كثير ما يتم الخلط ما بين الـ flare-up و الآلام البسيطة اللي تتبع علاج العصب؛
لذلك حبيت أبين الفرق بينهم في هذي السلسلة 👇🏼
لذلك حبيت أبين الفرق بينهم في هذي السلسلة 👇🏼
Flare-up defined as an acute exacerbation of a pulpal and/or periradicular pathosis after initiation or continuation of root canal treatment. It usually necessitates an unscheduled visit for further management.
The differences between the routine post-endo discomfort and flare-ups are shown in the table below👇🏼
Some of the etiological factors are summerized in the figure below 👇🏼
Suggested preventive measures:
1- Selection of instrumentation technique that extrude less debris apically (crown-down).
2- Complete chemo-mechanical preparation in one session.
3- Placement of antimicrobial intracanal medicament between the visits.
1- Selection of instrumentation technique that extrude less debris apically (crown-down).
2- Complete chemo-mechanical preparation in one session.
3- Placement of antimicrobial intracanal medicament between the visits.
4- DO NOT leave teeth open.
5- Maintain the aseptic chain during intracanal procedures.
6- Occlusal reduction if the tooth is tender to percussion.
5- Maintain the aseptic chain during intracanal procedures.
6- Occlusal reduction if the tooth is tender to percussion.
7- Always forewarn your patients about flare-ups or even post-po discomfort.
If any of that happened, they will be ready for it without panicking. If not, they will appreciate how caring you are!!
If any of that happened, they will be ready for it without panicking. If not, they will appreciate how caring you are!!
Management:
One or more of the following treatments is usually considered in order to manage flare-ups:
1- Drainage through canal and/or proper instrumentation.
2- Incision and drainage.
3- Pharmacological management.
One or more of the following treatments is usually considered in order to manage flare-ups:
1- Drainage through canal and/or proper instrumentation.
2- Incision and drainage.
3- Pharmacological management.
Pharmacological management includes, narcotics, antibiotics and/or corticosteroids.
Corticosteroids inhibit the activity of phospholipase A2 which eventually will reduce the synthesis of inflammatory mediators.
Corticosteroids inhibit the activity of phospholipase A2 which eventually will reduce the synthesis of inflammatory mediators.
Indications for corticosteroids:
•Prevention and/or Relief of interappointment or post-operative endodontic pain / swelling.
•Severe pain not controlled by NSAIDs or Narcotics.
•Prevention and/or Relief of interappointment or post-operative endodontic pain / swelling.
•Severe pain not controlled by NSAIDs or Narcotics.
Relative contraindications:
•Uncontrolled infections.
•Pregnancy, Gastric Ulcer, Glaucoma.
•Kidney Failure.
•Immunocompromised patients.
•Uncontrolled infections.
•Pregnancy, Gastric Ulcer, Glaucoma.
•Kidney Failure.
•Immunocompromised patients.
Corticosteroids can be given by an intramuscular injection in the deltoid muscle, buccal infiltration (4 mg dexamethason) or orally (4 mg methylprednisolone).
At the end, the following flowchart might be helpful in management of flare-up 👇🏼
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