Inter-visit inflammatory reaction, also known as emergency during root canal treatment (EIAE) or inter-visit pain, is a common complication of chronic periapical infection (commonly known as dead pulp teeth) treatment, especially sinusless type (including multi-rooted teeth with sinus tracts) is most likely to occur, the incidence of 23.3%-50.9% reported at home and abroad, and is a major problem that has long plagued dentists. After nearly 1,000 cases of observation, the incidence rate has been controlled to less than 5%, and the reaction degree is mild, which is introduced as follows for colleagues’ reference.
I. Step-by-step decay and disinfection method.
First consultation.
① Routinely open the pulp and drop a little 3% hydrogen peroxide in the fossa;
② Select different types of enlargement needles according to the thickness of the root canal to find the root canal, reach into the root canal about 2/3, and do appropriate enlargement;
③Wash with hydrogen peroxide 1-2 times;
④Insulate the root canal with cotton twist to absorb the fluid;
⑤ Dip the cotton twist into the FC until saturation, then press the cotton ball until half dry (1-2 presses), and place it into the upper part of the root canal, multiple teeth can be covered with the exposed part at the mouth of another root canal or pulp chamber without multiple cotton twists;
(6) Temporary sealing of the cavity (after 1-48 hours, the sealing time can be more for short FC).
Re-visit: remove the cotton twist, routinely clean the apical part, and expand, clean and dry the root canal according to the situation; seal the medicine with less irritating calcium hydroxide, pomegranate oil, CP and other medicines.
Re-visit: treatment can usually be completed.
Precautions.
①The cotton twist should not be too wet;
②The fluid in the root canal should be drained
③The cotton twist should not be too tight;
④The seal should be tight, and the residual root can be sealed temporarily with zinc;
⑤ cautiously used for those with coarse apical holes.
Second, the type of inflammatory reaction between treatment
1, bacterial: most common, mainly due to improper treatment of dead pulp teeth.
2.Chemical: Commonly caused by sealing arsenic inactivator and improper FC.
3, traumatic: mostly seen in the expansion of the root beyond or lateral penetration, also seen in the filling body is too high.
FC-induced reactions or allergies are characterized by significant facial swelling, but not severe pain.
(For more details, see? Practical Endodontics?)
III. Treatment of inflammatory reactions between consultations.
1.Decide whether to open according to the degree of inflammatory reaction;
2.Adjustment ;
3, drug treatment: nitro-mizole drugs plus antibiotics orally for 3 days, dexamethasone 3 tablets in 3 oral doses, only 1 day of medication can be given. General reactions with oral, with chills and fever can be selected as appropriate for sedation.
IV. Discussion
The root canals of dead pulp teeth contain decaying material formed after inflammation and necrosis of the pulp, which becomes a culture medium for the growth and reproduction of bacteria (the majority of which are anaerobic). When the root canal is cleaned and enlarged, if the dogmatic method of enlargement is followed to the end at once, there will inevitably be bacterial decay material pushed out of the apical foramen, leading to acute periapical inflammation.
Some doctors may feel that the more serious the enlargement, the heavier the inflammation, and some may occur even if the apical foramen is not exceeded, and the length of the root canal measured by radiography does not solve the problem. This is because the root canal anatomy is complicated, the root tip at the lateral branch root canal more, many root canal apical hole is not in the root tip but in the root side, root canal expansion and flushing pressure, may extrude the decay, even a little, will cause acute inflammation. Of course, there are differences in the composition of the root canal and the immunity of the patient’s body, so the degree of reaction varies and the severity of symptoms varies.
The step-by-step decay disinfection method is to divide the root canal into three equal parts, near the root canal mouth 2/3 can be regarded as a safe area (see figure), can safely expand, while near the root tip 1/3 should be regarded as a dangerous area, as there are mines, can not just enter. In the first clear rot can only clear, expand 2/3, cleaning (advocate cotton twist swab, not advocate syringe rinse) and suction dry, sealed into a small amount of FC, using its strong sterilization effect and evaporation, penetration function;
The bacteria in the rotten matter that has not been cleaned will be killed; even if not killed can destroy its toxin, so that the bacteria have no killing power, as the broken limbs of people have no fighting power, so the second root expansion is relatively safe. Of course, the instrument still can not exceed the apical hole, otherwise, there is the possibility of traumatic inflammatory reaction.
Before the root expansion drops of hydrogen peroxide in the fossa, so that part of the hydrogen peroxide with the enlargement needle into the root canal, combined with the decay and produce bubbles, both will be decay with the bubble overflow, but also have a certain sterilization effect, can play a certain auxiliary role.
Dexamethasone is an adrenal corticosteroid, also known as glucocorticoid. It has anti-inflammatory, anti-allergic and anti-toxin effects, and has a good effect on the prevention and treatment of inflammatory reactions between consultations. According to my observation, the pain can be relieved within 2-3 hours after the drug is administered, and those with severe pain can take an additional tablet of Fenbid. This drug is contraindicated for patients with hypertension, malignant tumors and tuberculosis, but it is not a big problem if the condition requires taking it once or twice. As for the preventive medicine, if you can master the step-by-step decay and disinfection method, it is not necessary to use it for every patient, but only for those who need to complete the root expansion and root filling at once for the reason of dead pulp teeth.