Topic : Clinical Protocol for Endodontic Emergencies

Subject Code :2111

Subject Name :BDS – Conservative Dentistry and Endodontics
Delivered by : Dr. K. Selvarathi.
Department : Conservative Dentistry and Endodontics

Topic : Clinical Protocol for Endodontic Emergencies

Staff name : Dr. Selvarathi. K

CLINICAL PROTOCOL FOR
ENDODONTIC EMERGENCIES
• REVERSIBLE PULPITIS
• Irreversible pulpitis and normal periapex.
• Irreversible pulpitis and acute apical periodontitis.
• Necrotic pulp with acute apical periodontitis, with no
swelling.
• Necrotic pulp, fluctuant swelling, with drainage.
• Necrotic pulp, fluctuant swelling, with no drainage.
• Necrotic pulp, diffuse facial swelling, with drainage
through canals.
• Necrotic pulp, diffuse facial swelling, with no
drainage.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
REVERSIBLE PULPITIS
• It is induced by caries,exposed dentin, recent dental treatment,
defective restorations.
• Conservative removal of the irritant will resolve the problems.
• restoration- dycal+GIC
• Symptoms from exposed dentin-
• Surface loss-restore with GIC or RmGIC
• topical application of desensitizing agents.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Irreversible pulpitis and normal periapex
• Irreversible pulpitis and acute apical periodontitis

• Diagnosis
• Sensitive to thermal testing
• Severe spontaneous, nocturnal pain.
• Management
• Initiate root canal treatment
• Complete removal of pulp tissue.
• In case of time constraint-removal of coronal pulp or
tissue from widest canal.
• Torabinejad et al,Endodontics:principles and practice

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Necrotic pulp with acute apical periodontitis, with no
swelling
• Diagnnosis
• Not responsive to sensitivity testing
• Radiographic changes.

• Management
• Initiate RCT.
• Instrument to working length
• Ca(OH)2 closed dressing.

• Single visit RCT can also be done.

Topic : Clinical protocol for
Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Necrotic pulp, fluctuant swelling, with drainage

• Tissue swelling may be associated with an

periradicular abscess
• Swellings may be confined or diffuse, firm or
fluctuant.
• Swelling may be controlled through the root canal or
incising the fluctuant swelling.
• If the swelling is localized it is preferred to be
controlled through the root canal.
• Access—complete debridement—finger pressure-
mucosa-facilitate drainage
• Ca(OH)2 closed dressing.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Incision and drainage—principles

• Make the incision at the site of greatest fluctuant

swelling.
• Dissect deeply to completely evacuate all the
compartmentalized areas.
• To promote drainage the wound should be kept
clean.
• Warm Salt water mouth rinses---results in dilation of
vascular vessels for better healing.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Necrotic pulp, fluctuant swelling, with no drainage.
• Necrotic pulp, diffuse facial swelling, with drainage through canals.
• Necrotic pulp, diffuse facial swelling, with no drainage.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Cracked tooth
• Diagnosis-dye solutions,transillumination
• Cracked tooth syndrome is so called since it presents
with various symptoms
• Symptoms
• Vital teeth-sudden and sharp pain during mastication.
• Non-vital or obturated teeth-dull ache sensitive to
mastication.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
 Topic : Clinical protocol for
Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Flare-ups

• An endodontic flare-up is defined as an acute

exacerbation of a periradicular pathosis after the
initiation or continuation of non-surgical RCT.
• Incidence-2-20%.common-females under the age of
20yrs.
• mostly seen in maxillary laterals,mand.first molars,
large periapical lesions and retreatment.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Causes for flare-up
• Over instrumentation
• Pushing debris periapically
• Incomplete removal pulpal tissue
• Overextension of root canal filling materials.
• Chemical irritants
• Hyper occlusion
• Root fractures
• Microbiological factors.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• Management of flare-ups

• Occlusal adjustment.
• Analgesics are helpful in many of the cases.
• If not managed by analgesics,re-entry shaping and
cleaning is done followed by calcium hydroxide closed
dressing.

• Prophylactic use of antibiotics is of no use.

• Pickenpaugh et al,J.Endod 2001

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
• CONTRAINDICATIONS FOR RCT-HIGH RISK

• Prosthetic heart valve.

• Previous infective endocarditis.
• Congenital heart disease
• Cardiac transplantation

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
 Topic : Clinical protocol for
Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
 Topic : Clinical protocol for
Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
 Topic : Clinical protocol for
Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
SWALLOWING AND ASPIRATING
• Rubber dam should be used in all situations of endo treatment.
• Gauze can be used during crown cementation.
• After swallowing---
• Advice diagnostic chest x-ray, abdomen PA view
• Patient is referred to concerned doctor.
• Endoscopy and bronchoscopy can be done
(ENT/surgical gastroentologist)

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
Overextensions and overfill
• Gross overextensions into vital structures may cause permanent
paresthesia.
• SYMPTOMS-patient if feels an electric shock during treatment in spite
of LA given the it is a warning for over instrumentation in mandibular
teeth.
• Gutta percha extrusions should be removed before 72 hrs of initial
treatment.
• If not surgical approach to remove the overextended GP.

Topic : Clinical protocol for

Subject : Endodontics endodontic emergencies Speaker : Dr. K. Selvarathi
Thank you