Endodontic Emergencies
Endodontic Emergencies tests rapid relief of pain and swelling, recognition of spreading infection, and appropriate use of drainage and drugs.
Core rules
- Emergencies include irreversible pulpitis, acute apical abscess, flare-up, and trauma; the priority is source control, not just analgesia.
- For a fluctuant swelling, incision and drainage plus access and drainage of the pulp space relieve pressure; pus should be sent for culture when indicated.
- Antibiotics are adjuncts for systemic involvement, spreading infection, or immunocompromise; they are not a substitute for drainage.
- Assess airway, floor of mouth, trismus, and systemic signs; urgent referral or hospital care is needed for spreading cellulitis.
- A flare-up after treatment may need re-access, drainage, and review of working length and retained tissue.
Worked example
A patient has a painful, fluctuant buccal swelling, a necrotic molar, and no fever. Access is established, pus drains, and the swelling is incised. Analgesia is prescribed. Antibiotics are not routine because the infection is localised and drainage has been achieved. If the patient had fever or trismus, antibiotics and urgent review would be added.
Traps that cost marks
Prescribing antibiotics without drainage; waiting for a fluctuant swelling to resolve spontaneously; missing a spreading infection; and failing to re-access a symptomatic tooth after a flare-up.