Effective strategies for pain management in
Endodontic Therapy
Prepared by: Dr. Dilnya Ali
Definition of pain: Pain is defined as an unpleasant sensory
and emotional experience associated with actual or potential
tissue damage or described in terms of such damage.
Pain is a warning signal and primarily protective in nature.
*Feeling pain can be a good thing because it helps you
understand what you are going through, and you cannot fix
something you do not understand.
,Types of Endodontic pain:
1-Pre-operative pain
2-Inter-operative pain (Inter-appointment pain).
3-Post-operative pain( Post-obturation pain).
*Inter-operative and post-operative pain that result from dental
procedures may be attributed to dentist errors and are reffered
to as"Flare up"
-Definition of flare-up: The occurance of severe pain and
swelling following an endodontic treatment appointment,
requiring an unscheduled visit and active treatment.
A- Pre-operative pain:
Acute pulpitis.
Acute pulpitis with apical periodontitis.
Acute periapical abscess:
a) Localized
b)Diffused (Cellulitis).
1-Acute pulpitis manifests as a sudden, sharp and severe pain.
Analgesics often fail to relieve the pain. Individuals with this
condition experience discomfort when consuming both hot
and cold food and beverages. In the advanced stages of acute
pulpitis, the pain intensifies when exposed to heat but eases
,when exposed to cold stimuli. Additionally, it is crucial to
account for the possibility of diffuse or reffered pain,
necessitating a thorough examination of the entire mouth and
teeth. The pain is typically spontaneous and can persist for
periods ranging from ten minutes to several hours. Such cases
require immediate emergency treatment.
Emergency treatment options:
A-Complete Removal of pulp tissue (Pulpectomy):-
Local anesthsia.
Rubber dam.
Access cavity opening.
Irrigation.
Working length determination.
Mechanichal shaping.
B-Partial pulp removal (Pulpotomy):-
Local anesthesia.
Rubber dam.
Removal of coronal pulp tissue
Irrigation in access cavity with Sodium hypochlorite
Moisten a cotton pellet with formocresol, and apply it to
the access cavity for one minute, then remove it.
, *Dampen a cotton pellet with formocresol, then place
another cotton pellet on top of the dampened one and
apply the second one to the cavity for 1 minute. Then
remove the cotton pellet, if there is no bleeding, apply a
clean cotton pellet to the cavity, and then apply a
temporary filling. After two days, you can proceed with
the next steps.
*It is important to note that if there is no bleeding and the
cavity is clean, you can perform pulpotomy and complete
the endodontic treatment after two days. However, if
bleeding persisits and the cavity remains unclean after the
application of formocresol, pulp extirpation is required.
*An important note: When removing all the pulp
tissue(Coronal+ Radicular), it is crucial to avoid using a
cotton pellet dampened with formocresol, as it can lead to
inflammation of the periodontal ligaments.
*Never use endodontic files during Pulpotomy procedure, as
they may cause laceration and severe pain. Simply clean the
pulp chamber without touching the radicular pulp.
2-Acute pulpitis with apical periodontitis: The pulp is
inflammed and this inflammation has extended to the
periodontal ligaments.
Endodontic Therapy
Prepared by: Dr. Dilnya Ali
Definition of pain: Pain is defined as an unpleasant sensory
and emotional experience associated with actual or potential
tissue damage or described in terms of such damage.
Pain is a warning signal and primarily protective in nature.
*Feeling pain can be a good thing because it helps you
understand what you are going through, and you cannot fix
something you do not understand.
,Types of Endodontic pain:
1-Pre-operative pain
2-Inter-operative pain (Inter-appointment pain).
3-Post-operative pain( Post-obturation pain).
*Inter-operative and post-operative pain that result from dental
procedures may be attributed to dentist errors and are reffered
to as"Flare up"
-Definition of flare-up: The occurance of severe pain and
swelling following an endodontic treatment appointment,
requiring an unscheduled visit and active treatment.
A- Pre-operative pain:
Acute pulpitis.
Acute pulpitis with apical periodontitis.
Acute periapical abscess:
a) Localized
b)Diffused (Cellulitis).
1-Acute pulpitis manifests as a sudden, sharp and severe pain.
Analgesics often fail to relieve the pain. Individuals with this
condition experience discomfort when consuming both hot
and cold food and beverages. In the advanced stages of acute
pulpitis, the pain intensifies when exposed to heat but eases
,when exposed to cold stimuli. Additionally, it is crucial to
account for the possibility of diffuse or reffered pain,
necessitating a thorough examination of the entire mouth and
teeth. The pain is typically spontaneous and can persist for
periods ranging from ten minutes to several hours. Such cases
require immediate emergency treatment.
Emergency treatment options:
A-Complete Removal of pulp tissue (Pulpectomy):-
Local anesthsia.
Rubber dam.
Access cavity opening.
Irrigation.
Working length determination.
Mechanichal shaping.
B-Partial pulp removal (Pulpotomy):-
Local anesthesia.
Rubber dam.
Removal of coronal pulp tissue
Irrigation in access cavity with Sodium hypochlorite
Moisten a cotton pellet with formocresol, and apply it to
the access cavity for one minute, then remove it.
, *Dampen a cotton pellet with formocresol, then place
another cotton pellet on top of the dampened one and
apply the second one to the cavity for 1 minute. Then
remove the cotton pellet, if there is no bleeding, apply a
clean cotton pellet to the cavity, and then apply a
temporary filling. After two days, you can proceed with
the next steps.
*It is important to note that if there is no bleeding and the
cavity is clean, you can perform pulpotomy and complete
the endodontic treatment after two days. However, if
bleeding persisits and the cavity remains unclean after the
application of formocresol, pulp extirpation is required.
*An important note: When removing all the pulp
tissue(Coronal+ Radicular), it is crucial to avoid using a
cotton pellet dampened with formocresol, as it can lead to
inflammation of the periodontal ligaments.
*Never use endodontic files during Pulpotomy procedure, as
they may cause laceration and severe pain. Simply clean the
pulp chamber without touching the radicular pulp.
2-Acute pulpitis with apical periodontitis: The pulp is
inflammed and this inflammation has extended to the
periodontal ligaments.
