Endodontics
Course Review
Enoch Ng, DDS 2014
Systematic Approach to Treatment
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[A]symptomatic irreversible pulpitis with normal apical tissues
Asymptomatic irreversible pulpitis – carious pulp exposure
o
Pulpotomy/partial pulpectomy
Coronal tissue removal to level where hemostatis can occur with moist cotton pellet
Temporize, plan to complete NSRCT within 4 weeks
o
Analgesics for mild pain, do NOT need antibiotics
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Symptomatic irreversible pulpitis with symptomatic apical periodontitis
o
Total pulpectomy
Instrument canals to proper working length, place Ca(OH)
2
Temporize, plan to complete NSRCT within 4 weeks
o
Analgesics for moderate/severe pain, do NOT need antibiotics
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Necrotic/previously treated pulp with symptomatic apical periodontitis
o
Total pulpectomy
o
Analgesics for moderate/severe pain, do NOT need antibiotics
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Necrotic/previously treated pulp with acute apical abscess
o
Total pulpectomy
o
Drain either through tooth or incision though most fluctuant point of swelling
o
Analgesics for moderate/severe pain
o
Antibiotics for systemic involvement, inadequate surgical drainage, diffuse swelling,
persistent/progressive infections, immunocompromised patients
Interappointment Emergencies (Flare-Ups)
Symptoms
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Pain/swelling which necessitates unscheduled visit
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Low incidence (1.8-3.2%)
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Causative factors – pre-op pain/swelling, pre-op
apical diagnosis of SAP or AAA, apical radiolucency
Prevention
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Long acting local anesthetic
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Complete cleaning/shaping
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Analgesics
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Psychological preparation of patient
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Verbal instruction
Treatment
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Check occlusion
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Reassure patient with prescription for
mild/moderate analgesic
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For pain with no swelling – reaccess tooth,
reconfirm CWL, complete cleaning and shaping,
remedicate, analgesics
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For pain with swelling – reaccess tooth, reconfirm
CWL, complete cleaning and shaping, remedicate,
incision and drainage, analgesics, antibiotics if
systemic symptoms present
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Hospitalization
Follow-up Care
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Contact patient daily until symptoms resolve
Post-obturation Emergencies
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Infrequent
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Pain at mild level from overextension of obturating material associated with highest incidence of discomfort
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Reassure patient, provide analgesics, double check right treatment was provided
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If pain persists – surgical RCT, extraction
Indications for Hospitalization
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Difficulty breathing/swallowing, elevated tongue, bilateral submandibular swelling, soft palate swelling
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Difficult patient compliance, dehydration, appropriate monitoring, extra-oral surgical drainage