Factors Associated with Endodontic Interappointment Emergencies of Teeth with Necrotic Pulps

By Torabinejad M, Kettering J, McGraw J, et al

Date: 01/1988
Journal: JOE


Purpose of the study was to help define factors contributing to interappointment (IAE) emergencies-looked at factors controlled by dentist & host factors


-n=2000 patients, ½ of which required unscheduled emergency appointment for pain and swelling after C&S

-all teeth had to be necrotic, with or without PA, with or without pain before treatment

-Initial visit canals C&S- either no intracanal medicament, pellet with camphorate monochlorophenol or formocresol placed

-some patients given analgesics, antibiotics or no medication after initial appointment based on clinicians judgement

-recorded age, sex, tooth type, systemic diagnosis, allergies, preop complaint, presence and size of PA lesion, penetration of apex getting length, if meds were prescribed after 1st appointment, and if sinus tract present


Host factors

  • Patients in group aged 40-59 had most IAE-under 20 the least
  • Age and sex combined-women over 40 had significantly higher rates of IAE than males
  • As a group mandibular Bicuspids were most problematic
  • If patient had allergies they were SS more likely to have IAE
  • Systemic disease showed no association
  • Highly significant association b/w preop pain & swelling and IAE
  • Larger lesions & sinus tracts present-fewer IAE

Operating Factors

  • Retreats statistically significantly higher IAE
  • Patients put on medications after C&S SS lower IAE (analgesics more effective than ABs)
  • Use of intracanal medicaments had no effect

Clinical Significance:

Good information to be aware of-always let patients know of the possibility of post op pain, especially middle aged/older female patients, patients w/ preop pain & retreatment cases. Always recommend analgesics