Management of Endo Emergencies

Question 1

use of pulpotomy

Answer 1

immature tooth more
- want to have apexogenesis

used in sympotomatic irreversible pulpitits as emergency treatment

Question 2

hyperplastic pulpitis aka

Answer 2

pulp polyp

Question 3

describe pulp necrosis

Answer 3

may still have pain due to the C fibers response
- even though not responding to the cold

due to caries, trauma, perio disease

circumfrenterial spread of inflammation

can follow reversible pulpitis if etiology is not removed

peri-apical status will dictate treatment (in regards to emergency treatment)

Question 4

emergency treatment likely depends upon?

Answer 4

the peri-apical / peri-radicular diagnosis of the tooth

Question 5

symptomatic peri-radicular periodontitis

Answer 5

inflammation in the pulp has extended through the apical foramen into the pero-radicular area

EXCLUDES the occlusal trauma and periodontal abscess

Question 6

can you do pulpotomomy with apical symptoms?

Answer 6

NO - so it is contra-indicated in symptomatic peri-radicular periodontitist

Question 7

intra-cranial medicament usually

Answer 7

calcium hydroxide

Question 8

secondary acute peri-radicular eriodontitis

main causes?

Answer 8

secondary to the RCT
- overextension of endodontic instruments into peri-apical area

• extrusion of fluids, tissue, bacteria (bacterial products) into peri-apical area

Question 9

secondary acute peri-radicular eriodontitis presents?

Answer 9

likely history of RCT 1-2 days prior to therapy

spontaneous or continous pain

pain to chewing, percussion, palpation,

‘feels like tooth is higher than the adjacent teeth’

’ feels like pressure is building up in my jaw
- is there a swelling?

Question 10

secondary acute peri-radicular eriodontitis emergency treatment?

Answer 10

• occlusal adjustemnt
• investigate presence of additional canals
• intra-canal corticosteroid paste
• seal the access cavity again
• trephination of buccal cortical plate

Question 11

symptomatic peri-radicular periodontitis is presentation of

Answer 11

one presentation of chronic peri-radicular periodontitis with developing symptoms

• spontaneous pain
• pain to chewing/ brushing

Question 12

describe acute peri-radicular abscess as it presents and associated with?

Answer 12

advanced acute periradicular periodontitis

decreased host resistance

increased virulence of bacteria

a “true” infection

Question 13

pain present with acute peri-radicular abscess ? what do you need to consider

Answer 13

maybe – pain fibers located in the periosteum

look at the dental history
- history of pain?

Question 14

acute peri-radicular abscess systemic symptoms

Answer 14

fever/ lymphadenopathy/ sweating/ chills. GI disturbance

patient can feel and look sick

Question 15

acute peri-radicular abscess emergency treatemnt

Answer 15

management of odontogenic infections

Question 16

which one is a true infection

Answer 16

acute peri-radicular abscess

Question 17

management of odontogenic infections breaks down into?

Answer 17

Patient health

anatomical features

microbial factors

with infection in the middle
- diagram with all these surrounding / influencing the infection

Question 18

spread of odontogenic infection

Answer 18

through path of least resistance
- anatomic position in relation to the B and L cortical plates

relationship of apex of tooth to closest muscle attachment

Question 19

incision and drainage is what type of treatment?

Answer 19

surgical phase

Question 20

what does IAD do?

Answer 20

1. decrease number of bacteria
2. reduces tissue pressure
   - alleviates pain
   - improves circulation in area
3. prevents spread of infection
4. alters oxidation - reduction potential in tissue
5. accelerates healing and prevents spread of infection

Question 21

avoid what in IAD

Answer 21

‘needle-track’ infections

Question 22

anesthesia in IAD?

Answer 22

use regional blocks or infiltration

Question 23

decontamination uses what in IAD?

Answer 23

betadine scrub

Question 24

describe incision in IAD?

Answer 24

incision of HEALTHY TISSUE

• most dependent area
• subperiosteal
• 1/2 - 3/4 in lneght

’ rule of index finger’

Question 25

describe blunt dissection

Answer 25

part of IAD - curved hemostat - insert closed with beaks unblocked - open beaks to separate tissues - extend into adjacent spaces

Question 26

describe insertion of drain?

Answer 26

use sterile penrose tubing suture to healthy tissue allow to remain in place for 2-7 days

Question 27

when can you do endodontic therapy with IAD?

Answer 27

at time of surgical phase | - while the drain is in place

Question 28

removal of drain

Answer 28

24 hours after cleansing and shaping of root canal system after resolution of infection

Question 29

employ antibiotic therapy when?

Answer 29

in a compromised host resistance there has been systemic involvment fascial space involvment inadequate surgical drainage

Question 30

guidelines for antibiotic therapy

Answer 30

1. select an antibiotic with an ANEROBIC SPECTRUM 2. use larger doses for shorter periods of time 3. collect specimens prior to intiation of antibiotics 4. if available - utalize gram stain results to select intital antibiotic

Question 31

if no gram stain or culture and sensitivity results available what antibiotic should you use?

Answer 31

enicillin is antibiotic of choice | - acts on gram + and - and anerobic cocci

Question 32

describe penicillin use

Answer 32

first choice spectrum is gram+/- aerobic cocci and most anaerobic rods dosage - 1-2 gram loading dose - 500 mg every 6 hours for 5-7 days

Question 33

prescribe clindamycin when?

Answer 33

allergic to penicillin or when it has been 48 hours and pt. does not respond to the penicillin tx

Question 34

spectra and dosage of clindamycin

Answer 34

specrta - gram - anaerobic rods gram + aerobic streptococci dosage - 600 mg loading dose 150-300 mg every 6 hours for 5-7 days

Question 35

clindamycin can increase risk of? associated with which risk?

Answer 35

pseudomembranous colitis

Question 36

pseudomembranous colitis

Answer 36

overgrowth of C.diff -- which is gram + spore forming anaerobic rod growth is inhibited by lactobacillus, porphyromonas, peptostreptococcus approx. 5% of healthy aduts carry C. diff in their intestines 20% of adults in hospitals are C. diff asymptomatic carriers

Question 37

pt's more at risk for pseudomembranous colitis

Answer 37

elderly, inpatient in hospital, immunosuppressed

Question 38

pseudomembranous colitis most associated with which drug

Answer 38

1. cephalosporin 2. ampicillin 3. clindamycin

Question 39

c. difficile produces?

Answer 39

Toxin a - entertoxin toxin b- cytotoxin

Question 40

out-patient vs in-patient use of antibiotics results in pseudomembranous colitis

Answer 40

outpatient --> 1 in 3 of 100,000 IN PATIENT AT HIGHER RISK in patient --> 1-10 of 1,000 inpatient

Question 41

3 forms of pseudomembranous colitis

Answer 41

1. antibiotic associated diarrhea without colitis - not caused by overgrowth of C. diff 2. antibiotic associated without pseudomembrane formation - so get no produciton of toxins 3. antibiotic associated collitis with produciton of pseudomembranes

Question 42

antibiotic therapy can interfere with which drugs?

Answer 42

oral contraceptives

Question 43

metronidazole use?

Answer 43

indications/ spectrum - all anaerobic gram - rods - anerobic gram + cocci if after a day and a half we can switch to this and add this to the regime instead of giving clindamycin dosage - 500 mg every 6 hours for 5-7 days

Question 44

NSAID analgesics | is use PRN?

Answer 44

ibuprofen (motrin) - one tablet one hour pre-operative - one tablet every 6 hours NOT PRN

Question 45

use of applied heat?

Answer 45

intra-oral warm rinses

Question 46

reversible pulpitis emergency treatment

Answer 46

occlusal adjustment or if faulty restoratino - remove and replace with temporay - zinc oxide eugenol based restoration

Question 47

emergency treatment for symptomatic irreversible pulpitis

Answer 47

pulpotomy - when can (immature tooth and open apex) - apexogensis or pulpectomy USE NSAIDS

Question 48

internal resoprtion falls under what category

Answer 48

asymptomatic irreversible pulpitis

Question 49

hyperplastic pulpitis associated with

Answer 49

pulp poly | - asymptomatic irreversible pulpitis