An endodontic flare up is an acute exacerbation of an asymptomatic pulp or periapical pathosis after the initiation or continuation of root canal treatment.
The reported incidence of inter appointment flare ups ranges from 1.4-19%.
PREDISPOSING FACTORS-
1. Shaping errors
- Over Instrumentation during root canal procedure
- Under instrumentation- This may provide pulpal remnants for the persistence of microorganisms.
- Improper shaping protocol
2. Cleaning errors
Irrigant extrusion beyond the periapex ( sodium hypochlorite accident)
3. Pulpo Periapical status
Teeth with vital pulps result in fewer flare ups compared with the ones having necrotic pulps.
4.Retreatment cases
- These cases have a significantly higher chance as there is greater chance of pushing the necrotic debris apically during the treatment.
- Microbiota associated with these cases are usually therapy resistant.
5. Anxiety
6. Preoperative history of pain
MECHANISM OF FLARE UP
Microbial infection and periapical inflammation
↙ ↘
Asymptomatic phase Progression of disease
where disease persists
without progressing
↓
Introduction of irritants
↓
Severe inflammatory response
↓
Endodontic flare up
MANAGEMENT
- Anxiety reduction
- Behavioral intervention
- Occlusal reduction
- Antibiotics
- Long acting local anesthesia
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