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A Painful Dental Emergency Dilemma

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Diagnosis, All by Date


The inflammatory mediators peak in the tissues at 48 hours after initiation of endodontic therapy. A patient presenting with an acute pulpitis may have an exaggerated response noted 2 days later, especially in the case of mandibular molars. There are variations of host responses amongst different patients.

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A patient with an irreversible pulpitis leaving town the next day and no time in your schedule: What do you do?

Patient: 77 year-old male with a history of high cholesterol

Chief Complaint: Lower left tooth pain for the last 2 days

Dental History: The patient has had numerous large dental fillings and crowns through his mouth. The lower left posterior teeth all have crowns with the suspected lower left first molar having had a porcelain-fused-to-metal crown placed within the last 5 years. There had been no pain prior to 2 days of the examination. The patient reported that the pain had been severe the previous night and was at a 4/10 level at the time of examination.

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