Necrosis Pulpar

Clinical Research

Vital Signs of the Emergency Patient with Pulpal Necrosis and Localized Acute Apical Abscess
Chad A. Campanelli, DDS,* Richard E. Walton, DMD, MS,* Anne E. Williamson, DDS, MS,* David R. Drake, MS, PhD,* and Fang Qian, PhD†
Abstract
Vital signs aid in assessing patient health and the disease severity. The objectives of this study were to determine changes in vital signsof patients with pulpal necrosis (PN) and acute apical abscess (AAA). The vital signs measured at the emergency visit were blood pressure, heart rate, temperature, and lymphadenopathy. Visual analogue scales (VASs) were used to assess (1) pain and (2) malaise. Emergency treatment was rendered. At a subsequent (baseline) visit and with clinical symptoms resolved, systemic vital sign measurementsand VASs were repeated. The presence or absence of swelling with vital signs and VASs of pain and swelling were compared. Compared with baseline, data showed no marked elevation in temperature, blood pressure, or lymphadenopathy, regardless of presence or absence of swelling. VAS measurements of pain and malaise did show statistically significant higher numbers at the emergency appointment,indicating a difference from baseline. Swelling versus no swelling did not differ. Vital signs were not impacted by localized AAA, although pain and malaise were greater. Vital signs might not be useful determinants of treatment or pharmacotherapeutic measures with localized AAA. (J Endod 2008;34:264 –267)

Key Words
Acute apical abscess, emergency, malaise, vital signs

From the *Department ofEndodontics and †Department of Preventive and Community Dentistry, University of Iowa, Iowa City, Iowa. Address requests for reprints to Anne E. Williamson, DDS, University of Iowa College of Dentistry, Department of Endodontics, 435 Dental Science Bldg-S, Iowa City, IA 52242. E-mail address: anne-williamson@uiowa.edu. 0099-2399/$0 - see front matter Copyright © 2008 by the American Association ofEndodontists. doi:10.1016/j.joen.2007.11.022

mergency patients are part of a general dental practice. Ninety percent of emergencies involving pain are of pulpal or periapical origin (1). Acute apical abscess (AAA) is a common emergency periapical diagnosis. The AAA can be with or without swelling. When no swelling is evident, this indicates that the abscess is confined to bone (2). When apatient presents with AAA, regardless of the absence or severity of swelling (when present), immediate treatment is necessary. As part of diagnosis, there should be an assessment of the patient’s systemic condition. Vital signs are determined both for general health screening and for baseline measurements. Presumably, vital signs assess health and degree of disease, on the basis of systemic and localsigns and symptoms. Vital signs are also a suggested guide in treatment decisions such as local (incision for drainage, pulpal debridement) and systemic management (pharmacotherapeutics), as well as decisions on referral (3). Vital signs that can be readily and objectively measured include temperature, blood pressure, pulse, and lymphadenopathy. Subjectively (patient reporting), levels of painand malaise can also be recorded. Changes in these systemic signs might correlate to the host’s defense system and the severity of the disease. Signs of systemic involvement include pyrexia (elevated temperature), lymphadenopathy, and malaise (4). In general, body temperature greater than 101°F indicates a significant response to an infection. Tachycardia (a heart rate greater than 100 beats perminute) might also indicate infection (5). Blood pressure that has significantly decreased (systolic, 90 mm Hg) also might indicate response to infection. In extreme cases in which sepsis is possible, normal or increased cardiac output and decrease in vascular resistance result in hypotension (6). If a febrile patient has chills and hypotension, septic shock is also suspected (7). Lymphadenopathy...