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Abstract: The child had multiple caries and had toothache for many times, but it did not attract the family’s attention, and the parents just bought the medication for her on their own. Recently, the child had severe tooth pain and the effect of medication was not good, so she came to our outpatient clinic and was diagnosed as chronic periapical abscess. She was diagnosed with chronic periapical abscess and was given root canal treatment + composite resin restoration, and the child’s discomfort was eliminated, the tooth form was restored, and the disease was cured.
Basic information】Female, 4 years old
Disease Type】Chronic periapical abscess
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Surgical treatment (composite resin restoration, root canal treatment)
Treatment period】3 times of outpatient treatment, 15 days of treatment period
Results】The child’s discomfort was eliminated, the tooth form was restored, and the disease was cured.
I. Initial consultation
The child came to our outpatient clinic with toothache and swollen gums. The parents described that she had toothache and pus in her gums a long time ago, and each time she took painkillers and anti-inflammatory drugs to solve the problem. In the last 3 days, the child had severe tooth pain, which was worse when biting, and a large packet of swollen gums was visible, and taking medication had no obvious effect. Based on the family’s description, the initial diagnosis was periapical disease.
In order to clarify the diagnosis, we further examined the oral condition of the child and took x-ray film, and found that: the tooth had a large area of caries, and based on the history of gingival pus overflow, the typical symptoms of spontaneous severe pain, percussion pain and loosening of the tooth, and the translucent image of the periapical alveolar bone on x-ray film, we diagnosed periapical abscess.
II. Treatment history
I explained the condition to the parents and suggested the option of root canal treatment. Initially, the parents were concerned that root canal treatment would interfere with tooth replacement and wanted medication. I told the parents that standardized root canal treatment would not affect tooth replacement, but if not treated, it might affect the development of permanent tooth germ, and the current situation was not suitable for drug treatment. After communication, the parents agreed to the treatment. The treatment was performed in 3 visits, the first visit was performed under local anesthesia using a dental drill to open the pulp, extract the pulp, expand the roots, first flush the area and place dry cotton in the root canal. 5 days later the second treatment was performed, the root canal was flushed, disinfected and Vitapex was sealed in the root canal. After another 5 days, the child’s gingival swelling and pain were eliminated, and the root canal was filled, and the composite resin restoration was done after cementum bedding to restore the tooth profile and polish the tooth.
III. Treatment effect
Root canal treatment should be performed in 3 sessions, with an interval of about 1 week between the 2 follow-ups. During the treatment period, care should be taken to avoid biting hard food with the tooth being treated, and not to eat or drink for 2 hours after each treatment. The child’s treatment results were very good, and the tooth pain was significantly reduced after the first treatment, and the swelling of the gums was reduced and there was no more pus after the treatment was completed. After the composite resin restoration, the tooth shape was also restored to its original shape. After 3 outpatient visits and 15 days of treatment, the child’s discomfort was eliminated, the tooth shape was restored, and the disease was cured. 3 months later, the X-ray was taken and showed that there was no hypodense shadow around the root tip, indicating that the inflammation had been eliminated.
IV. Notes
I am glad that the child recovered successfully and is no longer troubled by toothache, but in order to let the child have healthy teeth and confident smile in the future, I tell the parents that if they find symptoms of toothache, gum swelling and tooth discoloration in the future, they must come to the dentistry department in time to avoid delaying treatment, and it is also recommended to have oral examination 1-2 times a year.
In life, pay attention to try not to buy sweets and processed snacks for the affected children, cook without adding sugar, and drink less drinks in general. The child is too young to learn to clean his teeth thoroughly by himself, so he needs parents’ help and guidance to brush his teeth for 3 minutes every morning, noon and night using the pasteurized brushing method.
V. Personal insight
Many people do not pay enough attention to toothache and think that it will be cured by taking some medicine. In fact, most toothaches require further examination and treatment in dentistry, and toothache is very intense when acute periapical abscess appears, and prolonged delay will not only cause great pain to the child, but also aggravate the condition. In this case, the parents initially did not consult the doctor in time, but after communication, they realized that the condition needed to be treated in time, and their cooperation later paved the way for the ideal treatment result.