Endodontic practices often experience patients with dental emergencies, as about 85% of most dental emergencies involve periapical or pulpal infections. These emergencies often require immediate attention due to the severity of the infection, the swelling location, and factors that inhibit the person’s ability to speak, eat, or move their jaw correctly. In these cases, endodontists have to act hastily to diagnose the condition causing their severe pain and treat it by looking at the patient’s problems more in-depth within a short amount of time and performing treatments to alleviate their condition.
But what does this process look like? What factors come into treating problematic infections within a short amount of time? What treatments are most commonly used during endodontic emergencies? As endodontists, we’re here to offer an inside look into how endodontic emergencies are handled, why we recommend seeing an endodontist for dental emergencies, and what available treatments there are to remove infections and relieve pain.
How Do Endodontists Diagnose Under Dental Emergencies
To properly handle patients’ dental emergencies, their symptoms need to be diagnosed within a limited amount of time, as various conditions can contribute to the overall outcome of the emergency procedure. During the first initial appointment, the patient’s medical history and dental history have to be taken into account to determine the potential cause. Determining the potential cause of their condition requires going through the diagnosis process. This includes asking questions about their symptoms, when these symptoms first occurred, and other factors related to their situation. As endodontists, the diagnosis process also involves the use of periodontal probes, electric pulp testers, thermal tests, and periapical radiographs to determine if the issue is from the endodontic area.
Measuring the condition under these tests and procedures can heavily influence how these procedures will advance into treatment. Determining if the condition is of endodontic origin is a vital part of the process because areas outside of the endodontium can change the course of treatment and result in different protocols being enacted. Common conditions that are associated with an endodontic emergency include:
- Cracked Teeth Syndrome: Cracked teeth syndrome occurs when a tooth has incompletely cracked, creating microscopic fissures within the tooth, but doesn’t cause the tooth to break off completely and can be strenuous to detect with regular x-rays.
- Periapical Abscess: An abscess is formed from a severe infection created by cavities that have not been appropriately treated. The abscess creates infections along the inside of the root canal system and can affect the periodontium area, causing significant swelling and pain.
- Reversible Pulpitis: Reversible pulpitis occurs when the inner pulp tissues of the tooth cause inflammation and can often result from failed restorations, dental trauma, and untreated cavities, and often can occur before abscesses form.
- Irreversible Pulpitis: When pulpitis becomes irreversible, the inner pulp of the tooth becomes necrotic, compromising blood circulation to the inner tooth and causing internal decay within the root channels, leading to tooth extraction.
Dental emergencies that are not of endodontic origin, including neurological disorders, maxillary sinus disorders, myofascial pain, and vascular pain problems, can affect the overall treatment process. All factors, including age, pain tolerance, and medical history, are considered when handling these emergencies, and during treatment, endodontists have to adapt to various circumstances and perform procedures based on those pain factors.
How Endodontists Address Pain-Related Issues During Treatment
The purpose of treatment during an endodontic emergency is to minimize the condition as much as possible and counteract any occurring issues that develop during treatment. Providing pain relief under these immediate circumstances can allow the endodontist to address long-term dental problems and enact treatment plans with their patients to resolve more complex dental problems that may be further diagnosed.
As the first line of defense, endodontists will generally perform either a pulpotomy or pulpectomy. Pulpotomies are the preferred choice for emergency treatment due to their conservative methods in restoring the tooth’s function and its high success rate in pain relief. However, using these treatments depends on the condition affecting the patient, ultimately determining the outcome. Emergency pulpotomies will often create different results, and all of which depends on the patients underlying conditions if present within emergency circumstances.
However, under the most favorable conditions, emergency pulpotomies followed up by endodontic treatment will most likely create a highly successful outcome. On the other hand, underlying conditions that need to be addressed will change the outcome of the treatment, including:
• Preceding Restorative Treatment: Any signs of restorative treatment, including crowns, implants, and veneers, will affect the overall procedure chosen by the endodontists and adjust according to those conditions.
• Cracked Teeth Syndrome: Microscopic fractures found during treatment can affect the overall pulpotomy or pulpectomy procedure attempting to relieve pain.
• Apical Periodontal Disease and Treatment: Periodontal disease can alter the emergency procedure due to the severity of infection present in the gums or the risk of reinfection when handling tooth or endodontic pain.
• Severe Periapical Lesions/Abscess: Periapical lesions and abscesses can form after a root canal procedure and can affect the procedure overall.
During the diagnosis and treatment procedures, endodontists ultimately have to determine the overall survival rate of the affected tooth or area. If the tooth affected cannot be saved due to the presence of necrotic tissues, then more invasive procedures such as extractions will need to be performed. After treatments, adjunctive endodontic therapies can also be used during an emergency procedure to alleviate pain as much as possible.
The Risks of Post-Endodontic Emergency Procedures
To further reduce the risk of reinfection, follow-up appointments may be scheduled to address the overall progress of the emergency treatment. Potential issues can arise after treatment, including root fractures, microleakage, filling material irritation, and overfilling the root channels causing pain. For patients with these side effects, it’s essential to speak with their endodontists to address these issues and plan out long-term treatment plans.
Overall, endodontists under emergency circumstances require quick thinking and actions to help patients experiencing chronic or severe pain, and endodontists within these circumstances work to alleviate pain as much as possible by reducing the failure rate through effective technique and professionalism.
