ENDODONTIC PAIN CONTROL

Dr. Ameer H. AL-Ameedee
Ph.D in Operative and Esthetic Dentistry












THE MAIN CAUSE OF THE PAIN IS EDEMA RESULTS IN INCREASED FLUID PRESSURE WHICH STIMULATES PAIN RECEPTORS

THE IMMEDIATE GOAL OF THE TREATMENT SHOULD BE THE REDUCTION OF PRESSURE OR REMOVAL OF THE INFLAMED PULP OR PERIRADICULAR TISSUE.
1-PAINFUL IRREVERSIBLE PULPITIS WITHOUT APICAL PERIODONTITIS
TREATMENT:-PROFOUND ANESTHESIA-COMPLETE PULP EXTIRPATION -CLEANING & SHAPING OF THE CANALS IS DESIRABLE.-IN MOLARS ;PULPOTOMY MAY BE ENOUGH TO RELEASE PRESSURE-MEDICAMENTS :CAMPHOR SEALED IN THE CANALS.-A MILD ANALGESICS BUT NO ANTIBIOTIC
2-PAINFUL IRREVERSIBLE PULPITIS WITH ACUTE APICAL PERIODONTITIS

3-PULP NECROSIS WITHOUT SWELLING

-DRY THE CANALS WITH PAPER POINTS -FILL THE CANALS WITH NON SETTING CALCIUM HYDROXIDE.-MEDICAMENTS :CAMPHOR SEALED IN THE CANALS AND CLOSE IT WITH TEMPORARY FILLING-MILD ANALGESIC IS NEEDED(ANTIBIOTIC IS RARELY NEEDED)
4-PULP NECROSIS WITH LOCALIZED SWELLING(associated with acute apical abcess)


-TREATMENT IS BIPHASICFIRST: DEBRIDMENT OF THE CANALSSECOND:DRAINAGE OF BUS
LOCALIZED SWELLING SHOULD BE INCISED &DRAINED TO :1-RELEASE OF PRESSURE.2-REMOVAL OF THE VERY POTENET IRRITANT.
-IN PATIENTS WITH A PERIRADICULAR ABCESS & NO DRAINAGE FROM THE CANALS,PENETRATION OF THE APICAL FORAMEN WITH SMALL FILE(UP TO 25)MAY INITIATE DRAINAGE & RELEASE PRESSURE.-DRAINAGE THROUGH THE TOOTH MAY BE ENOUGH IN SOME CASES.
-MOST OF THE CASES NEED DRAINAGE THROUGH THE TOOTH & THE MUCOSAL INCISION-DRAIN MAY BE NEEDEDTO PERMIT CONTINUED DRAINAGE
TREATMENT - DEBREDMENT & DRAINAGE .-HEAVY IRRIGATION WITH DISTILLED WATER -IT IS ADVISED NOT TO USE SODIUM HYPOCHLORIDE WITH THE PRESENCE OF BUS BECAUSE THIS MAY LEAD TO THE FORMATION OF PLUG. -DRY THE CANALS WITH PAPER POINTS & CLOSE.-MEDICAMENTS :CAMPHOR SEALED IN THE CANALS-CLOSE WITH GOOD TEMPORARY FILLING-MILD ANALGESIC &ANTIBIOTIC IS NEEDED
-Make sure that there is no bus in the canals before you close-Don’t leave these teeth open for drainageButIf the drainage through the canal is not stopped, the access may be left opened for further drainage BUT NOT MORE THAN 24 HRs
ANTIBIOTIC OF CHOICE:A COMBINATION OF-WIDE SPECTRUM ANTIBIOTIC FOR AEROBIC BACTERIA(Penecillins)-METRONEDAZOLE(Flagyl) FOR ANEROBIC BACTERIA
5-PULP NECROSIS WITH DEFFUSE SWELLING

TREATMENT -DRAINAGE IS VERY IMPORTANT IF THERE IS FLUCTUATION & BUS.-EXTRAORAL INCISION WITH DRAIN MAY BE NEEDED.-REMOVAL OF IRRETANTS BY DEBRIDMENT OF CANALS OR EXTRACTION OF INFECTED TOOTH.-STRONG ANTIBIOTIC (I.V.)& ANALGESIC .-MAY NEED HOSPITALIZATION..

CAUSITIVE FACTORS-PREOPERATIVE COMPLICATION-OVERINSTRUMENTATION( BLOOD IN TH CANALS)-REMAINING INFLAMMMED PULP TISSUE-IMPROPER PREPARATION OF PATIENT
1-PREVIOIUSLY VITAL CASES WITHOUT SWELLING TREARTMENT-ASSURANCE OF PATIENT-GOOD ANALGESIC-REOPEN THE TOOTH( MAKE GOOD DEBRIDMENT & IRRIGATE)-INTRACANAL MEDICAMENTS 
2-PREVIOUSLY NECROTIC CASES WITH NO SWELLING
TREATMENT-OPEN THE TOOTH-RECLEAN & IRRIGATE THE CANALS WITH SODIUM HYPOCHLORITE-DRY & CLOSE.
IF ACUTE APICAL ABCESS IS DEVELOPED:-DRAINAGE IS NECESSARY( THROUGH THE TOOTH OR THE SOFT TISSUE)-CLEANING & IRRIGATION OF THE CANALS-DRY & CLOSE.-ANTIBIOTIC & NSAID IS NEEDED
POSTOPERATIVE EMERGENCIES
ONE THIRD OF ALL ENDO CASES EXPERIENCE SOME PAIN FOLLOWING OBTURATION.
CAUSES:-OVERFILLING IS THE MAIN CAUSE-HIGH OCCLUSION-IRRITATION FROM THE SEALER OR GUTTAPERCHA
TREATMENT -DISCOMFORT: REASSURANCE &MILD ANALGESICS.-REMOVAL OF THE HIGH POINTS-RETREATMENT IS INDICATED IF PAIN PERSIST &ENDO TREATMENT HAS BEEN OBVIOUSLY INADEQUATE.
-APICAL SURGERY ( APECICTOMY) IN PATIENTS WITH PERSISTENT PAIN WITH OVER FILLING-PATIENTS WITH GOOD ROOT CANAL TREATMENT BUT WITH PERSISTENT SWELLING AFTER OBTURATION,INCISION & DRAINAGE MAY BE ENOUGH.

THE END