1. Dr. Michael M. Hoen hoenmi@udmercy.edu

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
Through the tooth
Through the soft tissue
Through the bone

7. Drainage through the tooth

8. Drainage through the tooth

9. Drainage through the tooth

10. Incision and Drainage Through the Soft Tissue

11. Incision and Drainage Through the Soft Tissue

12. Laser Incision and Drainage through the soft tissue

13. Drainage through the bone
Trephination
Error

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

22. Ludwig’s Angina

23. Ludwigs’ Angina

24. Fehrenbach M, Herring S. Spread of Dental Infection
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
Medscape reference
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 et.al.

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

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

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

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

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

34. Problem Solving in Endodontics Gutman J, Lovdahl P. 5th ed
Problem Solving in Endodontics Gutman J, Lovdahl P. 5th 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
Mikes’ Guidance for Prevention of Emergency Visits a.k.a. “Rules of Disengagement”
Talk about expectations
Consider creating artificial drainage
Reassure patients of your availability
Provide appropriate prescriptions
Schedule follow-up visits
Know when to cut your losses
Level of Evidence 5

43. Abscessed Tooth Ache Blues