طـDentistry ـب الأسـنـان

#Endodontic #Flare_Up ⛔️INTERAPPOINTMENT EMERGENCIES ✅Treatment of Flare-ups 1⃣Reassurance (the “Big R”) is the most important aspect of treatment. The patient is generally frightened 😰 and upset and may even assume that extraction is necessary. 😱 🤗The explanation is that the flare-up is neither unusual nor irrevocable and will be managed. 1⃣Previously Vital Pulps with Complete Débridement: ✅patient reassurance and the prescription of a mild to moderate analgesic often will suffice. 💢 it is important to check that the temporary restoration is not in traumatic occlusion 2⃣Previously Vital Pulps with Incomplete Débridement ✅The working length should be rechecked, ✅ the canal(s) should be carefully cleaned with copious irrigation of sodium hypochlorite. ✅A dry cotton pellet is then placed, followed by a temporary filling, ✅a mild to moderate analgesic is prescribed 3⃣Previously Necrotic Pulps with No Swelling ✅The tooth is opened ✅ the canal is gently recleaned and irrigated with sodium hypochlorite. ✅Drainage should be established if possible 🔰 If there is active drainage from the tooth after opening, ✅the canal should be recleaned (or débridement completed) and irrigated with sodium hypochlorite. 🔰The rubber dam is left in place after the tooth is opened; the patient is allowed to rest pain-free for at least 30 minutes or until drainage stops. ✅Then, the canals are dried, calcium hydroxide paste is placed, and the access is sealed 💢If there is no drainage, the tooth should also be ✅lightly instrumented, ✅ gently irrigated, ✅ medicated with calcium hydroxide paste, ✅and then closed. 😃 The symptoms usually subside but do so more slowly than if drainage was present. Again, patient education and reassurance are critical. A long-acting anesthetic and an analgesic regimen for moderate to severe pain are helpful; ❗️antibiotics are not indicated 4⃣Previously Necrotic Pulps with Swelling 🔵Previously necrotic pulps with swelling are best managed with: ✅ incision and drainage. In addition, it is most important that the ✅canals have been débrided. If not, ✅they should be opened and débrided, ✅ medicated with calcium hydroxide paste, and closed. ✅Then incision and drainage with placement of a drain are completed. 💢Occasionally but rarely, a flare-up or a presenting acute apical abscess may be serious (cellulitis) or even life- threatening🚨 🚨🚑These situations may require hospitalization and aggressive therapy with the cooperation of an oral surgeon. ♻️Follow-up Care With flare-ups, the patient should be contacted daily 🏃 until the symptoms abate. 📞 Communication may be made by telephone. 😫Patients with more serious problems or those that are not resolving (many do not and require additional measures) should return to the dentist for treatment as previously described, depending on findings. 😨When symptoms recur or cannot be controlled, these patients should be considered for referral. Ultimate treatment by a specialist may include extra measures, 🚑🚑 such as apical surgery, or even hospitalization. ⛔️Reference Endodontic principles and practise   4th edition Mahmoud Torabinejad, DMD, MSD, PhD Professor and Program Director Department of Endodontics School of Dentistry Loma Linda University Loma Linda, California Richard E. Walton, DMD, MS Professor Department of Endodontics The University of Iowa College of Dentistry Iowa City, Iowa  https://t.me/Dentistry6

#Endodontic_Case #Flare_Up 👳A 42-year-old male patient with 👉a noncontributory medical history returns to your office the day after instrumentation, irrigation, and closure of tooth # 3. 😖He complains of severe pain and sensitivity when touching the tooth or masticating. 😶There is no swelling in the muccobuccal fold. ✍Treatment notes indicate that you instrumented three canals to a #20 K file and used rotary instruments. How would you treat this patient? 🤔 🔵Answer 🔰• Provide local anesthesia. 🔰• Check occlusion. Reduce occlusion if not already done and restorative consider- ations permit. 🔰• Confirm measurement. 🔰• If the tooth was instrumented only up to a 20 K file or less ⛔️, it is likely that tissue was left in the canals. 🔰• Re-instrument all canals to a 25–30 K file and/or rotary instrument. 🔰• Irrigation. 🔰• Place calcium hydroxide dressing. 🔰• Closure." 🔰• Analgesics. 🌐Goal of Treatment: 🔵The treatment is biologically based. 🔵Confirming the measurement and re-instrumenting should eliminate residual tissue in the canals without further damage to the apical tissues. 🔵Occlusal reduction will put the periodontal ligament at rest. https://t.me/Dentistry6

#Endodontic_Case #Flare_Up 💂A 31-year-old male presents 24 h after endodontic instrumentation. 🚫 His medical history indicates an allergy to penicillin. 💢He has a large fluctuant swelling in the muccobuccal fold adjacent to #30. ⬆️He reports the swelling has increased significantly in the last 12 h, as has his pain. 🤕 🙂Treatment notes indicate that he presented with an asymptomatic non-vital tooth without a radiolucent lesion. 👌 Tooth # 30 was instrumented to a 25 K file and 30 rotary instrument. 🚿 It was irrigated with sodium hypochlorite. 🤗Adjacent teeth have no restorations and no caries. ❓❓❓❓ How would you treat this patient?❓❓ 🔵Answer • Inferior alveolar nerve block. • Take the patient’s temperature (optional, depending on size of swelling, localization, and presence of malaise). • Confirm measurement control. • Re-instrument and enlarge the canals and irrigate with sodium hypochlorite. • Attempt to establish drainage through the canal. • Place calcium hydroxide dressing. • Closure. • Reduce occlusion, if restorative considerations permit. • Incision and drainage for the fluctuant swelling. • Analgesics/antibiotic (note penicillin allergy). Clindamycin is an appropriate substitute. • Patient should return in 24–48 h for reassessment and recleaning/shaping and irrigation. ☺️Goal of Treatment: The suggested approach addresses the microbial cause of the exacerbation. 🌸The goal is to eliminate or significantly reduce the intracanal microbial flora and decompress the periapical tissues. 💊The use of antibiotics is a supplement to the clinical treatment and is not a “cure” of the basic microbial problem. In a non-vital case (no vascular circulation) little or none of the systemic antibiotic reaches the canal space. https://t.me/Dentistry6

#Endodontic #Flare_up Flare up عندما يستشيط السن غضباً 🔥 هيج ترجمتها ، وهالكلمتين ضروري جدا تعرفوها لأن يمثلون جزء مهم مهم مهم بعملك وعدم معرفتك الهم وعدم معرفتك لأسبابها وعلاجها راح يهز الثقة بينك وبين البيشنت وبالتالي راح تخسر البيشنت صدگني 💔 نگدر نعرف ال flare up على انه نوبات شديدة من الالم والتورم بعد قيامك بحشوة جذر بيرفكت وماشي كلش حسب الخطوات الصحيحة 🤷🏻‍♂️ تره كارثه 🤦🏻‍♂️ مهتم ومسوي حشوة جذر بيرفكت وتالي البيشنت يحس بألم أشد من الالم اللي اجه علموده وهيج راح يگول عليك مو خوش طبيب ويروح لواحد غيرك يگوله هاي شنو شمسوين بيك ويقلعله السن ويخلص من الوجع ويصير الطبيب الثاني هو البطل الاسطوري المنقذ الفلير اب بيه عدّة كومه اسباب بس اختصرها الكم بـ : تروما للنسيج السني او بقايا من ال pulp tissue او تروما للنسيج حول السن وخصوصا من تسوي انسترمنتيشن وتعبر الابكس وتضرب الانسجه هناك .. وهمين تصير اذا انت ال gutta percha تعبر الابكس يعني Over extended وهمين همين ، انتبهولي هنا 😒 شايفين الحالات اللي ينشروها اطباء الاسنان وتشوفون مادة السيلر عابرة الابكس او مثلما يسموها Sealer puff 💭 وهنا الطبيب اولما يشوفها يصور الحالة وينشرها ويستعرض عضلاته 💪 بس يمكن ما تعرفون ان البيشنت وره هالجلسة راح يعيش يومين او ثلاثه من الالم 🙂 لذلك نصيحة ابد لا تخلون اي مادة او اداة تعبر الابكس وخلّو شغلكم داخل ال channel فقط اي نرجع ونحجي شلون نتجنبها💡 اولن ن ينصحون انو بأول جلسة من تسوي pulp extirpation تسوون وياها instrumentation وتشيلون العصب بالكامل وتنظفون ال channels كلش زين ثانياً تستخدمون irrigation protocol مضبوط (شارحه قبل بسلسلة الاندو تلگوه بالهايلايت) ثالثاً تخلون intracanal medications مثل ال calcium hydroxide زين رغم كل هذا والبيشنت وره الجلسة الاولى او بعدما كملنه الحشوة صار عنده flare up يعني ألم شديد شنسوي ؟ من الاخير .. تعيد حشوة الجذر من البداية 😁 وتستعمل هالمرة intracanal medicament يتكون من Corticosteroid + antibiotic وهذا اسمه ledermix البيشنت تنطوه مسكنات واللي هي Ibuprofen + paracetamol سويه واذا اكو ويه ال flare up تورم بالمنطقة فأحسن شي تسوي drainage لان هاي abscess ووراها تعيد الانسترمنتيشن والارگيشن واخير شي بالعلاج انو تخفف من الاطباق يعني تسوي occlusion reduction هسه نجي للحچي المرتب واللي يدل على انك طبيب ممتاز وهي امكانيتك انو تتوقع راح يصير flare up حتى قبل لا تبدي بحشوة الجذر 😁 اول شي ال females توقع نسبة جبيرة منهم يصير عدهم هاي الـ flare up 🤷🏻‍♂️ (دوم مشاكلهم هوايه 🤦🏻‍♂️😂) ثاني شي بالاشعة اذا شفت Large periapical radiolucency همين توقع تصير عندك ثالث شي اذا البيشنت عنده حساسيات تجاه علاجات او اكلات معينه همين تصير عدهم رابعاً اذا البيشنت الالم مالته من يعض ع السن يعني Acute periapical periodontitis فمعرفتك ليگدام انو راح يصير flare up راح يخليك تتجنبها وهيج انت تفوز ♥️ وشكرا 😁 https://t.me/Dentistry6

#Endodontic #Flare_Up 🔵CONCLUSION The occurrence of mild pain and discomfort is common even if the treatment rendered is of highest standard. But still 🌟psychological preparation of the patient, 🌟complete cleaning and shaping of root canal system, 🌟 use of long acting anesthetic and analgesics 👇👇👇 decrease the incidence of inter appointment flare- ups in mild to moderate levels. 👌Prompt and effective treatment of flare-ups is an essential part of overall endodontic treatment. ⛔️Reference 🌐IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 9, Issue 4 (Sep.- Oct. 2013), PP 26-31 www.iosrjournals.org 🌐Flare-Ups in Endodontics – A Review Priyanka.S.R , Dr.Veronica (Saveetha Dental college, Saveetha University, India) (Department of Conservative dentistry and Endodontics, Saveetha Dental college, Saveetha University, India) 🌐Article information J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2): S294–S298. 📘Textbook of Endodontics SECOND EDITION Nisha Garg MDS (Conservative Dentistry and Endodontics) Ex Resident, PGIMER, Chandigarh Ex Resident, Government Dental College, Patiala Presently at, Manav Rachna Dental College Faridabad, Haryana, India Amit Garg MDS (Oral and Maxillofacial Surgery) Ex Resident, Government Dental College PGIMS, Rohtak Presently at, Manav Rachna Dental College Faridabad, Haryana, India  https://t.me/Dentistry6

#Endodontic #Flare_Up 🔰6⃣Previously Necrotic Pulps without Swelling Teeth with necrotic pulp often develop as acute apical abscess after the initial appointment. 😭As the lesion is confined to bone, there occurs the severe pain. 🔵management: 1- establish accurate working length 2- complete instrumentation of root canal. ( In these cases, the tooth is opened and the canal is gently recleaned and irrigated with copious amount of sodium hypochlorite. ) 3-Drainage must be established if possible. If there is drainage from tooth after opening, then tooth is again cleaned and debrided completely and irrigated with sodium hypochlorite. 4- After drying the canal, calcium hydroxide dressing is placed 5-access is sealed. ⛔️If there is no drainage from the canal, still gently open the tooth, lightly instrument and completely debride the canal. After debridement, copiously irrigate the canal with sodium hypochlorite and place calcium hydroxide paste and close the access. Prescribe analgesics and antibiotics. 🔰7⃣ Previously Necrotic Pulp with Swelling 💠management 1- incision and drainage. 2- canals should be opened 3-debrided and gently irrigated with sodium hypochlorite solution. 4-calcium hydroxide paste should be placed and closed https://t.me/Dentistry6

#Endodontic #Flare_Up 🔰5⃣Previously Vital Pulps with Complete Debridement. 💠Treatment: 1-patient reassurance 2-prescription of mild to moderate analgesic . 3- no need of reopening and placing corticosteroids in the canal to reduce the pain and swelling https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 🔰3⃣ Recrudescence of chronic apical periodontitis (Phoenix Abscess): 🕴 It is a condition that occurs in teeth with necrotic pulps and apical lesions that are asymptomatic. ⚔There is no exacerbation of previously symptomless periradicular lesion. ☠The reason for this phenomenon is thought, to be due to the alteration of the internal environment of root canal space during instrumentation which activates the bacterial flora. 💢Mobility, tenderness and swelling are usually the sign and symptoms found in phoenix abscess. 🔰4⃣ Recurrent periapical abscess ▶️It is a condition where a tooth with an acute periapical abscess is relieved by emergency treatment after which the acute symptoms return ♻️ In some cases, the abscess may recur more than once,😰 due to microorganism of high virulence😈 or poor host resistance.🤒🤕 https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 🔰 2⃣ Incomplete removal of pulp tissue 🤗Whenever a pulpotomy or partial pulpectomy has been done, 😭the patient may experience pain due to incomplete removal of inflamed pulp tissue 👉 In this condition, sensitivity to hot🔥 and cold ❄️or pain on percussion 💥🔨is usually seen. 📈Confirmatory test: 1-Apply rubber dam, 2-place a sterile paper point, of course short of working length. 3- When paper point is removed, it will display brownish discoloration indicative of inflamed seeping tissue. 💠Treatment: 1-the working length should be rechecked 2-the canals should be carefully cleaned with copious irrigation of sodium hypochlorite. 3-A dry cotton pellet is then placed followed by a temporary filling 4-a mild analgesic is prescribed 5- the tooth relieving from occlusion. https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up ⚡️The cause of this pain may be: • Overinstrumentation • Over medication • Forcing debris into periapical tissues 📈Confirmatory test: 1-Apply the rubber clamp and use a sterile paper point. 2- Access and mark the working length. 3- place the paper point in the canal. 📝 If over instrumentation has happened by fault, then the paper point will go beyond the working length without obstruction. On withdrawal, tip of the point will show a reddish or brownish color indicating inflamed tissue in the periapical region and absence of stop in apical preparation https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 💊6. Intracanal medicaments: For relief of pain during root canal treatment, commonly used intracanal medicaments are: 💊 antimicrobial agents (cresatin, CMCP have been tried to provide relief of pain) 🚿irrigating solutions: ( sodium hypochlorite) 💊corticosteroids. because of their anti- inflammatory activity. Corticosteroids also hyperpolarizes the nerve present in inflamed area and thus reduces the nerve impulse transmission. 💉7. Medications: Commonly used systemic drugs are: a. Analgesic🌬 (ibuprofen, diclofenac sodium, aspirin and etoricoxib) b. Antibiotic⚔🛡 ( pencillins and its derivatives are commonly prescribed. Metronidazole, tinidazole, ornidazole and clindamycin are also used because of their effectivity against anaerobic infections) c. Corticosteroid🔮 https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up ⬇️4. Relief of occlusion: To prevent postoperative pain and/or to reduce intra-appointment pain. 🔵5. Calcium hydroxide therapy: It is intracanal dressing used for therapeutic purpose for prevention or treatment of flare- ups. https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 3. Establishment of drainage: In the presence of suppuration, drainage of exudate is the most effective method for reducing pain and swelling In most cases, accumulated exudate will surge from root canal affording immediate relief. But in some cases, root canal instruments are needed to pass through packed dentinal shavings in the apical third of canal. After exudation, access cavity is closed again to avoid exposure of canal to oral flora and salivary products. https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 📌 2. Complete debridement of root canal system: Single most effective method to reduce flare-ups is complete debridement by cleaning and shaping of root canal system https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_Up 😇1. Reassurance to the patient: المريض في حالة الطوارئ هذه يكون خائف جداً ومتوتر لذلك تطمين المريض خطوة مهمة جددداً لعلاج الحاله.. فيجب عليك استعادة ثقة المريض و تهدئته وايضا عليك شرح ماحصل له وان هذا الامر شائع و سيتم السيطرة عليه ومعالجته ... https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_up بعد أن تعرفنا على الأسباب والعوامل اللي تؤدي لحصول flare up يجب علينا التعرف على كيفية التعامل مع هذه الحالات 🌀DIAGNOSIS AND MANAGEMENT OF FLARE-UPS من المهم جداً اخبار مريضك باحتمالية احساسه بالألم بعد اول جلسة ... وتنبيهه إلى ضرورة أخذ مسكنات للألم في حال وجود ألم بعد الزيارة الاولى.. معرفة سبب الألم يحدد مدى نجاح تخطي حالة flare up والسيطرة عليها https://t.me/Dentistry6

#Endodontic #Flare_up 🌀Definition is described as the occurrence of 🔸 pain, 🔹swelling or the combination of these🔹🔸 during the course of root canal therapy, which results in unscheduled visits by patient.🏃 أيضاً 👇👇👇👇 🌐AAE defines a flare- up “As an acute exacerbation of periradicular pathosis after initiation or in continuation of root canal treatment” من الممكن ظهور الألم في أي مرحلة من مراحل المعالجة اللبية 👇👇 💢soon after initiating endodontic treatment for an asymptomatic tooth 💢shortly after the initial emergency treatment 💢 during the course of treatment. وأيضاً حدوثه ناتج عن عدة عوامل وأسباب أهمها 👇👇👇👇👇 🌀Etiology The etiology of flare-up is multifactorial. They include,  1⃣- Microbial factors.👿 Many teeth present with infection and pain after endodontic intervension because of persisitent bacterial presence. 2⃣- Host factors : 🤕 *Patient’s age👴 * gender👫 * stress😤 * psychological factors😩 *immunological status🚫 *periapical tissue response♻️ * Changes in periapical tissue pressure💢 *effects of chemical mediators.🚥🚦  3⃣-Treatment procedures✍ ⚠️Failing to clean canals especially in the apical region, can result in treatment failure. 🚨 * mechanical or chemical injuries ⛏*Incomplete debridement 💦* apical extrusion of debris. ⚡️ *overinstrumentation ☄*irrigant extrusion, 💥* overextended or *underextended obturation. 3. Periapical extrusion of debris: قد تكون هذه الdebris : 👇👇 * pulp tissue fragments Or * necrotic tissues Or *microorganisms وجميعها تؤدي إلى 😵periapical inflammation and flare-ups بالإضافة إلى The extrusion of irrigant solutions ( sodium hypochlorite) beyond apex, 😭it may result in violent tissue reaction and unbearable pain 4 Overfilling: Large overfills of obturating materials like gutta- percha or sealers are responsible for pain In addition, 😳gross-overfilling can cause nerve damage because of chemical toxicity of obturating materials and also, the mechanical nerve damage can be caused by over extended filling. 5- Periapical lesion: Pulp with larger periapical radiolucency have more bacterial stains and are more infected. These bacteria can cause acute problem if inoculated periapically‼️‼️ 6. Retreatment: Retreatment cases show more flare-ups https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_up https://t.me/Dentistry6 https://t.me/Dentistry6

#Endodontic #Flare_up 💢Flare-ups💢 امر غير مرغوب الحدوث ويسبب ارباك وانزعاج وتوتر لكل من المريض والطبيب لذلك يجب اتخاذ الاجراءات الوقائية لمنع حدوثه ومعرفة طريقة المعالجة في حال حدوثه . وهذا ماسنتعرف عليه بإذن الله https://t.me/Dentistry6

#Endodontic #obturation All things about obturation https://t.me/Dentistry6