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TREATING ENDODONTIC EMERGENCIES (NBDE PEARL)

Ricky Rubin

VITAL PULP EMERGENCY: patient may report spontaneous, sharp, or radiating pain. Classic chief complaint is sudden, intense, and prolonged painful response to COLD.  

  • Vital Emergency Treatment: achieve profound anesthesia (can be tough), reduce occlusion if needed, prepare access cavity, and perform pulpotomy. If bleeding stops, place a dry cotton pellet and place a provisional restoration or complete definitive treatment if time permits. If bleeding persists from a specific canal after completing the pulpotomy, extirpate the pulp from the culprit canal. 

NECROTIC PULP EMERGENCY: patient may report dull, throbbing ache, pain from biting pressure and/or intra/extra oral swelling. Classic chief complaint is severe pain to HEAT that is alleviated by a cold liquid

  • Necrotic Emergency Treatment: anesthetize, isolate and perform pulpotomy only then adjust occlusion. Place one large cotton pellet in access cavity and LEAVE TOOTH OPEN to drain exudate for 3-4 days is the most predictable relief. Complete RCT at next scheduled appointment.