Skip to main content
SpringerLink
Log in

Flare-Ups

  • Chapter
  • First Online:
Endodontic Pain

  • 1872 Accesses

Abstract

The incidence of exacerbations (flare-ups) has been estimated to range from 2 to 20 %. This wide variation is due to differences in definitions of exacerbations and differences in research methodologies. This chapter describes causes of exacerbations and their treatment. Factors predisposing patients to exacerbation are reviewed. The presence of preoperative pain or mechanical allodynia (reduced mechanical pain threshold or percussion sensitivity) was found to be a positive predictor of postoperative pain in more than 15 studies.

Also noted as evidence-based predictors of postoperative pain are specific iatrogenic factors. Pulpectomy or as an alternative, pulpotomy are described as predictable means of treating endodontic emergencies. The significance and tracing of sinus tracts are also described.

The goal of an emergency visit is limited to making an accurate diagnosis and bringing the case under control symptomatically. Depending on clinical factors, incision and drainage is an important therapy in appropriate cases. Pulpectomy, pulpotomy, trephination, and occlusal reduction are reviewed as potential treatment modalities during an emergency visit.

Studies have determined that the most favorable response of periapical tissues occurred when both instrumentation and filling were short of the periapical constriction. This chapter also reviews the management of gross overfilling on the maxillary sinus and mandibular canal.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Appelbe OK, Sedgley CM (2007) Effects of prolonged exposure to alkaline pH on Enterococcus faecalis survival and specific gene transcripts. Oral Microbiol Immunol 22(3):169–174

    Article  PubMed  Google Scholar 

  2. Arias A, De La Macorra JC, Hidalgo JJ et al (2013) Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 46(8):784–793

    Article  PubMed  Google Scholar 

  3. Barnett F, Tronstad L (1989) The incidence of flare-ups following endodontic treatment. J Dent Res 68:1253

    Google Scholar 

  4. Caviedes-Bucheli J, Azuero-Holguin MM, Correa-Ortiz JA et al (2011) Effect of experimentally induced occlusal trauma on substance p expression in human dental pulp and periodontal ligament. J Endod 37(5):627–630

    Article  PubMed  Google Scholar 

  5. Genet JM, Hart AA, Wesselink PR et al (1987) Preoperative and operative factors associated with pain after the first endodontic visit. Int Endod J 20(2):53–64

    Article  PubMed  Google Scholar 

  6. Hargreaves KM, Cohen S, Berman LH (2011) Cohen’s pathways of the pulp. Mosby Elsevier, St. Louis

    Google Scholar 

  7. Hasselgren G, Reit C (1989) Emergency pulpotomy: pain relieving effect with and without the use of sedative dressings. J Endod 15(6):254–256

    Article  PubMed  Google Scholar 

  8. Henry M, Reader A, Beck M (2001) Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth. J Endod 27(2):117–123

    Article  PubMed  Google Scholar 

  9. Houck V, Reader A, Beck M et al (2000) Effect of trephination on postoperative pain and swelling in symptomatic necrotic teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(4):507–513

    Article  PubMed  Google Scholar 

  10. Kantz WE, Henry CA (1974) Isolation and classification of anaerobic bacteria from intact pulp chambers of non-vital teeth in man. Arch Oral Biol 19(1):91–96

    Article  PubMed  Google Scholar 

  11. Kvist T, Reit C (2000) Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment. Endod Dent Traumatol 16(2):71–74

    Article  PubMed  Google Scholar 

  12. Lin LM, Rosenberg PA, Lin J (2005) Do procedural errors cause endodontic treatment failure? J Am Dent Assoc 136(2):187–193; quiz 231

    Article  PubMed  Google Scholar 

  13. Menezes-Silva R, Khaliq S, Deeley K et al (2012) Genetic susceptibility to periapical disease: conditional contribution of MMP2 and MMP3 genes to the development of periapical lesions and healing response. J Endod 38(5):604–607

    Article  PubMed Central  PubMed  Google Scholar 

  14. Molander A, Reit C, Dahlén G et al (1998) Microbiological status of root-filled teeth with apical periodontitis. Int Endod J 31(1):1–7

    Article  PubMed  Google Scholar 

  15. Moos HL, Bramwell JD, Roahen JO (1996) A comparison of pulpectomy alone versus pulpectomy with trephination for the relief of pain. J Endod 22(8):422–425

    Article  PubMed  Google Scholar 

  16. Morsani JM, Aminoshariae A, Han YW et al (2011) Genetic predisposition to persistent apical periodontitis. J Endod 37(4):455–459

    Article  PubMed  Google Scholar 

  17. Nagle D, Reader A, Beck M et al (2000) Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(5):636–640

    Article  PubMed  Google Scholar 

  18. Nist E, Reader A, Beck M (2001) Effect of apical trephination on postoperative pain and swelling in symptomatic necrotic teeth. J Endod 27(6):415–420

    Article  PubMed  Google Scholar 

  19. Nixdorf DR, Moana-Filho EJ, Law AS et al (2010) Frequency of nonodontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod 36(9):1494–1498

    Article  PubMed Central  PubMed  Google Scholar 

  20. Nixdorf DR, Moana-Filho EJ, Law AS et al (2010) Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod 36(2):224–230

    Article  PubMed Central  PubMed  Google Scholar 

  21. O'keefe EM (1976) Pain in endodontic therapy: preliminary study. J Endod 2(10):315–319

    Article  PubMed  Google Scholar 

  22. Pickenpaugh L, Reader A, Beck M et al (2001) Effect of prophylactic amoxicillin on endodontic flare-up in asymptomatic, necrotic teeth. J Endod 27(1):53–56

    Article  PubMed  Google Scholar 

  23. Polycarpou N, Ng YL, Canavan D et al (2005) Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 38(3):169–178

    Article  PubMed  Google Scholar 

  24. Ricucci D, Langeland K (1998) Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J 31(6):394–409

    Article  PubMed  Google Scholar 

  25. Rocas IN, Siqueira JF Jr, Santos KR (2004) Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod 30(5):315–320

    Article  PubMed  Google Scholar 

  26. Rosenberg PA (2003) Clinical strategies for managing endodontic pain. Endod Top 3:78–92

    Article  Google Scholar 

  27. Rosenberg PA, Babick PJ, Schertzer L et al (1998) The effect of occlusal reduction on pain after endodontic instrumentation. J Endod 24(7):492–496

    Article  PubMed  Google Scholar 

  28. Siqueira JF, Barnett F (2004) Interappointment pain: mechanisms, diagnosis, and treatment. Endod Top 7(1):93–109

    Article  Google Scholar 

  29. Siqueira JF, Rôças IN (2005) Exploiting molecular methods to explore endodontic infections: part 2–redefining the endodontic microbiota. J Endod 31(7):488–498

    Article  PubMed  Google Scholar 

  30. Siqueira JF, Rôças IN, Provenzano JC et al (2009) Relationship between Fcgamma receptor and interleukin-1 gene polymorphisms and post-treatment apical periodontitis. J Endod 35(9):1186–1192

    Article  PubMed  Google Scholar 

  31. Sjogren U, Hagglund B, Sundqvist G et al (1990) Factors affecting the long-term results of endodontic treatment. J Endod 16(10):498–504

    Article  PubMed  Google Scholar 

  32. Torabinejad M, Kettering JD, McGraw JC et al (1988) Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 14(5):261–266

    Article  PubMed  Google Scholar 

  33. Trope M (1991) Flare-up rate of single-visit endodontics. Int Endod J 24(1):24–26

    Article  PubMed  Google Scholar 

  34. Tsesis I, Faivishevsky V, Fuss Z et al (2008) Flare-ups after endodontic treatment: a meta-analysis of literature. J Endod 34(10):1177–1181

    Article  PubMed  Google Scholar 

  35. Tsuchiya H, Mizogami M, Ueno T et al (2007) Interaction of local anaesthetics with lipid membranes under inflammatory acidic conditions. Inflammopharmacology 15(4):164–170

    Article  PubMed  Google Scholar 

  36. Walton R (2002) Interappointment flare-ups: incidence, related factors, prevention, and management. Endod Top 3:67–76

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endodontics, New York University College of Dentistry, New York, NY, USA

    Paul A. Rosenberg DDS

Authors
  1. Paul A. Rosenberg DDS
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Rosenberg, P.A. (2014). Flare-Ups. In: Endodontic Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54701-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54701-0_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54700-3

  • Online ISBN: 978-3-642-54701-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation