What To Do During Endodontic Emergency? Part I

What is Endodontic Emergency?

Defined as an unscheduled visit associated with pain or swelling from pulpoperiapical pathoses requiring immediate diagnosis and treatment.



  1. Pre endodontic emergencies
  2. mergencies during treatment/Inter appointment flare ups
  3. Post endodontic emergencies

Pre endo emergencies are:

  1. Acute reversible pulpitis
  2. Acute irreversible pulpitis
  3. Acute apical periodontitis
  4. Acute alveolar abscess
  5. Acute periodontal abscess
  6. Cracked tooth syndrome
  7. Crown fracture
  8. Root fracture
  9. Tooth Avulsion
  10. Referred pain

Post endo emergencies:

  1. Vertical Fracture
  2. Over obturation
  3. Under obturation


DEFINITION: It is a mild to moderate inflammatory condition of the pulp
caused by noxious stimuli in which the pulp is capable of returning to the uninflamed state following removal of the stimulus
It is characterized by sharp pain lasting but a moment, more often brought on by cold than hot food or beverages.
The patient can identify the tooth.
Momentary pain that subsides on removal of stimulus


Trauma as from a blow or from a disturbed occlusal relationship

Thermal shock as from preparing a cavity with a dull bur or keeping the bur in contact with the tooth long or from over heating during polishing a filling
Excessive dehydration of a cavity with alcohol or chloroform, or irritation of exposed dentin at the neck of a tooth
Placement of a fresh amalgam filling in contact with ,or occluding a gold restoration
Chemical stimulus as from sweet or sour food stuffs OR from irritation of a silicate or self curing acrylic filling
Bacterial as from caries
The best Rx is prevention.

In a recently restored teeth occlusion is adjusted.

In cases of marginal leakage or secondary caries ,the old
restorations are removed and replaced with sedative cement.,

Pain usually disappears within several days ,if it persists
then pulp has to be extirpated


It is a persistent inflammatory condition of the pulp, symptomatic or asymptomatic, caused by a noxious stimulus. Acute Irreversible pulpitis exhibits pain usually caused by hot or cold stimulus

The pain is sharp, piercing or shooting and it is generally severe.

Abnormally responsive to heat and cold

Pain occurs spontaneously

Pain lasts for several minutes to hours and lingers even after removal of stimulus

Nocturnal pain ,pain on bending or lying down position.



The procedure is as follows:


Access cavity prepared and canals located

Extirpate the canals

Cleaning and shaping with the use of irrigating solution like Naocl. Pain persists if inflamed pulp remains in root canal because inflammatory process will extend into peri radicular tissues
Closed dressing given and occlusion relieved


It is a painful inflammation of periodontium as a result of trauma, irritation or infection through root canal whether the pulp is vital or non vital.

Occlusal trauma
Wedging of foreign objects
Blow to tooth
Over instrumentation or over filling
Symptoms: Pain & tenderness of the tooth,sometimes the tooth may be extruded.


Vital tooth——–symptomatic Rx
Non vital———Root Canal Treatment



It is a localized collection of pus in the alveolar bone at the root apex following pulp death with extension of infection through apical foramen into periapical tissues

It is accompanied by a severe local reaction and at times general reaction of systemic toxicity such as elevated temperature, dizziness ,malaise ,nausea,lack of sleep,headache etc.

Patient may present with no swelling,
with intra oral sinus OR
with swelling [facial asymmetry ]
Removal of necrosed pulp,
cleaning and shaping of root canal, placement of CaOH2
Obturation of the R.C in the next visit
These steps will restore the tooth to functional health.

3 ways to resolve it:

1. Establish drainage through root canal

2. Establish drainage by incising a fluctuant swelling [if the
swelling is hard ,rinse it 3-5 mins with hot saline]

3. Antibiotics
use of antibiotics is regarded as an aid to drainage .

Incision and drainage — incise at the site of greatest fluctuance
The clinician should dissect gently through deeper tissues and
thoroughly explore all parts of abscess cavity.

To promote drainage ,the wound should be kept clean with
hot water mouth rinses.

In cases where periapical drainage cannot be established, surgical Trephination is done.

Trephination is the surgical perforation of alveolar cortical plate [over the root end] to release the accumulated tissue exudate that is causing pain.

[A small vertical incision is made adjacent to the tooth, the mucosa is retracted and No.6 round bur is used to penetrate cortical plate. This provides a drainage.]

Recent technique involves use of engine driven perforator to enter the medullary bone with out the need of incision.