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Abstract: The patient’s right lower wisdom tooth became swollen with pain 2 days before, but he did not go to the hospital in time because of his work, which led to the aggravation of his swelling and pain, and then he came to the hospital. After examination, the patient was initially diagnosed with peri-coronitis of the wisdom tooth, and was treated with local irrigation and symptomatic medication, and after the inflammation subsided and the wisdom tooth was extracted, all the symptoms that existed before the patient’s visit have been relieved.
Basic information】Male, 30 years old
Disease Type】Pericoronitis (wisdom tooth pericoronitis)
Hospital】Qilu Hospital of Shandong University
Date of consultation】August 2021
Treatment plan】Medication (minocycline hydrochloride cream, loxoprofen sodium tablets, tinidazole, amoxicillin) + surgery (wisdom tooth extraction)
Treatment Period】2 weeks
Treatment effect】The patient’s tooth swelling and pain were eliminated, and no significant discomfort was seen on review.
I. Initial consultation
The patient, Mr. Chen, came to the clinic anxiously and reported that 2 days ago, the right lower wisdom tooth was not only swollen, but also painful. The patient’s face was basically symmetrical and there was no abnormality. After examining the oral cavity, it was found that the patient’s lower right wisdom tooth was partially erupted and part of the crown was covered by the gum, while the gum was mildly red, swollen and painful on pressure, but there was no fluctuation and pus exudation, so the patient needed to be given anti-inflammatory treatment and wisdom tooth extraction. The patient was informed of the specific treatment modality and the treatment was carried out with the patient’s consent.
II. Treatment procedure
The patient’s lower right wisdom tooth was rinsed and minocycline hydrochloride cream was applied, while the patient was instructed not to rinse his mouth or drink water for half an hour. The patient was also given corresponding anti-inflammatory drugs such as loxoprofen sodium tablets, tinidazole tablets and amoxicillin capsules to reduce swelling and pain. 3 days later, after treatment with topical and oral medications, the patient’s gingival inflammation was relieved and he came to the hospital again for extraction operation.
By taking oral CBCT, it was learned that the root of the patient’s right lower wisdom tooth was a single root, which was far from the mandibular nerve canal. After excluding the existence of contraindications to anesthesia and tooth extraction, the right lower wisdom tooth was extracted under local anesthesia. After the operation, we confirmed that there was no broken root, observed the patient for half an hour, and discharged him from the hospital. Before discharge, ibuprofen tablets were given for pain relief, and precautions in daily life were also instructed.
III. Treatment effect
After 3 days of local and systemic medication for pericoronitis, the patient’s inflammation was not only controlled, but also the gingival swelling and pain was relieved. One week after the wisdom tooth was extracted, the patient came to the outpatient clinic for a review. At this time, it was seen that the gingival swelling and pain had disappeared, the extraction sockets no longer bled, the wound surface healed well, and there was no indication of dry socket, and the patient had no obvious discomfort, including infection or swelling and pain.
IV. Precautions
Remind the patient to pay attention to some matters after the operation.
1. Patients were instructed not to eat within 2 hours after tooth extraction, after which it was recommended to eat warm and soft food and avoid spicy and stimulating food, while brushing and rinsing the teeth only after 1 day.
2. In daily life, it is recommended to rinse the mouth carefully after meals to keep the oral cavity clean and hygienic, but it is necessary to pay attention to the patients to master the correct way of brushing. Patients can carry out appropriate physical exercise to enhance their resistance.
3, usually patients need to pay attention to adjust the state of mind, avoid frequent excitement, or anxiety and fire, and avoid staying up late, all have relative benefits to the recovery of the disease.
V. Personal insight
Most patients who have pain and swelling in their own teeth will choose to take their own medication to solve it and will not think about the need to extract the tooth, but in fact, the clinical method for the eradication of pericoronitis is to remove it, which can relieve the worries. However, it is important to note that in the acute stage, similar to the patient in this case, extraction should not be performed immediately, as this may lead to the spread of inflammation and even interstitial infection. Instead, the tooth should be extracted after the inflammation has been controlled by medication, which will not only remove the hidden problem, but also relieve the patient’s pain.