Endodontic Emergencies.pptx

1. Endodontic Emergencies
M RafiWaiez
Araak Oral & Dental care

2. Definition
• True emergency : unscheduled visit with diagnosis and treatment at the
same time.
• urgency indicates less severe problem which can be rescheduled for next
visit.

4. History of the Patient
• Most common component in CC of emergency patient is pain.
• pain on mastication, when teeth are in occlusion, and is localized in nature,
it is periodontal in origin
• if thermal stimuli leads to severe explosive pain and patient is unable to
localize, it is pulpal in origin.

7. Pretreatment Endodontic Emergencies
HotTooth
• painful tooth which requires immediate pain relief
• Most common causes is irreversible pulpitis.
• Teeth most difficult to anesthetize are the mandibular molars
• Bupivacaine is the anesthetic of choice when treating the “hot tooth”

8. Management of Hot tooth
• Explaining patient: short or no waiting time and use of iatrosedation.
• premedication:
anti-inflammatory to be taken 1 hour before the treatment
Provide time gap between anesthetic injection and starting the procedure.
lorazepam 1 mg night before sleep followed by 90 min prior to procedure
Additional anesthetic or supplemental injections

10. Dentin Hypersensitivity
• defined as “sharp, short pain arising from thermal, chemical, tactile, or
osmotic.
• Dentin may become exposed by:
1. gingival recession
2. Loss of enamel
Treatment options:
• Plugging dentinal tubules
• desensitizing the nerve

11. Acute Reversible Pulpitis
characterized by:
• Localized inflammation of the pulp
• Lowering of threshold stimulation forAδ nerve fibers
• Exaggerated, non-lingering response to stimuli
Management
• Removal of the caries
• Removal of restoration and replacing it with sedative

12. Acute Irreversible Pulpitis
• spontaneous pain
• Nocturnal pain
• exaggerated response to hot or cold
• Extensive restoration or caries involving the pulp
• Tooth may be responsive to electrical and thermal tests

14. Acute Apical Periodontitis
occlusal trauma or extension of pulpal pathology.
Tooth may be elevated out of its socket
Discomfort on biting or chewing
Sensitivity to percussion (hallmark diagnostic test)

15. Management of A.A.P
For vital tooth
 Symptomatic treatment and occlusal adjustment if required.
For nonvital teeth
 RCT
 Place sedative dressing
 Relieve the occlusion if indicated
 Prescribe analgesics

16. Acute Periapical Abscess (AAA)
• Swelling along with pain
• feeling that tooth is elevated in the socket
• May not have radiographic evidence
• Systemic features such as fever and malaise may be present
• Mobility may or may not be present

17. Management of AAA
Biphasic treatment:
• –– Pulp debridement
• –– Incision and drainage
• Do not leave tooth open between appointments
• In case of systemic features, antibiotics should be given
• occlusal relief
• NSAIDs
• Speed of recovery will rely on canal debridement

19. Traumatic Injury
• Main objective: immediate relief of pain.
• Luxation injury, fracture of crown or root, or avulsion of tooth.
• Main aim of re-implantation is to preserve maximum number of periodontal
ligament cells and prevent them from drying.

20. Cont…
storage media
ViaSpan=HBSS>coconut water>milk>green tea>egg white. Water is the least
desirable.

22. CrackedTooth Syndrome
• commonly seen in teeth with large and complex restorations
• Crack tooth can be diagnosed after taking case history of the patient
• dietary and parafunctional habits and any previous trauma
• Pain during biting, especially upon release of pressure is a classic sign of
cracked tooth syndrome

23. Treatment
of cracked tooth
• Urgent care involves immediate occlusal reduction.
• preserve the pulpal vitality (full occlusal coverage)
• crown
• If involves pulp and is superficial to alveolar crest, go for RCT.
• fracture below alveolar crest extract the tooth.

24. Intratreatment Emergencies
Mid-Treatment Flare-ups
Etiology
• Over instrumentation
• Inadequate debridement
• Missed canal
• Hyper occlusion
• Debris extrusion
• Procedural complications

25. Risk Factors Contributing Interappointment
Flare-Ups
• Preoperative pain, percussion, sensitivity, and swelling
• Retreatment
• Apprehension
• History of allergies

26. Prevention
• Psychological preparation of the patient
• Long-acting anesthetics such as bupivacaine
• Complete cleaning and shaping of the root canal
• Analgesics should be prescribed

27. Treatment
• Reassure patients
• Adjust occlusion
• Complete debridement along with cleaning and shaping
• Prescribe analgesics
• Never leave the tooth open for drainage
• Recall the patient until the painful symptoms subside

28. Hypochlorite Accident
• occurs when sodium hypochlorite gets extruded beyond tooth apex.
• severe pain, swelling, and profuse bleeding both through the tooth and interstitial
tissues.
Etiology
forceful injection of hypochlorite
irrigation of tooth with wide apical foramen
immature apex
apical resorption

29. Cont…
Clinical Features
• Edema
• ecchymosis along with tissue necrosis
• paresthesia
• secondary injection
• Mostly patients recover within 7–10 days
• But scarring and paresthesia may take a long time to heal.

30. Management
• Immediate aspiration
• application of icepacks
• Since infection can spread, prescribe antibiotics, analgesics, and antihistaminic
• In severe cases, steroids and hospitalization for surgical wound debridement is also
indicated
• Home care instructions: cold compresses to minimize pain and swelling
• Followed by warm compresses (after 24 h) to encourage healing

31. Prevention
• Use needles with closed end and lateral vents
• Tip of needle should be 1–2 mm short of the apex
• Never bind the needle in the canal, it should allow back flow of the irrigant
• Oscillate the needle in the canal
• Do not force the irrigant in the canal

32. Tissue Emphysema
• collection of gas or air in the tissue spaces or facial planes.
Etiology
• air from air-rotor is directed toward the exposed soft tissues
• When blast of air is directed toward open root canals
• As a complication of fracture involving facial skeleton.
blast of air

33. Clinical Features
• rapid swelling, erythema and crepitus
• (crepitus is pathognomonic of tissue emphysema)
• Dysphagia and dyspnea
• if emphysema spreads into neck region, it can cause difficulty in breathing
and its progression to mediastinum.

35. Vertical Root Fracture
Vertical fracture of crown and/or root can occur:
• During obturation (wedging forces of spreader or plugger)
• During postplacement in structurally weakened endodontically treated
tooth
• Due to fracture of coronal restoration because of lack of ferrule effect on
remaining root structure.

36. Cont…
Diagnosis:
• Periodontal probing may reveal single isolated narrow pocket adjacent to fracture
site.
• Radiograph may show lateral diffuse widening of periodontal ligament.
• Surgical exposure of tooth may reveal vertical root fracture (VRF).
Management: Prognosis ofVRF is poor and tooth generally undergoes extraction.

37. Management of Postobturation Emergencies
some discomfort following obturation which subsides in 2–5 days.
• Reassure the patient
• Prescribe analgesics
• Check occlusion
• Do not retreat randomly. Retreatment is done only in cases of persistent
untreatable problems.