 Definition: cases that require immediate

treatment
 Symptoms: uncontrollable pain
swelling and or bleeding
Diagnosis 

I-Case History (Patient’s Information) 

distract and friendly
II - MEDICAL HISTORY

(Diseases & Medication)

CARDIOVASCULAR SYSTEM. 
RESPIRATORY SYSTEM. 
DIGESTIVE SYSTEM. 
EXCRETORY SYSTEM. 
CENTRAL NERVOUS SYSTEM. 
ENDOCRINE SYSTEM. 
PREGNANCY. 
 Case History
III – PAST DENTAL HISTORY
PREVIOUS TREATMENTS.
PREVIOUS DENTIST.
PREVIOUS TRAUMA/ SYMPTOMS.
OVER ALL DENTAL IMAGE.
SPECIAL PROBLEMS
adverse reaction to LA
excessive bleeding
prolonged healing
IV - CHIEF COMPLAINT

 PATIENT’S OWN WORDS.

 ONSET, LOCATION, INTENSITY,
QUALITY& DURATION.
 RELIEFIING & ELICTING FACTORS.
 RECURRENCE .
ENDODONTIC KEY WORDS
REMEMBER !
 V-CLINICAL EXAMINATION

I- Extra-oral Examination:
[ INSPECTION- PALPATION

II- Intra-oral Examination:

General evaluation
[ VISUAL-PALPATION]
A/ Visual examination:
(Mirror, probe, tongue blade, dryness,
saliva ejector, fiberoptic light,
transilluminator)

B/ Percussion (vertical/ lateral)

WHY? To reveal condition of the
periodontium
C-Palpation test:

HOW? Bilateral rolling of index finger

Spread of inflammation from periapical
tissues to mucoperiostieum.
 DIAGNOSTIC AIDS
I/ PUlP SENSTIVIYY TEST:
1- Thermal Test:
Thermal tolerance zone (20- 50 degrees)

HOT:
Hot GP/ Hot burnisher

COLD: Air blast

Ethyl chloride/ Ice stick
Classic Responses to Thermal
Testing:
 Normal Pulp: Moderate transient pain
 Reversible Pulpitis: Sharp pain; subsides
quickly
 Irreversible pulpitis: Pain lingers
 Necrosis: No response
(Note false positive and false negative
responses common
 2-Electric pulp test

It detects the vitality of the pulp by

stimulating a response of the pulpal
sensory nerve fibers to an electric
current
 II/ RADIOGRAPHIC
EXAMINATION
2D image of a 3D object 
Distorted image 
No indication on pulp & soft tissue 
conditions
 Recent advance
RADIOVISIOGRAPHY 
Immediate radiograph
Exposure reduced 50- 90%
Eliminated processing/ chemicals
.

 SURGICAL MICROSCOPE
Precision by:
Enhanced magnification
illumination
instrumentation
I.Pre treatment Emergency

A) Trauma cases B) Non trauma cases

II.Inter treatment Emergency

III. Post treatment Emergency

 3 D’s for
Successful Management
 Diagnosis
 Definitive dental treatment
 Drugs
 objective Ex
Subjective Ex

Radiographic Ex

QUALITY OF PAIN QUANTITY OF PAIN

 Irreversible Pulpitis
Pain {sever sharp
lancinating throbbing }
 Spontaneous
 Irritant and lingers
 At night
 Diffuse
 No tenderness to
percussion
Treatment
Pulpectomy

Pulpotomy
 Acute pulpitis with apical
periodontitis
Pain {sever throbbing sharp}
Localised
Tendernous to percussion
Tooth elongated and bitting
relief pain
(pushes blood in dilated vessels away)
In late cases bitting increases
pain due to the increase in
the intra periapical
pressure
Radiographically :widened
lamina dura
Treatment

 Heavy dosage of L.A

 INTRA PULPAL A.
 TOTAL
PULPECTOMY
 Anti- Inflammatory can
be prescribed
 Necrotic pulp with localized swelling
 Sever localized throbbing pain
coupled with a swelling,
elongated tooth, pain on
percussion
Treatment
 I.D or violate the apex #25
Relief pain
Reduce no of m.o
 Complete cleaning and shaping or
debridment and closure
 Analgesics
 antibiotics if any signs of systemic
involvement
 Necrotic pulp with diffuse swelling

 Diffuse pain
Treatment
 Hot fomentation and Ab to localize
 Cleaning and shaping or total debridment
(irrigation &extirpation)
 analgesics
 II. Inter-treatment
Flare up
Pain & or swelling
Most depressive……………assure
the pt
Swelling
I.D or through the canal, canal
redebrided and sealed then
analgesics Ab may be
needed.
If the case was not an
emergency one at the start, it
may be called acute
exacerbation of a chronic one
 microorganisms
inflamation
Causes Host resistance
1. Microbial factor (aerobes)
2. Chemical mediators
3. Impaired host resistance
4. iatrogenic
 Dentist
Controlled Factors
 Over-instrumentation
 Inadequate debridement
 Missed canal
 Hyper-occlusion
 Debris extrusion
 Procedural complications
 Procedural Complications
 Perforation
 Separated instrument
 Zip
 Strip
 NaOCl accident
 Air emphysema
 Wrong tooth
 Treatment
 Overinstrumentation
assure the pt, anesthesia
irrigation, relief of occlusion then
analgesics mixture of Ab &
corticosteriods
 no instrumentation
 Incomplete instrumentation
assure the pt, anesthesia irrigation,proper
cleaning and shaping, then analgesics
 Post-treatment
 Pain x-ray satisfactory
Assure & analgesics
follow up especially if
performed by another
dentist

If pain does not subside

RCTTT
Pain and swelling
1. x-ray satisfactory
I.D, Analgesics and Ab
may be needed follow
up
2. x-ray unsatisfactory

Non surgical retreatment

surgery in few cases may
be needed
 Emergency cases are annoying both to the
patient and dentist
 Sometimes the dentist is a dream the
patient is looking for pls let the dream
comes true