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Dr. Michael M. Hoen Endodontic Emergencies.

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Presentation on theme: "Dr. Michael M. Hoen Endodontic Emergencies."— Presentation transcript:

1 Dr. Michael M. Hoen

2 Endodontic Emergencies

3 “It’s all about the pain and swelling”

4 Explanation of an abscess

5 Drainage or venting pressure helps effect relief

6 Drainage n Through the tooth n Through the soft tissue n Through the bone

7 Drainage through the tooth


9 Jw&feature=related

10 Incision and Drainage Through the Soft Tissue


12 Laser Incision and Drainage through the soft tissue

13 TrephinationError Drainage through the bone

14 Space Infections - Laskin n Canine or Infraorbital Space n Submental Space n Buccal Space n Submandibular Space n Palatal Infection n Sublingual Space n Pterygomandibular Space

15 Canine Space Infection

16 Infraorbital Space Infection

17 Buccal Space Infection

18 Submandibular Space Infection

19 Intraoral and Submental Space

20 Intraoral and Submental Space Infection Treatment

21 Ludwig’s Angina A life-threatening cellulitis that can advance into the pharyngeal and cervical spaces resulting in airway obstruction n Sublingual Space n Submandibular Space n Submental Space

22 Ludwig’s Angina

23 Ludwigs’ Angina

24 Fehrenbach M, Herring S. Spread of Dental Infection. Practical Hygiene, Sept/Oct 1997 Spread of dental infection PDF.pdf

25 Medscape reference

26 Cavernous Sinus Thrombosis

27 Cavernous Sinus Thrombosis

28 Flare-up …interappointment emergencies (IAE) such as pain or swelling which require nonscheduled office visits and palliative treatment… Torabinejad

29 Factors associated with increased incidence of flare-ups Torabinejad et al. n Age between 40 and 59 n Female n Mandibular bicuspids n History of allergies n Preoperative complaints n No or small periapical lesions n Retreatment cases Level of Evidence 4

30 Factors associated with decreased incidence of flare-ups Torabinejad et al. n Presence of a sinus tract n Taking medications postoperatively Level of Evidence 4

31 Flare-up Etiologic Factors Seltzer & Naidorf n Alteration of the local adaptation syndrome n Changes in periapical tissue pressure n Microbial factors n Effects of chemical mediators n Changes in cyclic nucleotides n Immunological phenomena n Various psychological factors Level of Evidence 5

32 Mor C, Rotstein I, Freidman S. Incidence of interappointment emergency associated with endodontic treatment. JOE 1992 n 4.2% incidence in 334 patients treated by undergraduate students n Significantly higher in nonvital teeth Level of Evidence 4

33 Problem Solving in Endodontics Gutman J, Lovdahl P. 5 th ed.

34 Problem Solving in Endodontics Gutman J, Lovdahl P. 5 th ed. Chapter 15 – Problem solving in the management of painful tooth emergencies

35 Restoration Failure Emergency Visit

36 Fracture Emergencies GW 8 year follow-up

37 Resorption Emergency GW

38 Stages of Replacment Resorption with eventual emergency visit Pink and Symptomatic

39 Tooth Related Sinus Problem / Emergency

40 Cerebral Cortical Insufficiency Re-avulsion Emergency

41 FLARE-UPS "The danger of periapical inflammation cannot be eliminated by any plan of treatment.” Dr. G.V. Black

42 Mikes’ Guidance for Prevention of Emergency Visits a.k.a. “Rules of Disengagement” n Talk about expectations n Consider creating artificial drainage n Reassure patients of your availability n Provide appropriate prescriptions n Schedule follow-up visits n Know when to cut your losses Level of Evidence 5

43 Abscessed Tooth Ache Blues

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