Endodontic Diagnosis and Triaging Endo Treatment during

the COVID 19 Outbreak

Pommy Hallen, DMD, FRCD(C)Surrey Endodontic Centre

www.surreyendo.comdrphallen@gmail.cominfo@surreyendo.com

DR. POMMY H

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Learning Objectives

• Simplified Endodontic Diagnosis - Pointers for Telephone Triage.

• SARS-CoV-2 (COVID 19) - PPE information - Back to Work?

• Management of Pain and Infections in the ERA of COVID 19.

success rate?in reality, the success rate is 100%–X, where X represents the clinician’s endodontic knowledge and skill as well as their “willingness”

J Esthet Restor Dent 18:280–300, 2006JOHN WEST, DDS, MSD

DR. POMMY H

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Pulpal and Periapical Disease

Pulpal and Periapical DiseasePulpal disease

•Normal pulp

•Reversible pulpitis

•Irreversible pulpitis•Symptomatic IP•Asymptomatic IP

•Pulp necrosis

•Previously Treated

•Previously Intiated

Periapical Disease

•Normal apical tissues

•Apical periodontitis•Asymptomatic AP•Symptomatic AP

•Acute apical abscess

•Chronic apical abscess

•Condensing Osteitis

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Examination procedures required to make an endodontic diagnosis

Medical/Dental history: Past/Recent treatment.

Chief complaint (if any): How long, symptoms, duration of pain,location, onset, stimuli, relief, referred, medications.

Clinical exam: Facial symmetry, sinus tract, soft tissue, periodontal status (probing, mobility), caries, restorations (defective, age).

Clinical testing: pulp tests Cold, electric pulp test, heatperiapical tests Percussion, palpation, Tooth Slooth (biting).

Radiographic analysis: New periapicals (at least 2), bitewing, cone beam-computed tomography.

Additional tests: Transillumination, selective anesthesia, test cavity.

Telephone Pointers

• Are you able to sleep at night?

• Can you describe the pain?

• Is it a short lasting quick stabbing pain?

• Or is it a dull, achy pain that radiates?

• Are you able to chew on that side of your mouth? On the tooth that hurts?

• Is the pain increased when you bend over to pick something up?

DR. POMMY H

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Normal Pulp

Symptoms:•Asymptomatic

Clinically:•Mild response to pulp testing•last for few seconds•No evidence of pulp irritants

•Radiographically:•WNL

NORMAL PULP

ÒLike all the other teeth ÒIf they are all sensitive that is normal

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Reversible Pulpitis

Symptoms:•Mild to moderate pain to stimuli•Non-lingering•No spontaneous pain•Recent dental treatment

Clinically:•Moderate non-lingering response to pulp testing•Clinical evidence of pulp irritant

Radiographically:•Shallow or deep carious lesions•Varying degree of calcification•No periapical pathological changes

Treatment:•Elimination of the cause

REVERSIBLE PULPITIS

ÒCold not >5-7secs

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Irreversible Pulpitis

Symptoms:•Moderate to severe pain•Intermittent or spontaneous•Diffuse, sharp radiating pain•lingers (more 10 sec)•True endodontic emergency

Clinically:•Moderate to severe lingering pain to pulp testing•Clinical evidence of significant pulp irritant(s)

Radiographically:•Deep carious lesion, restoration, fracture, etc.•Varying degree of calcification•Minimal or no periapical pathological changes

Treatment: RCT/Extraction

IRREVERSIBLE PULPITIS

ÒSymptomatic É>10 s to cold

ÒAsymptomatic ÉFilling/crown/caries removal will cause problems

DR. POMMY H

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Pulp Necrosis

Symptoms:•Asymptomatic until the disease progress to the periapical tissues

Clinically:•No response to pulp testings•Clinical evidence of pulpal irritant(s)•Signs of periapical pathology•Possible pain to Hot Liquids/Food

Radiographically:•Deep carious lesion, deep restoration, fracture, etc.•Varying degree of calcification•Minimal or no periapical pathological changes

Treatment: RCT/Extraction

DR. POMMY H

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