To Drill or Not to Drill: Management of Endodontic Emergencies and In-Process Patients during the COVID-19 Pandemic

Published:August 22, 2020DOI:https://doi.org/10.1016/j.joen.2020.08.008

Abstract

Introduction

Dental professionals are at a high-risk of contracting COVID-19 infection due to their scope of practice with aerosol-generating procedures. Recommendation by the Center for Disease Control to suspend elective dental procedures and avoid aerosol-generating procedures posed significant challenges in the management of patients presenting with endodontic emergencies and uncertainty of outcomes for endodontic procedures initiated, but not completed, prior to shutdown. The purpose of this study is to evaluate the success of palliative care on endodontic emergencies during the COVID-19 pandemic and to evaluate the stability of teeth with long-term Ca(OH)₂ placement due to delays in treatment completion.

Methods

Patients presenting for endodontic emergencies during COVID-19 Shelter-in-Place orders received palliative care, including pharmacological therapy and/or non-aerosol generating procedural interventions. Part I of the study evaluated the effectiveness of palliative care and need for aerosol-generating procedures or extractions were quantified. Part II of the study evaluated survivability and rate of adverse events for teeth that received partial or full root canal debridement and placement of calcium hydroxide prior to shutdown.

Results

Part I: Twenty-one patients presented with endodontic emergencies in 25 teeth during statewide shutdown. At a follow up rate of 96%, 83% of endodontic emergencies required no further treatment or intervention after palliative care. Part II: Thirty-one teeth had received partial or full root canal debridement prior to statewide shutdown. Mean time to complete treatment was 13 weeks. At a recall rate of 100%, 77% of teeth did not experience any adverse events due to delays in treatment completion. The most common adverse event was a fractured provisional restoration (13%), followed by painful and/or infectious flare up (6.4%) which were managed appropriately and therefore seemed successful. Only one tooth was fractured and non-restorable (3%) leading to a failed outcome of tooth extraction. The remaining four outcome failures (13%) were due to patient unwillingness to undergo school-mandated COVID testing or patient unwillingness to continue treatment due to perceived risk of COVID infection. Conclusions: Palliative care for management of endodontic emergencies is a successful option when aerosol-generating procedures are restricted. This treatment approach maybe be considered in an effort to reduce risk of transmission of COVID-19 infection during subsequent shutdowns. Prolonged Ca(OH)₂ medicament due to COVID-19 related delays in treatment completion appeared to have minimal effect on survival of teeth.