Emergency Endo

Question 1

When may emergency endo need to be carried out?

Answer 1

Pulpitis
Periapical infection
Cracked tooth 
Trauma involving pulp
Iatrogenic damage of pulp

Question 2

Symptoms of reversible pulpitis?

Answer 2

Pain - hot, cold, sweet
Pain doesn’t linger
Not spontaneous

Question 3

How do special tests of reversible pulpits respond?

Answer 3

Exaggerated response sensibility

PA normal

Question 4

Tx reversible pulpitis?

Answer 4

Remove causative factor
Temporary restoration
Montior

Question 5

What advice give pt w/ reversible pulpitis?

Answer 5

Pain should decrease
Analgesia as required
Return symptoms severe

Question 6

What analgesia advcie?

Answer 6

2 x 500mg paracetamol QDS

2 x 400mg ibuprofen TDS

Question 7

Symptoms for irreversible pulpitis?

Answer 7

Spontaneous pain
Pain lingers
Keep aware at night
Radiating pain

Question 8

Tx irreverisble pulpitis?

Answer 8

Extipation

Completion RCT

Question 9

How extipate a tooth?

Answer 9

Access –> remove pulp tissue –> irrigation –> dry –> sedative dressing

Question 10

Examples sedative dressing?

Answer 10

Ledermix

Odontopaste

Question 11

What hot pulp?

Answer 11

Tooth w/ pulpitis which is very painful and difficult to anaesthesie

Question 12

How tx teeth w/ hot pulps

Answer 12

Consider regional anaesthesia
Additional source innervation 
Multiple anaesthetic - lido + articaine 
Infra-ligamentary 
Intra-pulpal

Question 13

What need intra-ligamentatry?

Answer 13

Need shorter needle and cartridge - protect cartrdige shattering under high pressure

Question 14

What is intra-osseous anaestehsia?

Answer 14

Drill bone so can inject anaestheisa into medullary bone - profound but wear off quickly as area vascular

Question 15

What to do if can’t gain anaesthesia?

Answer 15

Remove much pulp tissue as poss and place sedative dressing
Advise analgesia
NO PLACE FOR AB IN PULPITIS

Question 16

Symptoms acute apical periodontitis?

Answer 16

Extreme pain from PA infection = TTP, tender palpation, swelling and redness mucosa

Question 17

What see acute apical abscess?

Answer 17

Swelling
Severe pain on pressure
Tooth feel elevated 
Mobility
Systemic features

Question 18

How tx a tooth w/ acute apical abscess?

Answer 18

Access cavity to drain pus - if no pus explore canal to encourage pus discharge

Question 19

What to do if suspect acute apical abscess but no drainage occur and swelling still present?

Answer 19

Drain swelling - leave drain

Question 20

Should ab be given for apical abscess?

Answer 20

Sign spreading infection - diffuse swelling, trismus

Sign systemic involvement

Question 21

Instruction pt w/ apical abscess?

Answer 21

Pt A&E if diff opening mouth, unwell, diff swallow or breathing

Question 22

How temporise tooth?

Answer 22

Calcium hydroxide paste
Sponge pellet
Intermediate filling - IRM/GIC

Question 23

Symptoms cracked tooth?

Answer 23

Pain on chewing
Sensitivity hot and cold
Pain difficult to locate
See fracture line

Question 24

How dx cracked tooth?

Answer 24

Ask pt bite cotton wool roll/ tooth sloot - pain on release of pressure most reliable aid

Question 25

Are radiograph useful in cracked tooth?

Answer 25

No

Question 26

How tx cracked tooth?

Answer 26

Rule out pulpitis If no pulpitis stabilise tooth w/ adhesive restoration/ crown If irreverisible RCT followed crown

Question 27

How provide temporary tx of cracked tooth?

Answer 27

Orthodontic band

Question 28

When would cracked tooth be unrestorable?

Answer 28

Fracture line extend below alevolar crest

Question 29

How detect vertical root fracture?

Answer 29

Deep periodontal pocket following fracture | J shaped lesion radiograph

Question 30

What assess if have endo flare up mid/post tx?

Answer 30

Is it a recent restoration | Is it recent endodontics

Question 31

What assess if suspect pain from recent restoration?

Answer 31

Measure depth and amount tooth structure removed Symptoms - what is diagnosis Restoration: leakage, occlusion

Question 32

Tx of pain from recent restoration?

Answer 32

Monitor and analgesia Adjust occlusion Place sedative dressing

Question 33

Why get endo pain mid or post tx?

Answer 33

Usually due bacterial contamination

Question 34

What phoenix abscess?

Answer 34

Non-vital tooth flares up when previously been asymptomatic

Question 35

Manage mid-tx flare ups?

Answer 35

Can re-open: follow conventional procedure

Question 36

Advice to pt who has mid-tx flare up?

Answer 36

Return if symptoms get worse Sympotms unlikely effect outcome endo proceudre Analgesia No ab

Question 37

Management post-endo pain?

Answer 37

Challenging Often due bacterial contamination Best monitor prior XLA/re-tx

Question 38

How tx trauma involving pulp?

Answer 38

Depends if open or closed apex

Question 39

How tx complicated root fracture in open apex?

Answer 39

Presever vitality w/ pulp cap/ partial pulpotomy

Question 40

When should pulp cap be attempted?

Answer 40

Small injury which is recent - smaller risk contaminastion

Question 41

How provide pulp cap?

Answer 41

LA --> dam --> clean w/ NaOCl --> apply pulp cap --> seal exposed dentien and restore

Question 42

Material for pulp cap?

Answer 42

Calcium hydroxide | Biodentine/MTA

Question 43

How provide partial pulptomy?

Answer 43

Remove pulp depth 2mm w/ round diamond Place saline pellet to stop bleeding Apply pulp cap material Seal

Question 44

How can iatrogenic damage of pulp be divided?

Answer 44

Non-carious exposure | Carious exposure

Question 45

Manage non-carious pulp exposure?

Answer 45

Pulp-cap placed

Question 46

Manage carious exposure?

Answer 46

Depends size and pt symptoms | If exposure has soft caries/ pt symptoms pulpitis - endo

Question 47

Why is partial pulptomy preferred?

Answer 47

Remove superfical and potentially infected layer of pulp

Question 48

What must do prior placing pulp-cap material?

Answer 48

Stop bleeding