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Department
of Endodontics, School of Dentistry, Estacio de Sa University, Rio de
Janeiro, RJ, Brazil.
LITERATURE REVIEW: Inter-appointment flare-up is characterized by the
development of pain, swelling or both, following endodontic intervention.
The causative factors of flare-ups encompass mechanical, chemical and/or
microbial injury to the pulp or periradicular tissues. Of these factors,
microorganisms are arguably the major causative agents of flare-ups. Even
though the host is usually unable to eliminate the root canal infection,
mobilization and further concentration of defence components at the
periradicular tissues impede spreading of infection, and a balance between
microbial aggression and host defences is commonly achieved. There are
some situations during endodontic therapy in which such a balance may be
disrupted in favour of microbial aggression, and an acute periradicular
inflammation can ensue. Situations include apical extrusion of infected
debris, changes in the root canal microbiota and/or in environmental
conditions caused by incomplete chemo-mechanical preparation, secondary
intraradicular infections and perhaps the increase in the
oxidation-reduction potential within the root canal favouring the
overgrowth of the facultative bacteria. Based on these situations,
preventive measures against infective flare-ups are proposed, including
selection of instrumentation techniques that extrude lesser amounts of
debris apically; completion of the chemo-mechanical procedures in a single
visit; use of an antimicrobial intracanal medicament between appointments
in the treatment of infected cases; not leaving teeth open for drainage
and maintenance of the aseptic chain throughout endodontic treatment.
Knowledge about the microbial causes of flare-ups and adoption of
appropriate preventive measures can significantly reduce the incidence of
this highly distressing and undesirable clinical phenomenon.
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