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Abstract: In this case, the child had another growth on the gingiva after a filling. The parents thought it was a fire, but the doctor diagnosed it as 75 periapical abscess after detailed examination. The child was afraid of tooth extraction, and with the doctor’s communication and reassurance, the child cooperated with the root canal treatment of the papillary tooth. After the treatment, the gingival abscess healed and the chewing of food was normal, with good results.
Basic information】Female, 6 years old
Disease Type】75 periapical abscess
Hospital】Nei Mongol Autonomous Region Maternal and Child Health Hospital
Date of consultation】December 2021
Treatment plan] Root canal treatment for milk teeth
Treatment Period】3 times outpatient treatment, 1 time/1 week, 3 months outpatient follow up
Results】The gingival abscess disappeared and the treatment effect was good
I. Initial consultation
Today’s pediatric dental clinic welcomed an anxious father who brought his timid child to see the dentist. The child was a bit afraid, mainly of tooth extraction, and the father anxiously inquired about the abscess on the child’s gums and whether it was caused by fire, and said that he had a filling elsewhere a year ago, and recently found an abscess on the gums, and medication did not help. The child was then asked to lie in the dental treatment chair, comforted and encouraged to cooperate with the preliminary examination, and could see that the mandibular posterior teeth basically had filled material, the filling body area was large, and swollen abscesses were visible on the buccal side of the gums. A preliminary diagnosis of 75 periapical abscess was made, and the child had no systemic chronic diseases and was usually in good health. Oral examination was first performed on the child: mixed dentition, general oral hygiene, large white filling on the 75 visible coincidental surface, percussion (+), probing pain (-) looseness (Ⅰ°) pustules visible on the buccal gingiva, no abnormal occlusal relationship. Auxiliary examination: X-ray dental film showed large high-density image of 75 crown near the pulp chamber, large low-density image visible at the root tip and root divergence, permanent tooth embryo in place. 36 Root tip flare-like. Diagnosis: 75 periapical abscess.
II. Treatment history
After communication with the child and family, a treatment plan was formulated: 75 root canal treatment of the papillary tooth, oral hygiene promotion for the child’s parents, and a follow-up visit once in 3 months. Considering that the nerve of this tooth was already necrotic, we directly opened the pulp and uncovered the top of the 75, and the child cooperated very well. The third time the child cooperated with the treatment exceptionally well, and the gums of the child returned to normal at the end of the treatment.
III. Treatment effect
Before the treatment, there was an abscess on the gum, but after the treatment, the abscess disappeared and the gum healed normally. Before treatment, the child was reluctant to eat food that was difficult to chew and had tooth pain when chewing food, but his diet was not affected after treatment. The treated child was afraid of dental visits, but after treatment started the child has been very cooperative and is not so afraid of dental treatment. After 3 weeks of outpatient treatment, the child’s teeth have basically returned to normal, and there is no abnormality at the 3-month follow-up, and the treatment effect is good.
IV. Notes
This child is recovering very well and I am very happy for her. It is recommended that the child needs regular follow-up after treatment, once every 3 months, and imaging review at 6 months. If the apical and root divergence hypodense images are found to become larger and spread to the permanent tooth germ, the focal tooth needs to be extracted in time, and the gap is maintained later according to the eruption of permanent teeth. Brush your teeth in the morning and evening, brush your teeth correctly and effectively, do not leave food residues, use fluoride toothpaste correctly, and control the frequency and quantity of sugary food and hard food intake.
V. Personal insight
Many parents think that swollen gums and abscesses are fires, but they are not fires. It is important to pay attention to oral hygiene in life to prevent this disease. Parents should take their children to the doctor first for regular dental treatment when the treated milk teeth become painful and the gums become abscesses like the child in this case, otherwise the normal development of secondary permanent teeth will be affected. In particular, dental x-rays should be taken, which are very useful in making a clear diagnosis and predicting inflammatory lesions. Parents should also be reminded that dental treatment requires regular follow-up visits with the doctor to detect oral problems in a timely manner, and to try to detect and treat milk tooth disease as early as possible.