Covid-19 and care for endodontists

Do you know what changes endodontists need to make in order to adapt care in times of COVID-19? Some regions of Brazil already have elective services released, while other places still have restrictions, serving only urgent cases. Therefore, before going into details about endodontic care, let's talk about urgent and emergency cases.

When we think about changes in the dental scenario, we can mention the adaptations that happened a short time ago, when AIDS or the awareness of the contagion of Hepatitis B entered the agenda. At that moment, the professionals started using the procedure gloves, something that was not common before.

What are emergency cases for endodontists?

In the scenario of emergency care for endodontists, dental urgency is when there is a clinical situation that cannot be postponed and that must be resolved quickly, but does not offer imminent risk to life.

Most of them are cases of diseases that affect the pulp of the teeth and that cause acute pain that is very difficult to bear. In this case, the diagnosis must be accurate and we need accurate data to be able to make the treatment plan as correct as possible.

It is difficult in dentistry to have an emergency. Often the terms are confused. Dental emergency implies a risk of life and this must be diagnosed and treated in the first moments after its discovery.

The correct diagnosis

For a correct diagnosis, in the case of endodontic emergencies, we need to have a balance and emotional domain in front of the patient. It is very important that the endodontist has extensive scientific knowledge of pulp pathologies and experience to conduct the clinical cases that will appear.

If you have any questions, it is okay to talk to fellow endodontists to ask for an opinion. Another tip is to ALWAYS listen to what the patient has to say. Never underestimate the information that only he can give you.

Endodontist, what to do when the patient arrives?

When a patient sits in his chair, the first thing to do is to follow Anvisa's recommendations and ask him to do a previous mouthwash. At that time, we used 1% hydrogen peroxide (15 ml for 1 min) followed by 0.12 chlorhexidine digluconate or, 02% (20 ml for 1 min). The literature supports the synergistic antimicrobial effect of both rinsing solutions.

In the clinical examination, as endodontists you need to know which tooth is really causing the pain. For this, you can count on visual inspection, sensitivity tests, percussion, palpation and sounding depth. Both may be essential to close the treatment plan.

Often the patient does not know what the tooth is, so our experience as endodontists is very important. Periapical radiographs at this stage are essential and help to complement the diagnosis. If for some reason the anatomy is complex or the periapical radiography is not conclusive, the indication for a high resolution computed tomography and small FOV (field of view) should be indicated.

After a correct diagnosis, we anesthetize the patient and mandatorily perform the Absolute Isolation. Absolute isolation will greatly avoid aerosol contamination. Ideally, the endodontist should have a vacuum pump in the office.

More details on endodontist care

After that, we must use auxiliary irrigating chemicals. They must have the best antimicrobial chemical and organic matter dissolving properties. Thus, the removal of pulp tissue or necrotic tissue is effective. Thus, we can solve the pain of our patients.

It is recommended that treatment be done in a single session at the first consultation. Or at the very least, we must already instrument all channels in their entirety and place an intracanal medication. In case the treatment has to be carried out in more than one session, it is very important to perform the temporary restoration between sessions with photopolymerizable composite resin. Thus, we will have the integrity of the restoration throughout the period before the next consultation.

It is important to schedule patients with time between consultations so that they do not cross paths in the waiting room. In addition, you still have time to clean and organize your environment with all the necessary protocols for the next patient.

All the measures mentioned above are important for the protection of professionals, patients and family members. Take care.

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Source: Todos pela Odontologia. Available at: http://todospelaodontologia.com.br/covid-19-e-os-cuidados-para-endodontistas/. Access on: 09/01/2020.