Palliative care better option to manage endodontic emergencies during COVID 19 pandemic: Study

Dental professionals are at high risk of contracting coronavirus disease 2019 (COVID-19) infection because of their scope of practice with aerosol-generating procedures. Centers for Disease Control and Prevention recommends the dentists to suspend elective dental procedures and avoid aerosol-generating procedures as they pose significant challenges in the management of patients presenting with endodontic emergencies and uncertainty of outcomes for endodontic procedures initiated, but not completed, before shutdown.

As a result, Biraj Patel and colleagues from the Department of Endodontics, University of Texas Health Science Center at San Antonio, Texas conducted the present study was 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 because of delays in treatment completion.

The study including 21 patients with 25 teeth undergoing treatment were divided into different parts where Part I of the study evaluated the effectiveness of palliative care and the need for aerosol-generating procedures or extractions was 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 before shutdown.

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, describes Patel.

Out of the total sample analyzed it was observed that only one tooth was fractured and non-restorable (3%), leading to a failed outcome of tooth extraction. The remaining 4 outcome failures (13%) were due to patient unwillingness to undergo mandatory COVID testing or patient unwillingness to continue treatment because of perceived risk of COVID infection.

Hence, the authors concluded that "Palliative care for the management of endodontic emergencies is a successful option when aerosol-generating procedures are restricted. This treatment approach may be considered to reduce the risk of transmission of COVID-19 infection during subsequent shutdowns. Prolonged Ca(OH)₂ medicament because of COVID-19 related delays in treatment completion appeared to have minimal effect on the survival of teeth."