Palliative care successful for endodontic emergencies during lockdown

Dental Tribune International

Mon. 5. October 2020

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SAN ANTONIO, U.S.: During the ongoing COVID-19 pandemic, aerosol-generating procedures in dentistry have been restricted in order to comply with a recommendation by the Centers for Disease Control and Prevention (CDC), since dental professionals are at high risk of infection. But how can endodontic emergencies be managed without drilling? A study has investigated the topic and found that palliative care seems to be the answer.

The World Health Organization declared SARS-CoV-2 a pandemic on March 11, 2020. Shortly afterwards, countries began to implement lockdowns, shutting businesses and nonessential services. In the U.S., elective dental procedures were suspended and, according to the CDC, aerosol-generating procedures were to be avoided. This led to challenges in the management of patients presenting with emergencies as well as concern among dentists about all in-process pending procedures started before the statewide shutdowns.

To drill or not to drill?

Researchers from the Department of Endodontics at the University of Texas (UT) School of Dentistry conducted a two-part study in order to investigate how endodontists could work around these extreme conditions while managing their patients’ pain. The results of the first part of the study showed that 81% of the 21 patients who presented with endodontic emergencies in 25 teeth during the statewide shutdown required no further treatment or intervention after palliative care at a follow-up rate of 96%.

In the second part, 31 teeth had received partial or full root canal debridement before the statewide shutdown. The mean time for completion of treatment was 13 weeks. At a recall rate of 100%, 77% of the teeth did not experience any adverse events resulting from delays in treatment completion. The most common adverse event was a fractured provisional restoration (13.0%), followed by a painful and/or infectious flare-up (6.4%). These events were managed appropriately and therefore deemed successful. Only one tooth was fractured and nonrestorable (3%), leading to the failed outcome of tooth extraction. The remaining four outcome failures (13%) were due to patient unwillingness to undergo school-mandated SARS-CoV-2 testing or patient unwillingness to continue treatment because of perceived risk of SARS-CoV-2 infection.

In an interview with Dental Tribune International, study co-author Dr. Biraj Patel explained the reasoning behind this study: “The school decided to defer aerosol-generating procedures in accordance with the state guidelines. We managed cases very differently to what we would have routinely done and were interested to see how successful we were. Furthermore, the literature has limited data on the effect of delaying treatment in endodontics and the outcomes of the palliative management of endodontic disease. Our report on the management of endodontic emergencies has important clinical implications for the dental community worldwide and aims to provide an insight into the effect of conservative management of endodontic emergencies without the use of aerosol-generating procedures.”

“Hopefully, the findings of our study will help dentists manage patients without aerosol-generating procedures during periods of lockdown”

As results have shown, palliative care proved successful for the UT researchers, but it is important to note that this level of endodontic emergency management is only a temporary solution and aerosol-generating procedures cannot be avoided forever. “The state witnessed a lockdown from March 23, 2020, to May 20, 2020, and palliative care was successful in managing patient symptoms during this time. However, if this lockdown had been longer, we may have had to reevaluate patients if they became symptomatic and potentially intervene with aerosol-generating procedures,” said Patel.

What is the long-term solution?

“At present, our school reduces the risk of transmission by testing all patients for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) prior to aerosol-generating procedures,” the endodontist added. “We make sure to follow the state and CDC guidelines, especially with regard to social distancing measures and personal protective equipment. We hope that a better understanding of the transmission of SARS-CoV-2, along with developments in rapid testing, will eventually reduce the risk to health care professionals. This will hopefully result in a reduced need for clinics to stay closed. The expectation is that we will see further lockdowns if cases of COVID-19 become uncontrolled. Hopefully, the findings of our study will help dentists manage patients without aerosol-generating procedures during periods of lockdown.”

The study, titled “To drill or not to drill: Management of endodontic emergencies and in-process patients during the COVID-19 pandemic,” was published on Aug. 22, 2020, in the Journal of Endodontics.

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