Chapter 5 HIGH YIELD

What are the categories of endodontic emergencies?

Pre-treatment, inter-appointment, post-obturation

What is an endodontic flare-up?

Severe pain and/or swelling between or after RCT appointments requiring unscheduled treatment

When should root canal obturation be deferred?

When the tooth is tender to percussion or finger pressure

What is the treatment for painful irreversible pulpitis without symptomatic apical periodontitis if time permits?

Full RCT (cleaning & shaping + obturation)

What is the emergency treatment for a single-rooted tooth with painful irreversible pulpitis without symptomatic apical periodontitis when time is limited?

Partial pulpotomy

What is the emergency treatment for a molar with painful irreversible pulpitis without symptomatic apical periodontitis when time is limited?

Partial pulpotomy of largest canal (palatal/distal)

What medications are prescribed for painful irreversible pulpitis pain relief?

Acetaminophen 650–1000 mg or Ibuprofen 400 mg

What is the emergency treatment for painful irreversible pulpitis with symptomatic apical periodontitis and extreme tenderness?

Partial or total pulpectomy

What procedure must not be done at the same appointment when treating painful irreversible pulpitis with extreme tenderness?

Obturation

What clinical step helps relieve symptoms in symptomatic apical periodontitis?

Occlusal reduction

What category of medication is used for symptomatic apical periodontitis pain?

NSAIDs

What is the treatment for pulp necrosis with symptomatic apical periodontitis and no swelling if time permits?

Complete debridement after working length determination

What is the treatment for pulp necrosis with symptomatic apical periodontitis and no swelling if time is limited?

Partial debridement

What is the protocol for cleaning and sealing a tooth with pulp necrosis and symptomatic apical periodontitis?

NaOCl irrigation, dry with paper points, fill with Ca(OH)2, seal with dry cotton + temp

Are antibiotics indicated for pulp necrosis with symptomatic apical periodontitis and no swelling?

No antibiotics

What is Phase 1 treatment for pulp necrosis with localized swelling (acute apical abscess / AAA)?

Complete cleaning/debridement and drainage through the canal

What is Phase 2 treatment for pulp necrosis with localized swelling (acute apical abscess / AAA)?

Incision and drainage (I&D) to relieve pressure

Should a tooth ever be left open to drain in an acute apical abscess?

Never leave the tooth open to drain

What irrigation and intracanal medicament are used for an acute apical abscess access seal?

Irrigation with NaOCl, place Ca(OH)2

How is a weeping canal managed during treatment?

Sit and wait until it stops

What type of pain medication is indicated for an acute apical abscess without systemic symptoms?

Analgesics only (NSAIDs)

When are antibiotics indicated for an acute apical abscess?

Only if systemic symptoms are present (fever, lymphadenopathy)

How does pulp necrosis with diffuse swelling (cellulitis) spread?

Spreads along fascial planes

How is drainage established for cellulitis?

Establish drainage through canal or I&D

Why are antibiotics required for cellulitis?

Due to the presence of systemic symptoms (fever, malaise, trismus, lymphadenopathy)

What treatment is required for advanced cases of cellulitis with multiple fascial spaces?

Hospitalization, IV antibiotics, multiple drains

When is incision and drainage (I&D) best performed?

When swelling is fluctuant and localized

What is the benefit of performing I&D on a nonfluctuant abscess?

Reduces pressure and facilitates healing by reducing irritants and increasing circulation in the area

Where is the incision placed during an I&D procedure?

Vertical stab incision at dependent site

How is dissection performed beneath the periosteum during an I&D procedure?

Blunt dissection under periosteum with hemostat

What type of drain is placed for cellulitis or a progressive abscess?

Rubber dam or Penrose drain

When is the surgical drain typically removed after an I&D procedure?

Drain removed after 1–2 days

What immediate clinical effect follows an I&D procedure?

Immediate pain relief

When is a drain NOT needed during an I&D procedure?

If purulence is fully evacuated or in the presence of a fistula

What is the first step in managing a post-obturation flare-up?

Check occlusion and remove trauma

What is the second most common reason for a post-obturation flare-up?

Overinstrumentation

What must be rechecked if pain persists due to overinstrumentation?

Working length

What cleaning and sealing steps are performed for post-obturation flare-up pain caused by overinstrumentation?

NaOCl irrigation, clean canals, dry, temp seal

Are antibiotics needed for irreversible pulpitis?

No

Are antibiotics needed for symptomatic apical periodontitis?

No

Are antibiotics needed for a draining sinus tract?

No

Are antibiotics needed after endodontic surgery?

No

Are antibiotics needed to prevent flare-ups?

No

Are antibiotics needed for the I&D of localized swelling?

No

Are antibiotics needed for systemic symptoms like fever, malaise, or trismus?

Yes

Are antibiotics needed for diffuse swelling or cellulitis?

Yes

Are antibiotics needed for hospital cases involving multiple fascial spaces?

Yes, IV

When is root canal treatment (RCT) contraindicated regarding periodontal health?

If the tooth has insufficient periodontal support

What is the alternative treatment when a tooth has insufficient periodontal support for RCT?

Extraction

What is the treatment for painful irreversible pulpitis without SAP according to the essential chapter points?

RCT or partial pulpectomy + Analgesics

What is the treatment for painful irreversible pulpitis with SAP according to the essential chapter points?

Partial or total pulpectomy + occlusal reduction + NSAIDs

What is the treatment for pulp necrosis with SAP according to the essential chapter points?

Comp/Partial debridement + NaOCl irrigation, Ca(OH)2 + temp + No Ant.

What is the treatment for pulp necrosis with AAA according to the essential chapter points?

Complete debridement -> drainage thru canal or I&D + Ant.

What is the treatment for pulp necrosis with Cellulitis according to the essential chapter points?

Drainage thru canal or I&D + Ant. Advanced cases may need hosp + IV antibiotics or multiple incisions