Authors: Natkin E.
Title: Treatment of endodontic emergencies.
Journal: Dent Clin North Am
Date: Apr 1974
Citation: 18(2):243-55
Category: Endodontic Emergencies
Evidence-based Ranking: 5
Treatment of acute pain from irreversible pulpitis • Not exposed to saliva o Best treatment is removal of pulp (as much as possible) o Formocresol if bleeding is present o Camphorated phenol if not o Close the chamber • Exposed to saliva o Limit pulp removal to 2-3 mm of apex to avoid pushing bacteria and debris out the apex Treatment of acute periapical abscess due to pulpal necrosis • Establish drainage through the canal if possible o Consider apical trephination if drainage cannot be obtained through intraoral incision of the soft tissue • Pulp chamber o Leave open if drainage was obtained or if apical trephination was attempted o Seal if no drainage from the canal but soft tissue drainage was obtained Soft tissue I & D • Attempt I & D if swelling fluctuant, if patient is in considerable pain, or if swelling is extensive. Other considerations • Prescribe antibiotic if drainage is not obtained and on a case by case basis (not routinely) • Adjust occlusion if needed; take out of occlusion if full coverage restoration is planned. • Prescribe analgesics (strong medication if drainage was not established) If patient does not improve after emergency treatment • Consider prescribing or changing antibiotics • Attempt or reattempt trephination or I & D