A systematic overview and treatment recommendation
Endodontic emergencies are characterized by severe to unbearable pain in the patient. This can be caused by symptomatic irreversible pulpitis, symptomatic apical periodontitis, acute exerbation after initial treatment or an acute apical abscess. Very good diagnostics prior to the start of treatment lead to a diagnosis and thus determine efficient pain therapy. Even today, however, attempts to relieve the patient's pain as quickly as possible range from "leaving the tooth open" to the insertion of paraformaldehyde-containing pastes and the administration of opioids or antibiotics. Unfortunately, the latter are still used as diagnostic aids or "painkillers". While local corticosteroid-containing preparations such as Ledermix, Odontopaste or Dontisolon were previously only recommended with great caution, current studies show that they do facilitate effective pain therapy. Corticosteroid-containing pastes can also be used effectively against painin symptomatic apical periodontitis. Adequate anesthesia should be administered before any dental procedure. In the case of irreversible pulpitis, four times the usual dose is required to block inflammatory sodium channels and prevent the transmission of irritation. Several cartridges of Artikain (Ultracaine) can and should therefore be administered before an operation in the emergency department.