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28 Cards in this Set
- Front
- Back
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what are the 3 D's of successful managment of endodontic emergencies?
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-diagnosis
-definitive dental tx -drugs |
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what are the 2 main factors that are related to pain in endodontic emergencies?
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-chemical mediators - lowers pain threshold as bradykinin/ prostaglandins can cause pain themselves or PGE2 which makes the nerve hypersensitive
-edema- pressure as the blood vessels become more permeable allowing for plasma components to leak into tissues. |
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what is the definition of an endodontic emergency?
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Occurrence of severe pain & or swelling following an endodontic treatment ,requiring an unscheduled visit and active treatment
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how is psychological management of the patient achieved during an endo emergency?
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1-CONTROL THE SITUATION
2-GAIN THE CONFIDENCE OF THE PATIENT 3-PROVIDE ATTENTION & SYMPATHY 4-TREAT THE PATIENT AS AN IMPORTANT INDIVIDUAL |
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what is the process of diagnosing an endo emergency?
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1-Medical and dental histories
2-Subjective examination 3-Objective examination 4-Periodontal examination 5-Radiographic examination |
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what is the general rule when pain is caused by temperature changes as opposed to pain caused by pressure with endo emergencies?
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temperature- pulpal origin
pressure- peri-radicular origin |
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what are the different ways that endo emergencies can be categorised?
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temperature- pulpal origin
pressure- peri-radicular origin |
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what is the classification of pre-treatment endo emergencies according to P Carrotte?
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-Dentine hypersensitivity
-pain of pulpal origin (reversible/irreversible pulpitis) -acute apical periodontitis -acute periapical abscess -traumatic injury -CTS |
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what are the potential causes of an endo emergency during tx?
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-Mid treatment flare- ups
-Exposure of pulp -Fracture of teeth -Recently placed restoration -Periodontal treatment |
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what are some causes of endo emergency after tx has been done?
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-Over instrumentation
-Over extended filling -Under filling -Fracture of root -High restoration |
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what is the most important thing to do before undertaking tx on a pre treatment emergency and how is it achieved?
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-gaining profound anesthesis
- this is achieved through intra-pulpal anesthesia and supplementary intra-osseous injection. |
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what is the definition of hypersensitive dentine and what are potential causes?
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Defined as sharp short pain arising from exposed dentin in response to stimuli typically thermal, chemical, osmotic or tactile &cannot be ascribed to any other form of dental defect or pathology
Can be caused by: -Exposed dentinal tubules due to Gingival recession -Periodontal surgery -Loss of enamel due to abrasion &erosion |
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what are some treatment options for hypersensitive dentine?
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-desensitising: potassium nitrate/ corticosteroids
-cover dentinal tubules to prevent fluid flow (chemical or physical blockage) -plugging dentinal tubules -dentine sealers -perio soft tissue grafting -lasers |
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what is the definition of hypersensitive dentine and what are potential causes?
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-Masticatory / Accidental trauma
-Morphologic factors: -Deep occlusal grooves -Steep cusp - fossa relationship - Mandibular molars -Bifurcation |
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How would you manage a sodium hypochlorite accident?
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-Don’t panic
-Administer local anesthetic immediately -Reassure and calm the patient -Monitor. Intracanal bleeding may take 30 mins to cease. •Administer analgesics (perhaps antibiotics) -Home care - medication, cold/hot compresses -Schedule another appointment or refer |
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what are the ultimate aims of an emergency appointment and what will dictate tx options used
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Ultimate aim is to:
-relieve pain -make mouth uncomfortable -improve function The tx option taken will depend on PULPAL STATUS |
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what is the difference between an abscess and cellulitis?
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abscess- Slocalised collection of pus within a tissue / confined space
cellulitis- symptomatic edematous inflammatory process that spread diffusely through connective tissue &facial planes |
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what are some anatomical areas that pose a problem if infection is reached?
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-Mandibular buccal vestibule
-Sub mental space -Sub lingual space -Sub mandibular space -Pharyngeal &cervical space (all of these can lead to Lugwigs angina) |
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how is infection spread into one of these spaces managed?
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-Prompt diagnosis
-Removal of reservoir of infection by drainage of infectious material through tooth, soft tissue alveolus -Surgical method for drainage I&D Needle aspiration -Trephination: creation of artificial fistula |
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what are the 3 methods of relieving pain in terms of establishing drainage?
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-Via the root canal
-apical trephination (Via the cortical plate) -surgical trephination (Via the soft tissues for localized swellings) |
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what is the process of achieving apical trephination?
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-Aggressively using #15-#25 file in canal beyond the root apex to obtain drainage
-Useful but not always practical -In some cases no drainage obtained -On occasion, drainage can be dramatic, copious and prolonged. Can be assisted by using a fine suction tip in canal -Allow drainage to complete before sealing the access cavity |
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when is incision and drainage used and how is it done?
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-used for fluctuant localised swelling
-#11 or #15 scalpel blade -Incision to bone along base of swelling (In Heffernons lectopia she says to do it at the most swollen part.....CSU) -Hemostats placed into incision and opened to allow drainage Do not attempt incision and drainage for diffuse swellings |
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describe the managment of an acute alveolar abscess that is diffuse?
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-if diffuse, means cellulitis
-Ab cover immediately -debride RC and close tooth -hot saline rinses -ref for medical attention -do not attempt drainage |
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What is a pheonix abscess?
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-A phoenix abscess is an acute exacerbation of a chronic periradicular periodontitis resulting from an increase in the virulence of the bacteria in the lesion and/or a decrease in the patient’s resistance
-The patient exhibits the same signs and symptoms of an acute periradicular abscess except the radiographic exam reveals a periradicular radiolucency associated with the involved toot |
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When are Ab's not required?
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pain without signs and symptoms of infection
-symptomatic reversible pulpitis -symptomatic apical periodontitis -teeth with necrotic pulps and radioluscencies -teeth with sinus tract (chronic apical abscess ) |
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When are Ab's required?
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-systemic involvement (fever, malaise, lymphodenopathy, trismus)
-progressive infection (cellulitis, osteomyelitis) -persistent infection |
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what antibiotics are given in which circumstances and describe in terms of:
-mode of action -contraindication/ warnings -dosing -adverse effects |
Penicillin (Pen VK)
-Beta Lactam that interferes with cell wall synthesis, Bacteriocidal affecting anaerobes -allergy -1g load dosing and 500 mg tid (3/day) fro 7-10 days Clincdamycin -given if allergic to penicillin or if penicillin therapy has failed to treat an adontogenic infection -interferes with protein synthesis, Bacteriostatic and effective against anaerobes -can cause pseudomembranous colloits -600 mg loading and 300 mg tid Metranidazole -interferes with DNA synthesis, bacteriocidal, effective against obligate anaerobes only -can cause nausea, diarrhea, metallic taste and interacts with alcohol -compatible with Pen and Clin -400 mg tid |
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what is biphasic treatment of pulp debridment?
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this involves doing both
-incision and drainage -pulp debridement The steps involved are -Incision &drainage Access cavity preparation -Local infiltration should not be given -Do not leave tooth open bet appointments -Culturing the exudate -Thorough irrigation In case of systemic features antibiotics should be given -Relieve tooth out of occlusion NSAID – to relieve post operative pain -Culturing exudate |
