Endodontic Emergencies.

An endodontic emergency is defined as a pathology associated with pain or swelling, related to pulp and periapical tissue which should be addressed immediately, leading to an unscheduled visit. Immediate diagnosis and treatment are required to give relief to the patient. Because dental pain has many causes, the clinician must diagnose its origins as quickly as possible to provide fast and effective relief.

Four topics will be addressed in the webinar: Is it really toothache? It’s toothache. So what is your plan?

The pain has lessened a little, but the jaw is swollen like a golf ball. It still hurts. What’s wrong? The first challenge for the clinician is to understand if the pain is odontogenic or non-odontogenic; a correct diagnosis must be assessed, determining the patient’s complaint together with the medical history. Pain characteristics, such as site, irradiation, time and circumstances of onset, relieving factors, and diagnostic aids should make the clinician able to determine a pulpal and periradicular diagnosis.

Another condition is acute periapical abscess. This may be considered an advanced stage of apical periodontitis. Treatment of acute apical abscesses involves incision for drainage and root canal treatment or extraction of the involved tooth to remove the source of infection. Drainage can be achieved through root canals by first opening up the pulp chamber, but, when swelling is present, incision for drainage should also be performed. The choice to leave the access cavity open for drainage will be discussed. Acute pain following root canal procedures is another not uncommon cause of unscheduled visits. There are several factors associated with pain after root canal treatment, including the presence of pulp remnants in the canals, over instrumentation, canal contents extruded through the apex, missed canals, too high temporary filling.