Dentaltown February 2018 - 48

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that sounds right. It does not, then it wasn't right? Seems the only way to do things right is to
decide after if it was right. Hardly helpful clinically.
Leaving this open may have been the "more correct call" but it's not possible to outline when
this should always be done and how we are able to always make the correct call. If this case left
open, then the patient swells. Then we get the "... well you should never leave a case open, more
bugs get in there," blah, blah. I think this case is "stuff happens" and after the fact, we are all
smart. ■
11/22/2017

dalmacija
Member Since: 04/14/15
Post: 43 of 89

Not to be critical, but when you have active purulent drainage and swelling, establishing a
drain is important. By sealing off the tooth, the drain is gone. ■
11/22/2017

flyfishdr
Member Since: 02/26/04
Post: 47 of 89

What I do when there is lots of drainage is let it drain. Often accompanied by some I&D.
Then put a needle in the canal, attached to high volume. Suck again. I put a paper point in and
it's wet. Again wet. Again, etc. I squirt calcium hydroxide in, close access. Next time it's dry and
I obturate. If this did not predictably work for me, I suggest, I would not be repetitively doing it.
Then there is your point-which is a good one-how do I know it won't drain more, and I
plugged the drain? The answer is I don't. I can't remember the last time (it has happened many
times though) where there was so much coming out no matter what I did, I knew closing it was
going to be an error. That happens and I guess I am making a clinical judgments on whether it
will drain more, for a specific case.
A canal that is just really oozing steady, and will not stop oozing steady, is the only time I
would leave it open. (I also have no idea how I quantify "really oozing steady," by the way.) I have
found most times, for me, that is not the case, though. So I place calcium hydroxide, close access
and easily obturate a dry canal next time. ■
11/22/2017

dalmacija
Member Since: 04/14/15
Post: 50 of 89

Anything can get worse; you need to remove the origin of the infection eventually. If you
simply I&D and do nothing else, they will get worse eventually. Just like you see when patients
get palliative care, like a extirpation: feels good for a month, then comes roaring back. ■
11/22/2017

Kelster08
Member Since: 08/28/17
Post: 56 of 89

Treatment update: When I saw the patient 24 hours after the RCT was initiated I prescribed
Flagyl in addition to the Augmentin. This was on advice given to me from the endodontist we refer
to. I think it helped. In the future, on a case that is a gusher like this one was, I think I will leave it
open for a short period. It was too scary when the swelling was moving up her cheek toward her eye.
Today patient came in for the final fill. No more swelling, and minimal pain on the tissue surrounding the tooth. Most likely due to the severe stretch of the tissue while swollen. When I opened
the tooth, it was clear that the infection was gone and the canal was super easy to clean and dry. ■
11/22/2017

HaasEndo
Member Since: 11/28/15
Post: 69 of 89

I never ever, ever leave a tooth open. No matter how many thousands of endos I've done and
how many swollen patients I've had. Never. No matter how swollen. If there's a lot of drainage
then I don't let them go home. It's almost never, ever an issue because I place a microsuction tip
in the instrumented canal to length, or even a bit past the blown apex, and help Mother Nature
with drainage. Then cal hydroxide and close it up.
Leaving it open will only let more bacteria into the tooth with all that are present in the oral

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