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Dr. Michael M. Hoen hoenmi@udmercy

Dr. Michael M. Hoen hoenmi@udmercy.edu. Endodontic Emergencies. “It’s all about the pain and swelling”. Explanation of an abscess. http://www.youtube.com/watch?v=YDCbiG9cZBA. Drainage or venting pressure helps effect relief. Drainage. Through the tooth Through the soft tissue

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Dr. Michael M. Hoen hoenmi@udmercy

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  1. Dr. Michael M. Hoenhoenmi@udmercy.edu

  2. Endodontic Emergencies

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

  4. Explanation of an abscess http://www.youtube.com/watch?v=YDCbiG9cZBA

  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 http://www.youtube.com/watch?v=oW6XbfW0WJw&feature=related

  10. Incision and Drainage Through the Soft Tissue

  11. Incision and Drainage Through the Soft Tissue http://www.youtube.com/watch?v=T5XqXrrKiuk

  12. Laser Incision and Drainage through the soft tissue http://www.youtube.com/watch?v=o7Bg0ItHTpA&feature=related

  13. Error Drainage through the bone Trephination

  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 SpaceInfection

  17. BuccalSpaceInfection

  18. SubmandibularSpace Infection

  19. Intraoral and Submental Space

  20. Intraoral and Submental Space Infection Treatment

  21. Ludwig’s AnginaA 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. Practical Hygiene, Sept/Oct 1997 Spread of dental infection PDF.pdf

  25. Medscape reference http://emedicine.medscape.com/article/763538-overview

  26. Medscape reference Cavernous Sinus Thrombosis http://emedicine.medscape.com/article/791704-overview#a0104

  27. Cavernous Sinus Thrombosis http://www.youtube.com/watch?v=cSGUCHhaKsY

  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 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 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. 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 EndodonticsGutman J, Lovdahl P. 5th ed. http://www.elsevier.ca/ISBN/9780323068888/Problem-Solving-in-Endodontics

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

  35. Restoration Failure Emergency Visit

  36. GW 8 year follow-up Fracture Emergencies

  37. Resorption Emergency GW

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

  39. Tooth Related Sinus Problem / Emergency http://www.youtube.com/watch?v=tB6qp92mMmo&feature=related

  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 forPrevention of Emergency Visitsa.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

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