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Current Trends in the Management of Endodontic Emergencies

Current Trends in the Management of Endodontic Emergencies Asmi A. Shah Introduction: The management of endodontic emergencies has changed over the last few decades and varies from practice to practice. This is due to the development of new materials, new irrigation techniques, and new evidence-based research which supports clinical success. An updated questionnaire is necessary to further advance the clinical knowledge in endodontic emergencies based on current practices. Therefore, the purpose of this research is to determine the difference practice modalities between members who are board certified, who are not board certified, and endodontic graduate residents. Materials and Methods: In 2021, every member of the American Association of Endodontics (n = 3157) were asked to complete a short survey about clinical practices and 394 (12.5%) completed the survey. The survey included questions regarding length of time between emergency treatment and definitive treatment, routinely prescribed antibiotics and analgesics, cone beam computed tomography use, level of pulp removal and instrumentation, and treatment modalities for teeth that exhibit swelling and drainage. The collected data were then statistically analyzed. Results: The overall preference in recommended analgesia was ibuprofen with 99.2% of all participants indicating that choice. The second most recommended analgesia was acetaminophen. It was recommended by 66.4% of all participants. The most recommended antibiotic was amoxicillin followed by clindamycin. Participants at all levels of education had similar choices in supplemental anesthesia. Board certified endodontists were more likely than non-board certified endodontists or residents to use a CBCT during endodontic emergencies (p < 0.05). Considering microscope use, board certified endodontists were more likely than non-board certified endodontists or residents to always use a microscope (p < 0.05). Most participants choice to wait 1-2 weeks from initiating treatment to completing treatment, an evidence-based recommendation. Majority of participants instrument to apex using the electronic apex locator, and completed the instrumentation in all 7 diagnoses. Among adjunct treatment, incision and drainage on average was selected over leave tooth open, insert drain, and artifistulation. Conclusion: Overall, residents and non-board certified endodontists treat patients similarly. The major differences are in CBCT use and microscope. Majority of participants instrument to the electronic apex locator reading and complete instrumentation. One major concern is the use of clindamycin which is no evidence based any longer and requires greater continued education on its prescription use in patients.