Apical periodontitis still hurts after multiple local anti-inflammatory treatments

The health of teeth is very important to people's body, because teeth have strong functional roles and are important tissues for people to tear food and help digestion. Dental problems are very common and can cause great damage to people's lives and cause severe pain. Apical periodontitis is a common symptom. Let’s see what to do if you still feel pain after multiple local anti-inflammatory treatments for apical periodontitis?

The acute suppurative stage of apical periodontitis is a localized painful inflammation that occurs around the root apex. According to its development process, it can be divided into two stages: acute serous apical periodontitis and acute suppurative stage of apical periodontitis.

Emergency treatment

In acute inflammation, patients feel severe pain. Examination may reveal obvious abnormal signs, such as congestion, swelling, tenderness upon palpation, percussion pain, enlarged and tender lymph nodes, increased body temperature, and increased white blood cell count.

The purpose of emergency treatment: to relieve acute symptoms, relieve patient pain, and prevent the rapid development of inflammation.

Principles of emergency treatment: establish drainage, reduce inflammation and relieve pain.

There are two methods, namely, pulpotomy and drainage and incision and drainage of abscesses.

Suitable for all stages and phases of acute apical periodontitis. Especially in the serous stage and apical abscess stage, pulpotomy and drainage can have an immediate effect in relieving pain. When slurry or pus accumulates in the periapical tissue, the pulp cavity is opened and the remaining pulp tissue in the root canal is removed, so that the periapical fluid passes through the apical foramen, the root canal, and is drained into the oral cavity. After drainage, the pressure of the periapical tissues decreased rapidly and the pain gradually eased. This drainage method does not damage the root periradiate membrane, has a good prognosis, and reduces pain for patients. It is the quickest and best drainage route. The following points should be noted during operation:

A. To maintain painlessness, a high-speed turbine and a sharp drill should be used. When drilling and grinding, use the left hand fingers to fix the affected tooth to avoid vibration. If pain persists, the procedure should be performed under local anesthesia.

B. In order to drain the periapical exudate, it is not enough to simply penetrate the pulp cavity. The pulp top must be uncovered and the remaining pulp tissue and its calcifications in the root canal must be removed to make the root canal unobstructed.

C. For teeth with small apical foramen, use a thin sterilized root canal treatment instrument to gently pass through the apical foramen, which will help drain the apical exudate, but do not repeat this many times. Otherwise, the infection will be brought out of the apical foramen and the periapical tissues will be mechanically injured, aggravating the inflammation and pain.

D. Clean the root canals with a mild root canal disinfectant, usually 2% to 5% sodium chloramine T (chlormethamine) solution. Then loosen the drainage cotton wick in the root canal and place a small sterilized cotton ball in the pulp cavity to prevent food debris from falling into the pulp cavity and obstructing drainage.