Dentaltown July 2020 - 24

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ER Today, Necrotic With Neck Swelling
A Townie wonders if he did the right thing after his wife ends up in the hospital after treatment

Batlle
Member Since: 08/29/18
Post: 1 of 39

My wife started having some pain on #18 Thursday night. Friday, we left town for the weekend. Saturday, she started swelling up with major pain. Sunday morning, the submandibular
swelling started getting large. We left earlier than planned and headed straight to the office; I
couldn't find an assistant, but we dealt with it.
#18 had an existing crown that was prepped very close to the mesial pulp horn. It seemed
like it was close to exposure because it had that translucent/calcified pulp horn showing. Her
previous dentist, who did it years ago, said it may need a RCT in the future. The existing crown
had multiple fracture lines in it from a heavy occlusion.
When I opened it up, it was necrotic, not a drop of blood and the ML root was heavily
calcified. The X-ray showed a very mild PARL but the M PDL was widened. I got through all
the canals with .08/.10/.15/.20 with RC prep and copious sodium hypochlorite irrigation. Filled
the canals with calcium hydroxide paste, dry cotton pellet, filled with Cavit, temporized, and
put her on Penvk 500mg. Will wait to complete the RCT/crown and hopefully the swelling
resolves soon.
She seems better now but poor thing had a rough ride. It all happened so quickly and
unexpectedly. I've done this so many times but every time it happens to someone close to me, I
start wondering if there's anything I could have done different or better.
Any advice or suggestions on how you handle these cases-anything different or extra steps
you take that I can implement in the future? ■
3/1/2020

rtcnls
Member Since: 06/24/03
Post: 2 of 39

I used to medicate most of these cases as you did. My current strategy is to leave the canals
empty to allow for space for any pressure (exudate or gases) to have a slight release. Also allows
quick access to leave a tooth open as needed. Typically will put a formo cotton pellet in the
chamber. The other thing you didn't mention is to lighten the occlusion in these cases, because
the pressure from the apical infection tends to raise the tooth into hyperocclusion and create a
miserable situation. ■
3/2/2020

almunk
Member Since: 12/17/05
Post: 3 of 39

I do the same; leave the canals empty. If you do a lot of endo, you will occasionally have
these cases that get away from you. It can be any tooth. I have had several patients end up in the
hospital with big infections from a tooth problem over 45 years. In general, the sooner you open
the tooth, the better. ■
3/2/2020

CheckRaise
Member Since: 09/01/14
Post: 4 of 39

To clear a few things, leaving it open is not the same as placing CaOH (or formocresol) and
placing cottom pellet. I am assuming this is two different visits?
I wasn't sure anyone still used formocresol in adult teeth. ■
3/2/2020

24

JULY 2020 // dentaltown.com

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Dentaltown July 2020

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