ENDODONTIC EMERGENCIES

ACUTE IRREVERSIBLE PULPITIS - requires pulpectomy --pul pectomy or pulp extirpation, is the complete removal of a normal or diseased pulp from the pulp cavity of the tooth. In pulpectomy, the pulp is literally torn from the root canal when it is extirpated. Although pain can occur, it is frequently minimal and can be controlled with analgesics ACUTE ALVEOLAR ABSCESS - To the constant pain, drainage must be established through the root canal. Local anesthesia is not needed routinely, conduction anesthesia may be administered to reduce pain, as long as the injection route is distant to the infected area. Because most of the pain that occurs during the access cavity preparation is caused by tooth movement resulting from vibration of the high speed burn, one should stabilize the tooth with finger pressure so that penetration to the pulp chamber will be painless. - Leaving the tooth open for drainage reduces the possibility of continued pain and swelling. Routinely, hot saline rinses should be prescribed to assist drainage. ACUTE PERIODONTAL ABSCESS - Causes pain and swelling. This can occur in either vital or necrotic pulp. - If the pulp test indicate pulp vitality within the normal range, then emergency treatment consist of curettage, debridement, and establishment of drainage of the infrabony pocket through the sulcular crevice. At times incision o f the soft tissue is necessary. - If the pulp is affected it must be extirpated as well. When the pulp is abnormal and vital, the tooth is treated as if for acute irreversible pulpitis. If the pulp is necrotic, the tooth should be treated as if of acute alveolar abscess. EMERGENCIES DURING TREATMENT - Ideally, an endodontic emergency should not occur during treatment; however, it does occur occasionally. Patients should be warned during endodontic instrumentation that a reaction may occur within the next few days and that if it does, it can be controlled by medication, usually a mild analgesic. - When severe periodontitis is present, the patients pain can be relieved by reopening the tooth under the rubber dam, removing the sealed medicament , carefully wiping the root canal dry with sterile absorbent points, and resealing the canal with a cotton pellet from which a mild obtudent is expressed. - When the root canals have already been filled and discomfort is present, the occlusion should be checked and the completed treatment and root canal be re-evaluated. At times, the root canal filling must be removed, to relieve the pain and to establish drainage. In such cases, treatment should be as for an acute alveolar abscess. CROWN FRACTURES - When visible crack is found and the crown sheers off and if the pulp is not exposed, the treatment will be completed by covering the exposed dentin with a sedative dressing and

cementing a stainless steel band around the tooth. If the pulp is exposed, a band should be cemented in place, and pulpectomy should be performed. FRACTURED ROOT - This is an endodontic emergency if the tooth is painful and, especially, if the incisal segment is mobile. The prognosis for a horizontally fractured root depends on the location and direction of fracture. A horizontal fracture above the alveolar crest has an excellent prognosis because the tooth can be restored after endodontic treatment. The closer the root fracture is to the root apex, the more favorable the prognosis. - Traumatic injury to a tooth may cause pulpal death. When a fractured root with necrotic pulp requires emergency care, treatment consist of ligation for stabilization, root canal therapy. If pain and swelling is present the root canals may be left open for drainage. If the tooth is non restorable, it should be extracted as soon as possible.