Endodontics
Course Review
Enoch Ng, DDS 2014
Anesthesia
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Hyperanalgesia of pain receptors in inflamed tissue – increased excitability
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Patients in pain are often apprehensive – lowers pain threshold
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Dentists may not allow sufficient time for anesthesia to work
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Supplemental Anesthesia
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Premedication analgesics (600mg ibuprofen)
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Greater volume of anesthetic
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Bupivacaine (Marcaine)
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PDL injection
Use new sterile needle (no contamination of PDL space)
Inject at 3 points buccal and 3 points lingual around the tooth (line angles)
Look for blanching of tissue in area of injection
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Intrapulpal injection
Use new sterile needle (no contamination of pulp)
Backpressure (not anesthetic itself) is responsible for anesthesia
Patient may experience pain on injection, anesthesia duration only lasts 15min
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Intraosseous injection
X-tip or stabident, high success rate in cases of failed IAN block
Transient (~4min) tachycardia when epi is used
Avoided with use of mepivicaine (without epi)
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Analgesia
Antibiotics
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Pen VK or amoxicillin – loading dose 1000mg, 500mg every 6hr over 7 days
If symptoms don’t improve
Add 500mg q 8hrs metronidazole
Augmentin (amoxicillin and clavulanate)
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Penicillin allergy – clindamycin 600mg loading dose, 300mg q 8hrs over 7 days
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Antibiotic concerns
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Colitis from clostridium overgrowth – watery diarrhea, abdominal pain, cramping, low grade fever
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Patients taking oral contraceptives
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Post-op instructions
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Pain and swelling takes time to absolve
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Need proper nutrition, adequate fluids, compliance
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Will call every day to check up on patient until symptoms resolve