Endodontic

Emergencies

By Dr Ahmad Ali
Hamid
MDS Resident
Described as:

Endodontic emergency is defined as any condition

leading to an unscheduled visit associated with pain or
swelling ensuing from pulpoperiapical pathosis
requiring immediate diagnosis and treatment.
Classified as:

• Pre treatment
• Intra treatment
• Post endodontic
Pre treatment includes:

1. Inflamed tooth pulp

2. Exposed dentin surfaces
3. Acute reversible/irreversible pulpitis
4. Cracked tooth syndrome
5. Injury
Intra treatment includes:

1. Sodium Hypochlorite Accident

2. Exposure of pulp
3. Flare-ups in between treatment
4. Tissue Emphysema
5. Fracture in tooth
Post endodontic includes:
1. Vertical tooth fracture
2. Over Obturation
3. Under Obturation
 Pre Treatment

Inflamed tooth pulp:

• Also known as Hot Tooth
• Is the painful tooth which needs sudden pain relief
• Is commonly caused by irreversible Pulpitis
• Pre medication-anti inflammatory
• Lorazepam is helpful
• Patient should be informed aboutthe treatment to avoid fear.
 Pre Treatment

Cracked tooth Syndrome:

• Fracture including pulp or periodontal ligament.
• Patient is asked to bite on orangewood stick, rubber wheel, or tooth
sloth.
• Pain during biting, especially upon release of pressure is a classic sign
of cracked tooth syndrome.
 Pre Treatment

Traumatic Injuries:

• It may include fracture of root or crown, or avulsion of tooth

• Luxation injury- relief pain and reposition the dislocated tooth.

 Pre Treatment

Exposed Dentin Surfaces:

• Sharp, short pain arising from exposed dentin in response to stimuli
typically thermal, chemical, tactile, or osmotic and which cannot be
ascribed to any other form of dental defect or pathology.
• Cause- exposed dentinal tubules
1. Loss of covering periodontal structures leading to loss of
cementum
2. Loss of enamel due to tooth wear
 Pre Treatment

Acute reversible Pulpitis:

• It is characterized by sharp pain lasting for a moment, more often
brought on by cold than hot food or beverages. The patient can
identify the tooth. Momentary pain subsides on removal of stimulus.

• Symptoms- sharp shooting pain lasting for a short duration. Pain

brought on by cold beverages and sweets Clinically, the patient can
identify the tooth by pointing to it.
 Pre Treatment

Acute Irreversible Pulpitis:

• Acute irreversible pulpitis exhibits pain usually caused by hot or cold
stimulus
• It is a persistent inflammatory condition of the pulp, symptomatic or
asymptomatic, caused by a noxious stimulus.
• Symptoms- pain lasts for minutes to hours. It is spontaneous. It often
continues even when the cause is removed. Patient complaints of
disturbed sleep. Pain is experienced on sudden temperature change.
On taking sweets or acidic food stuffs. From packing of food into
cavity/ food impaction.
 Intre Treatment

Sodium Hypochlorite Accident:

•  A rare but significant complication of root canal treatment
•  Care must be taken when using and handling NaOCl as it is caustic to
the vital tissues and related injuries are a recognized risk.
• Preventive measures include wearing appropriate personal protective
equipment, ensuring the use of a well-sealed rubber dam and high
volume suction. Such precautions help to avoid injuries to skin, eyes,
ingestion or even aspiration.
 Intre Treatment
Exposure of Pulp:
•  As long as the pulp is still vital and the patient’s symptoms don’t
necessitate root canal therapy, vital pulpal treatments can be utilized. 
• The longer the exposure has been present, the higher the likelihood
for bacterial contamination of the pulp.
• Vital pulp therapy (VPT) techniques are means of preserving the
vitality and function of the dental pulp after injury resulting from
trauma, caries, or restorative procedures.
 Intre Treatment
Flare ups in between treatment:

• Flare up is describes as the occurrence of pain, swelling or a

combination of these during the course of root canal therapy which is
the result of unscheduled visits by the patient.
 Intre Treatment
Tissue emphysema:
• Cervicofacial subcutaneous emphysema (SE) is primarily caused by
dental treatment introducing gas into the subcutaneous tissue. 
• Air rapidly dissects into the subcutaneous tissue with face and neck
swelling, leading to respiratory distress, patient discomfort, and chest
pain.
• If subcutaneous emphysema is suspected, careful inspection and
examination must be undertaken.
 Intre Treatment
Fracture in tooth:
• A fractured or cracked tooth occurs due to age, tooth grinding,
trauma and other factors. 
• Treatment for a fractured tooth depends on how much damage your
tooth has.
• Common cracked tooth treatments include:
Bonding, Cosmetic contouring, Crown, Extraction, Root canal and
Veneer.
 Post Endodontic
Vertical Tooth Fracture:
•  Vertical root fracture is a big challenge to dentists for its diagnosis
and treatment.
• The treatment of complete vertical root fracture is the extraction of
the tooth followed by dental prosthesis or implant or joining the
separated fragments by different types of bonding system, laser or bio
ceramic cements, and reimplantation with a good success rate.
 Post Endodontic

Under/Over Obturation:
•  From the current study analysis, it is observed that the most
commonly identified mishaps were related to obturation, wherein the
maximum cases had under-obturation-mishaps. Access and
instrument-related mishaps were not found to occur frequently, as
the majority of the cases (over 80%) did not show any such mishaps.
PREVENTIONS
Preventive Measures to Avoid Endodontic Emergencies:

• Regular Dental Check-ups

Regular dental visits for check-ups and cleanings can help identify and address dental issues before they escalate
into emergencies.

• Maintaining Oral Hygiene

Proper brushing, flossing, and rinsing techniques, along with a balanced diet, can minimize the risk of dental decay
and infection.

• Using Protective Gear

When participating in activities with a high risk of dental trauma, such as contact sports, wearing mouthguards or
other protective gear can significantly reduce the likelihood of endodontic emergencies.
Thank you!