If the tooth is still painful after pulp opening for pulpitis, endodontic anesthesia can be performed and the pulp can be extracted directly after complete drug absorption, root canal preparation, and placement of clove oil cotton twist for pain relief. It is also possible to seal a rapid deactivator at the bottom of the pulp chamber and remove the deactivated pulp after two days to clean the root pulp. If the x-ray shows a large amount of inflammatory secretions in the apical region, oral cephalosporin and nitroimidazole antibiotics need to be administered along with further pulp opening and drainage to promote inflammation. Extraction is an option if the crown is extensively defective, the tooth is looser than II degree or more, and there is persistent pain. If the gum swelling is significant and causes swelling of the jaw and face, systemic antibiotics are best applied.