Acute irreversible pulpitis

DIAGNOSIS AND MANAGEMENT OF EMERGENCIES . Cold in early stage . hot and relieved by cold in late stage (called hot tooth) Pain elicited by Duration Quality intensity Referred pain Localized pain Other characteristics . lingered . Sharp or dull . moderate to severe . Pain is more diffuse in late stage . pain is localized in early stage . exacerbated when lying down . spontaneous . may keep the patient awake at night . Usually with Large carious lesion or defective restoration

Acute irreversible pulpitis with symptomatic apical periodontitis

. chewing . Cold in early stage . hot and relieved by cold in late stage (called hot tooth) . lingered . sharp . severe

Necrotic pulp with symptomatic apical periodontitis

. chewing

Necrotic pulp with Acute apical abscess with no swelling

.chewing

Necrotic pulp with Acute apical abscess with localized vestibular swelling
.chewing

Necrotic pulp with Acute apical abscess with diffuse swelling

.chewing

. lingered . sharp . moderate to severe

. lingered . sharp . severe

. lingered . sharp . moderate to severe

. lingered . sharp . moderate to severe

. exacerbated when lying down . spontaneous

. Necrosis could affect just one canal of multi rooted teeth . The tooth may present with confusing symptoms . May be discolored

. may be mobile . patient is afebrile

. may be mobile . patient is afebrile

. may be mobile . patient is febrile

Visual examination of the tooth Pain on palpation

. Usually with large carious lesion or defective restoration

. May be discolored

. May be discolored

. May be discolored

or Electric pulp test Cold test Heat test . Severe lingered pain . Severe lingered pain

or

X-ray examination Emergency treatment

. Minimal changes . Patient management and building rapport . NSAID then anesthesia we can give here local anesthesia because the inflammation is only in the pulp . access cavity

. Widened periodontal ligament . Patient management and building rapport . NSAID then anesthesia Block anesthesia Intra pulpal and intra ligament are C.I. because the patient is already in pain . access cavity . pulpectomy

. if heat is applied for too long, the tooth may respond, possibly relating to remnants of pulpal fluid or gases expanding and extending into the periapical region. . Widened periodontal ligament . Patient management and buiding rapport . Anesthesia given in some cases where there are still some viable pain receptor

. periapical radioluscency . Patient management and buiding rapport . I can fix the tooth and dont give anesthesia

. periapical radioluscency . Patient management and buiding rapport . I can fix the tooth and dont give anesthesia

. periapical radioluscency . Patient management and buiding rapport . I can fix the tooth and dont give anesthesia

. access cavity . debridement & cleaning and shaping with crown down motion and sodium hypochlorite irrigation

. access cavity . debridement & cleaning and shaping with crown down motion and sodium hypochlorite irrigation

. access cavity . debridement & cleaning and shaping with crown down motion and sodium hypochlorite irrigation . concerning drainage, either: When I do access cavity drainage occurs I violate the apex by file Incisional drainage Trephination

. access cavity . debridement & cleaning and shaping with crown down motion and sodium hypochlorite irrigation . drainage is done by an incision intraorally

. pulpotomy

. placement of dry cotton pellet then temporary closure of access cavity

. placement of cotton pellet with terracortyl then temporary closure of access cavity

. drying the canal with paper point then pacement of caoh in the canal then temporary closure of the access cavity

. drying the canal with paper point then pacement of caoh in the canal then temporary closure of the access cavity

. drying the canal with paper point then pacement of caoh in the canal then temporary closure of the access cavity

. drying the canal with paper point then pacement of caoh in the canal then temporary closure of the access cavity

Relieve occlusion Postoperative medication . Ibuprofen 400 mg or acetaminophen 650 mg . Ibuprofen 600 mg + . Analgesics (NSAID 600 . NSAID . NSAID acetaminophen 1000mg 0R 800mg) acetaminophen 1000 mg + codeine 60 mg . if just pain and the pulp was totally extirpated: reassure the .Recleaning and shaping to the WL with irrigation with sodium . incision and drainage and patient hypochlorite then drying then caoh placement and finally debridement then drying then caoh . if the pulp previously not totally extirpated : cleaning and temporary closure of access cavity placement and finally temporary shaping to the W.L. with sodium hypochlorite irrigation then closure of access cavity place dry cotton pellet and temporary closure of the canal If the previous treatment is acceptable reassure the patient and prescribe analgesics . if inadequate root canal treatment and uncorrectable : apical surgery . if acceptable root canal treatment : incision and drainage Patients with postobturation emergencies that do not respond to therapy should be referred to an endodontist for other treatment modalities such as surgery . Antibiotics intravenously .analgesics

Inter appointment emergency ( flare up)

. if flare up occurs : incision and drainage and debridement

Post appointment emergency ( Flare up) Patient not responding to endodontic therapy

PREPARED BY MARWA MERHEB