20 HyperocclusionRosenberg PA, Babick PJ, Schertzer L, Leung A. The effect of occlusal reduction on pain after endodontic instrumentation. J Endodon 1998;24:492.
21 HyperocclusionResearchers have found that patients most likely to benefit from occlusal reduction are those whose teeth initially present with symptoms.Indiscriminant reduction of the occlusal surface is not indicatedPRE-OP PAINPULP VITALITYPERCUSSION SENSITIVITYABSENCE OF A PERIRADICULAR RADIOLUCENCYCOMBINATION OF THESE SYMPTOMS
30 Non-surgical Emergency Treatment PulpotomyPartial pulpectomyComplete pulpectomyDebridement of the root canal system*
31 Surgical Emergency Treatment Incision for drainageTrephination/apical fenestration
32 Rationale for I & D Decreases number of bacteria Reduces tissue pressureAlleviates pain/trismusImproves circulationPrevents spread of infectionAlters oxidation-reduction potentialAccelerates healing
44 DrugsPre - op / loading doseLong acting anesthesiaPrescription
45 Codeine Prototype opioid for orally available combination drugs Studies found that 60 mg of codeine (2 T-3) produces significantly more analgesia than placebo but less analgesia than 650 mg aspirin, or 600 mg acetaminophenTroullis E, Freeman R, Dionne R. The scientific basis for analgesic use in dentistry. Anesth Prog :123.
46 CodeinePatients taking 30 mg of codeine report only as much analgesia as placeboTroullis E, Freeman R, Dionne R. The scientific basis for analgesic use in dentistry. Anesth Prog :123.
47 Ibuprofen and Acetaminophen* 57 patientsLocal anesthesia, pulpectomy, post- op analgesicPlacebo600 mg ibuprofen600 mg ibuprofen & 1000 mg acetaminophen*Menhinick KA, Gutman JL, Regan JD, Taylor SE and Buschang PH. The efficacy of pain control following nonsurgical root canal treatmnent using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. Int Endod J 2004;37:
48 Ibuprofen and Acetaminophen* Visual analogue scale & baseline 4-point category pain scale1 hr, 4 hr, 6 hr, 8 hrGeneral linear model analysesSignificant differencesPlacebo and combinationIbuprofen and combinationNo significant differencePlacebo and ibuprofen
49 Ibuprofen and Acetaminophen* “The results demonstrate that the combination of ibuprofen and acetaminophen may be more effective than ibuprofen alone for the management of postoperative endodontic pain.”
54 Indications for Antibiotic Therapy Systemic involvement Compromised host resistanceFascial space involvementInadequate surgical drainage
55 Guidelines for Antibiotic Therapy Select antibiotic with anaerobic spectrumUse a larger dose for a shorter period of time (“hard and fast” rule)
56 Appropriate Antibiotic Selecting theAppropriate AntibioticGram stain results available: antibiotic-sensitivity chartsC & S results available: antibiotic-sensitivity chartsNo gram stain or C & S results:PCN is antibiotic of choice
57 Penicillin VStill, the drug of choice for infections of endodontic originLoading dose: 1-2 g then 500 mg qid x 7-10 days
58 Metronidozole (Flagyl) Used in conjunction with Penicillin V500 mg of Penicillin V with 250 mg Metronidozole, qid x 7-10 days
59 ClindamycinLoading dose: 300 mgmg qid x 10 days