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Treatment of endodontic urgent care cases.

This article describes treatment for urgent care cases involving the dental pulp and periradicular tissues: acute pain of pulpal or periradicular origin, acute pain from endodontic procedures, and management of traumatically injured teeth.

Acute Disease↗

The tender tooth. Dentoalveolar, pericoronal, and periodontal infections.

Dental caries and periodontal disease are the most common afflictions of the tooth. These infectious diseases cause considerable pain and discomfort and ultimately loss of the tooth. Apart from local effects, these infections may extend beyond natural barriers and result in complications that can vary in severity from the excruciating pain of acute pulpitis to life-threatening infections of the deep fascial spaces of the head and neck. In this article, the clinical and pathologic features of dental caries, pulpitis, periapical abscess, pericoronitis, and periodontal infections are discussed as well as prevention and treatment of infections involving the tooth, with emphasis on endocarditis prophylaxis.

Child↗

Anaerobic infections in the head and neck region.

Anaerobic bacteria form the predominant flora of the oral cavity, outnumbering facultative organisms by 10-1,000: 1. The type of anaerobic bacteria and their concentration depend on the anatomical site and the degree of anaerobiosis in the different sites in the mouth. Three groups of anaerobic bacteria inhabit the oral cavity; the strict anaerobes, the moderate anaerobes, and the microaerophilic group of organisms. The majority of anaerobic bacterial infections occurring in the region of the mouth, head and neck are caused by the commensal flora. These infections include dental and periodontal disease where the predominant organisms are Bacteroides species, Veillonella, Bifidobacteria, Peptococcus, Peptostreptococcus and Propionibacterium species. More recently, Bacteroides endontalis has been isolated from a periapical abscess of endodontal origin and B. gingivalis, B. intermedius, Haemophilus actinomycetemcomitans and Wollinella species in chronic periodontal disease. Treponema species and other strict anaerobes are seen in smears of severe periodontal disease and acute necrotising gingivitis, but have not yet been isolated in pure culture. Until such time, their role in disease remains uncertain. Fusobacterium nucleatum is specially associated with severe orofacial infections which may extend into the mediastinum. Other anaerobic infections include chronic otitis media, chronic sinusitis and mastoiditis, and brain abscess. Treatment of these conditions should include the use of beta-lactamase resistant antimicrobials, such as clindamycin or one of the nitroimidazoles with penicillin.

Abscess↗

[Dentinal dysplasia type I].

Dentinal dysplasia is one of the rarest hereditary disturbances of dentin formation characterized by the teeth present with short blunt roots, considerably reduced or obliterated pulp spaces, periapical abscess or cysts without an obvious causative factor, and spontaneous exfoliated. These features were observed on a patient referred for prosthodontic assessment, and an investigation of other members of the family revealed that the father and two siblings were also affected. The report described the clinical, radiographic, histologic and scanning electron microscopic features and discussed the features which separated from dentinogenesis imperfecta.

Dentin Dysplasia↗

Endodontics. Diagnostic, treatment planning, and prognostic considerations.

An efficient systematic approach to proper diagnosis of pulpal and periradicular disease is presented. Then treatment planning considerations that determine if a tooth can be endodontically treated, if it has strategic value to be treated, and if the patient really wants the treatment are discussed. The long-term success rate of endodontic treatment is also discussed along with the predictability of emergency treatment for the patient being treated for urgent care.

Acute Disease↗