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Abstract: The child had caries long ago, but did not pay attention to it and did not receive treatment, and did not go to the clinic after the toothache because it did not last long. Later on, she found that the gingiva had developed a small package without pain and itching, and came to the clinic and diagnosed chronic apical periodontitis, which was related to the lack of timely consultation of the previous caries. Through root canal treatment, the child’s condition improved and the discomfort was relieved.
Basic information】Female, 7 years old
Disease Type】Chronic apical periodontitis
Hospital】The First Hospital of Harbin Medical University
Date of consultation】August 2020
Treatment plan] Root canal treatment
Treatment Period】2 outpatient treatments, 1 week apart
Effectiveness】The child’s condition was cured and the gums and teeth returned to normal.
I. Initial consultation
The child’s gums had small pockets that did not go away, so his family brought him to the clinic. After inquiry, we learned that the child’s teeth had been bad for a long time and had pain at night last year, but the pain disappeared after a few days, so the child had not been treated. Recently, a small packet was found on the gum without pain, but it did not go away even after several days of observation.
Examination revealed that: the tooth in the corresponding position of the gingival pouch was obviously defective and it was a carious tooth. The inflammation was in the chronic stage which could have no pain or only slight pain. From the medical history and typical manifestations, it was initially judged as periapical periodontitis, and dental radiographs were taken, and transillumination images of alveolar bone destruction appeared around the roots and roots of the child’s teeth, and chronic periapical periodontitis was diagnosed.
II. Treatment history
Since the affected tooth was a baby tooth, the child’s family asked whether treatment was necessary. I answered that this situation might affect the development of permanent teeth if left untreated, so it was necessary to dispose of it, either by root canal treatment or tooth extraction. The child’s family agreed to choose root canal treatment.
After the initial visit, the root canal was opened, extracted, dilated, flushed, and anti-inflammatory Vitapex was placed in the root canal. 1 week later, the root canal contents were removed and the canal was backfilled with zinc oxide iodoform paste.
III. Treatment effect
The treatment was carried out in two sessions, one week apart. During the treatment, I advised the child not to eat foods that were too hard or too cold or too hot, and not to develop the bad habit of biting hard objects such as tape and bottle caps with his teeth. After the treatment, the child’s teeth were intact and he was able to chew food normally, and the pockets on the gums were removed soon after the treatment was completed. When the child comes back for a follow-up visit nearly one year later, the filling material remains intact, the tooth is not painful, and the gums are not overflowing with pus, redness, or pain, which means the treatment is successful.
IV. Notes
I am glad that the child’s symptoms have improved after treatment, but while I am happy for the child’s recovery, I also ask the child and his family to pay attention to oral health. Because dental treatment is not a one-time thing, there is no way to guarantee that no oral disease will occur in the future, so in order to prevent disease, you need to focus on whether the gums appear swollen, foreign bodies, whether the teeth are chipped, black or yellow, and whether there are painful symptoms. After treatment, the diet is based on the principle of low sugar and high fiber, avoiding foods with high stickiness and sugar content, and trying not to drink beverages. Young children often have little self-control and like to eat snacks. Parents must control them and set an example by not storing sugary snacks such as cakes, plums and jellies at home.
V. Personal Insights
Chronic apical periodontitis is easily ignored by children and their families because there is no obvious pain. In this case, the child first developed caries and did not pay attention to it, and then developed spontaneous pain at night, which is the manifestation of pulpitis already occurred, and then developed to periapical periodontitis. In addition to caries is a common cause, because the pulp of the tooth may be affected after the tooth is traumatically knocked, regardless of whether it is fractured or not, so whether the tooth is injured or has caries, it is recommended to go to the dentist in time.