[Kuilliyyah of Dentistry International Islamic University Malaysia

]

Emergencies
DR.SHAWFEKAR BTE HJ ABDUL HAMID

[2009]

In emergency treatment the main emphasis must be on 1) effective pain control and 2) ensuring a good long term prognosis. 2 .Emergencies Acute Pulpitis Acute Apical Periodontitis Acute pulpitis Acute pulpitis is usually caused by rapidly progressing caries or by leaking fillings associated with secondary caries. Adequate local anesthesia is a prerequisite for most of the treatment choices above.

placement of zinc oxide eugenol may prove to be effective.ZOE filling When excavation of caries does not lead to pulp exposure. Eugenol pellet + ZOE in lesion 3 . Leakage of eugenol in a pulpward direction probably accounts for the fact that over 95 % of teeth without exposure become symptom free with ZOE.

the coronal pulp tissue should be removed (pulpotomy).g. However. effective pain control (over 90 %) can be obtained by covering the exposure site with a eugenol pellet and filling the cavity with a zinc oxide eugenol dressing. "Ledermix") are widely used in many countries with good clinical effect. In addition to eugenol. a complete cleaning and shaping procedure followed by placement of a non-setting calcium hydroxide paste is preferable. A cotton wool pledget soaked in eugenol (or corticoid preparation) and a zink oxide dressing are then applied to the pulpal wound as shown in the figure. Eugenol + ZOE Sometimes a partial pulpectomy is performed as the first stage of treatment for acute pulpitis. Pulpotomy. Partial pulpectomy. eugenol (or 4 . Eugenol + ZOE To further increase the effectiveness of pain control (over 95 %) in pulpitis cases in carious teeth with pulpal involvement. corticosteroid-containing solutions and pastes (e. If cleaning and shaping cannot be completed.When excavation of caries leads to pulp exposure. The eugenol pellet should not be used in shallow cavities.

when this is not the case. The effectiveness of pain control of this treatment mode is still high (over 90 %). but slightly lower than that for a pulpotomy.a corticoid preparation) may be applied into the canal system and the cavity restored with (a eugenol pellet and) a ZOE top filling. Ca(OH)2 + topfilling Often time is the limiting factor in the treatment of patients with acute pulpitits. Calcium hydroxide in the root canal and a temporary restoration with good marginal seal results in excellent pain control in almost all cases (over 95 %). Acute apical periodontitis 5 . Pulpectomy. It is therefore better not to commence the initial preparation of the canals unless they can be instrumented completely. In cases in which all of the pulp tissue can be removed. the canal(s) may be obturated. However. the canals should be completely preparaed.

anesthesia is not needed because the pulp is necrotic. In such rare cases. and 3) ensuring good long term prognosis. Following the cleaning and shaping procedure.g. 2) The optimal treatment comprises complete preparation of the whole canal system. even partial removal of pulp tissue from the root canals further increases the probability to make the tooth 6 False . drainage of pus should be established by surgical incision following local anesthesia to the surface mucosa.In emergency treatment of acute apical periodontitis the main emphasis is on 1) effective pain control. certain risk patients). occasionally part of the pulp tissue may be vital. the patient is examined again later the same day. 4) Antibiotics are prescribed only when there are general indications for such treatment (e. 3) If an abscess present. Endodontic Emergencies Self Assessment Acute pulpitis True In symptomatic pulpitis without caries perforation (into pulp). ZnO eugenol filling almost always removes the symptoms rapidly In emergency treatment of acute irreversible pulpitis. malaise. pulpotomy with eugenol pellet in the chamber and top filling removes symptoms effectively In emergency treatment of acute irreversible pulpitis. A piece of rubber dam may be sutured to hold the incision open for a few days. Control of occlusion is essential. dangerous location or spreading of the infection. The preferred treatment of acute apical periodontitis is as follows: 1) Anesthesia: Often. Good knowledge about anatomy is required to ensure thet nerves and blood vessels in the region are not damaged. the canals are filled with a non-setting calcium hydroxide paste and the access cavity is sealed with a temporary restoration. the tooth is periostitic or placement of the rubber dam necessitates administration of a local anesthetic agent. fever. However. Apical patency may be checked with #10 or 15 file (avoiding overinstrumentation) to allow drainage of pus. 2) inhibition of the spread of infection. 5) Drainage of pus from the canal seldom lasts for more than five minutes.

from the canal. if present. instrumentation should be completed during the first appointment in emergency treatment of AAP 7 . instrumentation should be completed during the first appointment in emergency treatment of acute irreversible pulpitis AAP True Antibiotics should be always prescribed in the treatment of AAP (acute apical periodontitis) False Anesthesia is never required in the treatment of AAP because the pulp is necrotic Control of occlusion is a crucial step in the treatment of AAP Fluctuating abscesses should be incised in the treatment of AAP Drainage of pus. seldom lasts over five minutes Canals should not be instrumented during the emergency treatment of AAP even if the time would allow this Whenever time and symptoms allow.totally symptomfree Whenever time allows.