Dentaltown February 2018 - 46
message board
Swelling #9
After a patient returns with swelling after an RCT, this doc asks Townies where the treatment went wrong
Kelster08
Member Since: 08/28/17
Post: 1 of 89
I started an RCT on #9 for a 23-year-old patient yesterday. She
came to the office early this morning after being in the emergency
room since 3 a.m. She was given antibiotics and pain meds there.
When she arrived, her upper lip was very swollen. When I accessed
the tooth, purulent drainage came flowing from the canal. I cleaned
and filed and filled with calcium hydroxide. Covered the access
opening with EdgeTemp. Her lip was immediately less swollen. This
morning she called and said that she is more swollen again. What
did I do wrong? Should I leave it open? There is no distinct abscess
to open and allow to drain. Thanks in advance! ■
11/17/2017
hendoc4ct
Member Since: 04/12/11
Post: 2 of 89
If she is not in pain, leave it and monitor it day by day. If she is in pain, open the tooth and
leave it open. Maybe put a loose cotton pellet in the access so food doesn't contaminate it. ■
11/17/2017
Kelster08
Member Since: 08/28/17
Post: 3 of 89
The only pain she has is from the tissue swelling, not the tooth. She is taking Augmentin.
Just took her third dose while she was sitting in the chair because she was afraid the swelling was
an allergic reaction. ■
11/17/2017
gclive
Member Since: 03/19/14
Post: 5 of 89
Don't use Formocresol in permanent teeth. Don't leave teeth open. This case calls for incision and drainage, antibiotics and analgesics. ■
11/18/2017
rtcnls
Member Since: 06/24/03
Post: 6 of 89
gclive
Member Since: 03/19/14
Post: 7 of 89
Why not leave teeth open? ■
11/18/2017
The same reason you use a rubber dam: bacteria. Between bone and the open environment, a
seal is needed. That's why we have a periodontal attachment seal. The research on this question
is all old, because the question has been sufficiently answered. That's why most endodontists will
never leave teeth open. Also, preventing pulse granuloma. ■
11/18/2017
Fondcombe
Member Since: 09/24/11
Post: 8 of 89
jjj
Member Since: 04/23/05
Post: 9 of 89
46
I would prescribe Clindamycin 300mg QID for 8-10 days. ■
11/18/2017
Nothing wrong with leaving a tooth open in this situation for a day or two. Why have her
suffer? It can be closed later. No cotton pellets in the chamber if you're leaving it open. It will
swell up and cork it closed. Use an endo sponge. No need to automatically go to Clindamycin.
Penn-based antibiotics are your first line. Clinda is not stronger, it just has a mechanism of
action that is different than penn-based antibiotics.
FEBRUARY 2018 // dentaltown.com
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