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Abstract: The patient in this case was a young male in his late 20s. The patient came to the clinic with a self-reported swelling of the gums, causing slight swelling of the right side of his face, and his teeth were afraid to chew very chewy food. The patient reported that he had undergone filling treatment in a private clinic around the age of 13. After a brief communication with the patient, through oral examination and imaging, he was diagnosed with chronic apical abscess, a condition of periapical abscess, and then started outpatient abscess incision and drainage + root canal treatment + systemic anti-inflammatory treatment + full crown restoration, and after treatment, the gingival abscess subsided and the gums returned to normal, with good treatment results.
[Basic Information] Male, 20 years old
Disease Type】Periapical abscess
Hospital】Nei Mongol Autonomous Region Women and Children’s Hospital
Date of consultation】April 2020
Treatment plan】Surgical treatment (abscess incision and drainage, root canal treatment, full crown repair) + oral medication (cefradine capsules, metronidazole tablets)
Treatment period】4 weeks of outpatient treatment, regular follow-up
Treatment effect】Gum abscesses subsided, gums returned to normal, good treatment effect
I. Initial consultation
On a sunny afternoon, a young male patient visited the adult outpatient clinic. The right side of the patient’s face was slightly swollen, and he reported that he did not know whether it was caused by dental disease and was afraid to chew harder food. After a detailed history, it was found that the patient had a filling of his upper right posterior tooth in a private clinic at the age of about 13, and he could not remember the situation at that time. Recently, he had been uncomfortable with his teeth for some time, but he had not sought medical attention because he was busy. Recently, he noticed that the symptoms of discomfort had worsened and his face had become swollen, so he took the time to seek medical attention. I first performed a simple examination of the oral condition, arranged for the patient to undergo CBCT to further clarify the condition, and made a preliminary diagnosis: 16 chronic apical abscess, and after communicating the condition, gave the patient relevant examinations.
II. Treatment
Examination: gingival swelling, tooth misalignment, no abnormal occlusal relationship, partial defect of 16 coincidental surface visible, partial loss of filling material, looseness degree I, local abscess of gingiva on the buccal side, fluctuating sensation to touch, positive tenderness, positive percussion pain, negative probing pain, no response to cold and heat test compared with the contralateral tooth of the same name. Auxiliary examination: CBCT showed 16 palatal lateral teeth with extra-roots resorption, large hypodense images visible in the root tip, hypodense images in the root canal, and high-density filling images visible in the crown with the pulp chamber.
The gingival swelling in the apical region of the affected tooth was obvious, and the filling material was firstly removed, the pulp was opened and uncovered, three root canals were explored, the palatal root apices were coarse, and dark brown decaying matter was visible in the root canals, which were opened and drained, and the buccal abscess was incised and drained under local anesthesia and rinsed and drugged. At the same time, systemic anti-inflammatory treatment was given, with regular oral cefradine capsules and metronidazole tablets, and daily mouth rinsing after meals and daily root canal dressing changes. Postoperatively, 16 dental radiographs were taken to show root filling and later transferred to restorative dentistry for full crown restoration treatment.
(The above picture shows the CT examination of the tooth area)
Third, the treatment effect
One week after the standard treatment, the patient’s right tooth chewing function was restored, the gum swelling was obviously relieved, and the right facial swelling disappeared; 4 weeks after the standard treatment, the food embedment symptoms were obviously improved, and the tooth morphology and chewing function were improved, the gum returned to normal, and normal diet was resumed. The patient underwent a follow-up oral examination every 3 months and a dental film review every 6 months, and no significant abnormality or inflammation became larger or spread during the current review.
IV. Notes
We are glad that the patient’s periodontal disease continues to recover. However, the patient in this case is an outpatient and has no daily supervision by medical staff, therefore, the patient needs to be reminded that he should also follow medical advice at home and should not use the treated tooth to chew food until his condition has completely improved to prevent the treated tooth from experiencing increased pain and longitudinal cracking of the crown and root. If the swollen gums do not resolve, you should contact your primary care physician and follow up with a change of medication.
Rinse your mouth after meals daily after abscess incision and drainage, and avoid eating spicy, too cold, too hot and other irritating foods.
V. Personal insight
Although this patient was very young, her condition was delayed for a long time, which also made the treatment very difficult during the root canal treatment, because the apical foramen was severely damaged, which also directly affected the prognosis. Untimely medical attention can lead to aggravation of the condition, which can lead to both a slow recovery and an increase in the associated treatment costs and the number of follow-up visits. If an apical abscess is not treated in a timely manner, it can also lead to interstitial infection and even tooth extraction if the tooth cannot be retained.
It is also important to emphasize that medications should not be taken at your own discretion, but should be used under the guidance of a doctor. For any disease, doctors still recommend early detection and early treatment, regular follow-up, in addition to the prevention of oral diseases is very critical, should advocate the general public to conduct an annual oral examination to protect oral health.