root structure by bone and the loss of a
visible periodontal membrane. No known treatment is available for
replacement resorption.
IV. healing with inflammatory resorption. Clinical evaluation may detect signs
and symptoms of inflammation, infection, and mobility.
Radiography reveals radiolucent areas in the root and adjacent bone.
Endodontic treatment may arrest inflammatory resorption.
Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent Teeth Dental Traumatology
2012;28:88-96
68. HOT TOOTH
• The term ‘‘hot’’ tooth generally refers to a pulp that has been
diagnosed with irreversible pulpitis, with spontaneous, moderate-
to-severe pain
• Patients in pain as a result of a tooth diagnosed with irreversible
pulpitis have additional difficulties attaining pulpal anesthesia.
Management of endodontic emergencies chapter 2, Cohen pathways
of pulp 10th edition
69. Theories related to hot tooth
inflamed tissue has a lowered pH, which
reduces the amount of the base form of
the anesthetic needed to penetrate the
nerve sheath and membrane.
Therefore, there is less ionized form of
the anesthetic within the nerve to
produce anesthesia.
nerves arising from the inflamed tissue have
altered resting potentials and reduced
thresholds of excitability.
anesthetic agents were not able to prevent the
transmission of nerve impulses because of the
lowered excitability thresholds of inflamed
nerves
• Sodium channel expression on C fibers
shifts from TTX sensitive to TTX resistant
• TTX resistant channels are five times
more resistant to anesthetic (lidocaine)
• Bupivacaine found to be more potent
• Alternate and supplementary injection
sites: intraosseous, intraligamentory Dent Clin N Am 2010 Nusstein etal
Local anaesthesia strategies for hot
tooth
71. • The key to giving a successful PDL injection
remains the attainment of back-pressure during
the injection.
• The development of computer-controlled
anesthetic delivery systems (the Wand or the
Single Tooth Anesthesia [Milestone Scientific,
Livingston, NJ, USA] devices) have been found
to be able to deliver a PDL injection.
INTRALIGAMENTARY (PERIODONTAL LIGAMENT)
INJECTION
Dent Clin N Am 2010 Nusstein
etal Local anaesthesia strategies
for hot tooth
Dent Clin N Am 2010 Nusstein etal
Local anaesthesia strategies for hot
tooth
72. INTRAOSSEOUS ANAESTHESIA
Allows the practitioner to deliver local anesthetic solutions directly
into the cancellous bone surrounding the affected tooth.
several IO systems available
• Stabident , X-Tip, IntraFlow handpiece
• Key to success: deposition into the cancellous space;
• In 0-48% --- transient moderate to severe pain on perforation and
deposition of anesthetic
• Perforator breakage
• Optimal site: DISTAL to the problematic tooth
• Except second molars: MESIAL to the tooth
• Immediate onset
Dent Clin N Am 2010 Nusstein etal
Local anaesthesia strategies for hot
tooth
73. INTRAPULPAL ANAESTHESIA
• Moderately to severe painful
• Immediate onset
• Short (15 - 20 min) duration of action
• Pulp must be exposed
• Predictable under back-pressure.
• Indicated when PDL & IO injections fail.
Dent Clin N Am 2010 Nusstein etal
Local anaesthesia strategies for hot
tooth
74. Preemptive stategies to improve success of IANB injection:
• Use pretreatment oral doses of acetaminophen or a
combination of acetaminophen and ibuprofen versus
placebo in patients undergoing endodontic therapy.
• an IO injection of 40mg of methyl-prednisolone (Depo-
Medrol) and found that it significantly reduced pain.
• Give short morning appointments followed by good
morning breakfast.
• Premedication with lorazepam 1mg (after checking
interaction with other drugs) night before sleep followed by 90
minutes prior to procedure
Dent Clin N Am 2010 Nusstein etal
Local anaesthesia strategies for hot tooth
75. • A non-pharmacological method for
pain control is the use of
transcutaneous electrical nerve
stimulation [TENS]
• Stimulate superficial nerves for
localized pain relief
Dent Clin N Am 2010 Nusstein
etal Local anaesthesia strategies
for hot tooth
76. ENDODONTIC FLARE- UP
According to American Association of Endodontics (1998):
• An acute exacerbation of peri radicular pathosis after initiation or
continuation of root canal treatment
• Studies report 1.8-3.2 % flare-ups
• Flareup is described as the occurrence of pain, swelling or the
combination of these during the course of root canal therapy, which
results in unscheduled visits by patients (Gerald W Harrington,1992)
Stomatologija, Baltic Dental and Maxillofacial Journal, 16:25-30, 2014 Pain and flare-up after endodontic treatment procedures
Predisposing
Factors
77. Result of imbalance in host-
bacteria relationship.
F. nucleatum, Prevotella species
and Porphyromonas species
were frequently isolated from
flare-up cases.
Enterococcus faecalis is present
in retreatment cases.
78. INTERAPPOINTMENT
FLARE UPS
• Apical periodontitis
secondary to treatment
• Incomplete removal of the
pulp tissue
• Phoenix abscess
• Recurrent periapical abscess
• Flare ups related to necrotic
pulp
POSTOBTURATION
FLARE UPS
79. Previously Vital Pulps with Complete
Debridement - situation is unlikely to
be a true flare-up, and patient
reassurance and the prescription of a
mild to moderate analgesic
Previously Vital Pulps with
Incomplete Debridement- The
working length should be rechecked,
and the canal(s) should be carefully
cleaned with copious irrigation of
sodium hypochlorite.
A dry cotton pellet is then placed,
followed by a temporary filling, and a
mild to moderate analgesic is
prescribed
Previously Necrotic Pulps with No Swelling
Occasionally, these teeth develop an acute
apical abscess (flare-up) after the
appointment.
The tooth is opened and the canal is gently
recleaned and irrigated with sodium
hypochlorite the canals are dried, calcium
hydroxide paste is placed, and the access is
sealed.
The tooth should not be left open.
analgesic regimen for moderate to severe
pain are helpful; antibiotics are not
indicated.
Previously Necrotic Pulps with Swelling –
incision and drainage indicated.
Canals should be opened and debrided,
medicated with calcium hydroxide paste,
and closed
Treatment
of Flare-ups
Principles & practise of endodontics 3rd edit, walton & torabinejad
80. HYPOCHLORITE ACCIDENT
• It refers to any event in which sodium
hypochlorite extruded beyond the apex of a
tooth and the patient immediately manifests a
combination of some of the following:
• Severe immediate pain
• swelling
• Profuse bleeding both interstitially and
through the tooth.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
81. • Causes :
• Forceful injection of Naocl due to wedging of the irrigating needle
into the root canal.
• Irrigating a tooth with a large apical foramen, apical resorption or an
immature apex.
• Features :
• Edema and ecchymosis, accompanied by tissue necrosis, paraesthesia
and secondary infection.
• Although most patients recover within 1-2 weeks.
• Long-term paraesthesia and scarring have
been reported.
Management of endodontic emergencies
chapter 2, Cohen pathways of pulp 10th
edition
82. • Management:
• Immediate aspiration
• Cold pack over the affected area followed by
warm compresses to encourage healing.
• Regional block anesthesia administered.
• Monitor tooth for the next half hour.
• Bloody exudation extended from canal
denotes the bodies reaction to the irritant.
• Remove the fluid with high volume suction
to encourage further drainage.
Sodium Hypochlorite Accident: A Systematic Review Article in Journal of Endodontics · October 2016
83. • If drainage is persistent consider leaving the tooth open.
• Antibiotic coverage to prevent secondary infection
• Analgesics prescribed. Because of possible bleeding complication
with aspirin and NSAIDs an acetaminophen-narcotic combination
may be more appropriate.
• Corticosteroids – antiinflammatory process
• Prevention :
• Bend the irrigating needle at centre to confine the tip of the needle to
higher/coronal levels of root canal.
• Never bind the needle in the canal
• Oscillate the needle in and out to ensure that the tip is free to express
the irrigant with out resistance
• express the irrigant slowly and gently
Sodium Hypochlorite Accident: A Systematic Review Article in Journal of Endodontics · October 2016
84. • Clinical Note
• Š
Š
Always use passive irrigation and never force the irrigant into the
pulp space
• Š
Š
Sodium hypochlorite should be handled carefully as its
inadvertent seepage under the rubber dam can result in multiple
ulcers and leave the gingiva painfully inflamed
Š
Š
The recommended endodontic
irrigation needle is a 30-gauge
side-vented, close-ended needle
placed passively at:
3 mm short of working length in
posterior teeth
1 mm short of working length in
anterior teeth
Sodium Hypochlorite Accident: A Systematic Review Article in Journal of Endodontics · October 2016
85. AIR EMPHYSEMA
Air introduced into periapical tissues during invasive root
canal treatment - potential to do great harm.
Although rare occurence – but has a risk
Compressed air should never be used in drying of a root canal
that is open to periapical tissues
Textbook of endodontics Nisha garg
2nd edition chapter 21, pg 311
Through stenson’s duct
86. ASPIRATION / INGESTION OF ENDODONTIC
INSTRUMENTS
Aspiration of endodontic hand instruments happens only when
rubber dam is not in place.
Grossman had aptly stated (1955) that if an instrument is
swallowed by the patient, the dentist is likely to be confronted
law-suite.
High power suction along with rubber dam help in
prevention of aspiration of instruments.
Aspiration of endodontic instruments can be a clinical disaster
ending up in life threatening situations or ending up in the
need of major surgery to remove instrument
Textbook of endodontics Nisha garg
2nd edition chapter 21, pg 311
87. • EMERGENCIES DURING ENDODONTIC SURGERY
• Excessive uncontrolled bleeding
• Due to rebound phenomenon
• MEDICAL EMERGENCIES DURING ENDODONTIC
TREATMENT
• Syncope
• Hypoglycemic shock
Endodontic Principles & Practise 4th Edi. Torabinejad & Walton
89. • Following completion of root canal treatment,
patients usually complain of pain especially on
biting and chewing.
• The painful episodes are usually caused by
pressure exerted by insertion of root canal filling
materials or by chemical irritation from
ingredients of root canal cements and pastes.
OVERINSTRUMENTATION is directly
proportional to post operative pain.
If care of working length is not properly taken
overobturation or overfilling may result.
Textbook of endodontics Nisha garg
2nd edition chapter 21, pg 311
90. OVEREXTENDED OBTURATION leads to pain. Periapical
inflammation results in firing of proprioceptive nerve fibers in the
periodontal ligament.
• These results are short lived and abate in 24-48 hours. No treatment is
usually necessary in these cases.
PERSISTENT PAIN: Persistence of
pain or sensitivity for longer periods
may indicate failure of resolution of inflammation.
• In rare cases, inflamed but viable pulp tissue may be left in root canal.
• Retreatment is then indicated in such cases.
Textbook of endodontics Nisha garg
2nd edition chapter 21, pg 311
92. According to the AAE :
“ A true VRF is defined as a
complete or incomplete
fracture initiated from the
root at any level, usually
directed buccolingually ”
2.3% of total fractured teeth
Textbook of endodontics Nisha garg
93. Etiology
Root anatomy
Amount of remaining tooth structure
Presence of pre existing cracks
Overzealous application of condensation
forces to obturate an under- or overprepared
canal (wedging forces)
Bruxism
Textbook of endodontics Nisha garg
94. Pathogenesis
VRF
As it progresses to the PDL, soft tissue grows into
this fragment causing separation of these fragments
When it communicates with the oral cavity bacteria
enter into this area and initiate inflammatory
response
Disintegration of PDL, alveolar bone loss and
formation of granulation tissue
Textbook of endodontics Nisha garg
96. Dhawan A, Gupta S, Mittal R.
Vertical root fractures: An update
review . J Res Dent 2014;2:107-13
97. Clinical Features
Pain in mild to moderate usually
accompanied by bad taste.
The swelling is usually broad-based, and
mid-root in position
In VRF, sinus tract is located close to the
gingival margin as opposed to non-vital
teeth where sinus tracts are located more
apically (differential diagnosis from
endodontic infections).
The presence of two sinus tracts (at both
buccal and lingual aspects) or multiple
sinus tracts is almost pathognomonic for
a VRF.
Dhawan A, Gupta S, Mittal R. Vertical root fractures: An update review . J Res Dent 2014;2:107-13
98. Radiographic Features
Separation of root segments associated
with
• a radiolucency surrounding the bone
• between the roots
Hairline fracture–like radiolucency
Halo appearance—a combined
periapical
and periradicular radiolucency on one
or both
sides of the involved root(J type lesion)
Widening of periodontal ligament space:
Around the whole length of the root may
indicate VRF
Dhawan A, Gupta S, Mittal R. Vertical root fractures: An update review . J Res Dent 2014;2:107-13
99. Vertical root fracture.
After flap reflection and visualization, the
pattern of bony changes tends to be
consistent with oval or oblong "punched-
out" defects filled with granulomatous
tissue (VRF). This is differentiated from
the normal bony fenestration.
Endodontic Principles & Practise 4th Edi.
Torabinejad & Walton
As VRF progresses to the periodontal
ligament, soft tissue growth into the
fracture space increases the separation of
the root segments.
Along the fracture line the periodontal
ligament disintegrates, followed by bone
loss, which is progressive especially in thin
buccal bone plate.
100. Management:
When a longitudinal fracture of a root occurs, the prognosis for that
root is usually hopeless.
Hence, extraction of such teeth is the recommended treatment of
choice.
In multirooted teeth, hemisection or radisectomy may be indicated.
Š
Additional imaging techniques such as CBCT
(cone beam computed tomography) to detect
and visualize VRFs have been introduced.
Management of endodontic emergencies chapter 2, Cohen
pathways of pulp 10th edition
101. • Bonding the fractured segments with glass ionomer bone cement
and replanting the tooth in conjunction with an e-PTFE
membrane
• Two-stage surgical procedure of bonding with silver glass ionomer
cement, placement of a bone graft material and GTR therapy.
• Use of dual-cured adhesive resin cement is preferred for bonding
the fractured fragments
• Use of orthodontic elastics to join the buccal and palatal segments
of fractured tooth followed by sealing with a photocured resin
liner to allow the tooth to be endodontically treated and restored
with a cast crown
• Fitting of orthodontic bands before endodontic treatment to
prevent propagation of a crack or fracture
• Use of CO2 and Nd.YAG laser to fuse fractured tooth roots.
Other alternative attempts at treating VRF include:
Dhawan A, Gupta S, Mittal R. Vertical root fractures: An update review . J Res Dent 2014;2:107-
102. Repair of root fracture has been tried by binding
them with the help of adhesive resins, glass
ionomers and lasers.
But till date no successful technique has been
reported to correct this probem.
Textbook of endodontics Nisha garg
103. CONCLUSION
• The aim of emergency endodontic treatment is to relieve
pain and control any inflammation or infection that may
be present.
• The swift and correct diagnosis of emergency problems is
essential when providing treatment, especially in a busy
dental practice
• Effective caring and management of endodontic
emergencies not only represents a service to the public,
which the dentist can be proud of but also enhaces the
positive image of dentistry