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Endodontic Emergencies

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In this video Dr. Stephen Buchanan offers advice regarding the management of endodontic and non-endodontic emergencies.

When a patient presents as an emergency the clinician needs to decide if the etiology of the patient’s complaint is endodontic or non-endodontic. If non-endodontic, Steve addresses myofacial pain in the video (note, that the pain could also be of periodontal origin).

Steve manages myofacial pain by recommending soft foods, no gum, deep tissue massage, cold/heat, and regular administration of an NSAID.

For endodontic emergencies the tooth is either: vital, necrotic, or previously treated.

Previously treated root canals which have become symptomatic should not be squeezed into the practitioner’s schedule due to the difficulties associated with re-treatments. For these cases, it is best to prescribe an antibiotic:

Never prescribe azithromycin for an endodontic emergency.

Keflex 500 mg TID 7 days is recommended for prophylaxis.

Augmentin 500 mg TID 7 days is recommended for acute infections.

If the patient is allergic to penicillins, Steve recommends:

Biaxin 500 mg BID for 5 days.

Clindamycin 150 mg QID for 7 days (as opposed to 300 mg to avoid the gastrointestinal side effects associated with clindamycin)

Metronidazole can be added to any of the above antibiotics.

For vital teeth, NSAID may offer 1-3 days of relief, otherwise a pulpectomy and placement of a medicament such as calcium hydroxide is indicated.

For necrotic teeth, a relief in pressure is indicated.