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Abstract: A mother brought her little boy to the dental clinic, stating that her child had a fleshy ball growing on the gum, which did not become smaller even after sticking it with a needle, and medication did not help. After a detailed examination, she diagnosed periapical inflammation of the papillary teeth, and after communication, root canal treatment + filling treatment was performed for the papillary teeth. After the treatment, the gingival fistula healed and the chewing of food was normal.
Basic information】Male, 4 years old
Disease Type】Periapical Periodontitis
Hospital】Nei Mongol Autonomous Region Maternal and Child Health Hospital
Date of consultation】March 2021
Treatment plan】Papillary tooth root canal treatment + filling treatment
Treatment Period】3 times outpatient treatment, 1 time/week, 3 months outpatient follow up
Results】Gingival and fistula healing, good treatment effect
I. Initial consultation
On a sunny day, I went out to the children’s dental clinic as usual and was greeted by a young mother who asked me anxiously, “Doctor, my child has a fleshy ball on his gum, and I even stuck it with a needle but it didn’t get any smaller. First, I reassured the mother, then greeted the child and hoped the boy would relax. First of all, I asked the mother about the child’s tooth brushing, night milk, and how often he eats sweets. The mother told me that the child started brushing his teeth only when he was two and a half years old, and that he usually brushes his teeth very haphazardly, and is sometimes very uncooperative. She was a night nurse until she was two years old, and sometimes she would sleep through the night with her nipples in her mouth. He loves to eat candy, chocolate, soft cakes, etc. The baby’s mother noticed long ago that the baby’s teeth were black, but did not come to the doctor in time. She asked the baby to lie on the dental chair, comforted and encouraged him to cooperate with the preliminary examination, and could see that all the posterior teeth of the lower jaw were black with large cavities, the labial surface of the maxillary anterior teeth were black, the posterior teeth had black spots on the symphyseal surface, and there were fistulas on the gums. The preliminary diagnosis is “deep caries and periapical inflammation of milk teeth”, the child has no systemic chronic diseases and is usually in good health.
II. Treatment process
Firstly, I performed oral examination for the child: the milk teeth, general oral hygiene, 84 can be seen as large area of caries on the distal-middle adjacent surface, more decay, percussion (+), probing pain (-), looseness (-), buccal gingiva can be seen as abscess, no abnormality in occlusal relationship. x-ray dental film shows: 84 crown defect and pulp cavity are the same, 84 proximal-middle root tip and root bifurcation can be seen as low density image, 75 no abnormality, permanent tooth embryo in place The permanent tooth germ was in place. I considered that the child was nervous for his first dental visit, so I tried to calm the child as much as possible, carefully cleaned the decayed 84 tooth bit by bit, exposed the pulp after opening the pulp and uncovered the pulp cavity, a foul smell wafted out, and sealed the root canal after thorough flushing. The child was very cooperative in the follow-up treatment, and oral hygiene education was given to the parents of the child. A follow-up visit was made once in 3 months.
III. Treatment results
Before the treatment, there was a fistula on the gingiva, but after the treatment, the fistula disappeared and the gingiva healed well; before the treatment, the child was reluctant to eat food that was difficult to chew and had tooth pain when chewing food, but after the treatment, the diet was not affected; before the treatment, food impaction often occurred, but after the treatment, the situation was relieved. During the treatment, the child cooperated well and did not resist the treatment, which laid a good foundation for future follow-ups. There was no abnormality in the later follow-up, and the treatment effect was good.
IV. Notes
We are glad that the child cooperated positively with the treatment and that the gum treatment was effective. After the outpatient treatment, parents are advised to prepare some tooth-related picture books and cartoons for their children to positively guide them about the importance of dental health. The child is instructed that he/she should brush his/her teeth carefully, and the parents check his/her teeth more carefully and floss the gaps with children’s dental floss. During treatment, a light diet is recommended, avoiding spicy and stimulating foods and avoiding chewing foods that are too hard and sticky. If your child experiences any discomfort in the periodontal area, he or she should immediately visit the clinic for a review.
V. Personal insight
Parents should not easily use needles to puncture abscesses on any part of the body, as such behavior not only cannot cure the disease, but also can aggravate it or increase the risk of infection. Especially if the milk teeth become black, painful and other symptoms, parents should first take their children to the doctor for regular dental treatment, otherwise it will affect the normal development of secondary permanent teeth. Poor teeth directly affect the child’s diet, which in turn affects the child’s absorption of food and physical development. Long-term dental pain also affects the child’s psychological development.
During dental treatment, the doctor will try to keep the child as pain-free as possible, and most dental treatments should be pain-free, not too long, and performed in root canal treatment sessions. After each treatment, I provide oral hygiene education to parents and children, instructing parents on the spots where brushing is not possible, and making brushing 360° free. Again, the full cooperation of the child and parents is required, and finally the importance of regular follow-up visits is repeatedly emphasized.