Endodontic pain management

Pain of endodontic origin usually requires dental intervention as soon as possible. In the ideal case, this should represent the first step of regular dental treatment afterward. Full pulpotomy without root canal instrumentation is the first-line therapy for managing pain in symptomatic irreversible pulpitis. In exceptional cases, complete root canal preparation with the placement of intracanal dressings can be performed. Both treatment approaches reliably result in freedom from pain within 24 hours. In the case of symptomatic apical periodontitis, the mechanical root canal preparation up to a size that permits irrigation of the canals over their entire length is required. If orthograde access to the periradicular tissue appears impossible or very risky (e.g. root canal filled tooth with an intracanal post or instrument fragment), the administration of analgesics with additional long-term anesthesia may be indicated in order to enable causal treatment the following day with sufficient treatment time. For acute perira-dic-ular abscesses, the primary goal of pain management is to ensure the adequate drainage of pus. A simple incision without the trepanation of the affected tooth does not represent an adequate causal therapy. In exceptional circumstances, when the trepanation of the tooth is not possible, it should ensue promptly (ideally within 24 hours) after the incision. In the management of endodontic pain, medication can be considered as an adjunct to, but not a substitute for, the causal therapy indicated in each case. Keywords: apical periodontitis, irreversible pulpitis, periradicular abscess, pulpotomy, trepanation