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Abstract: The parents brought their child to the clinic with the complaint of toothache. After detailed examination and combined with the medical history, the diagnosis was acute attack of chronic pulpitis. After communicating with the child’s parents, the child underwent root canal treatment of the papillary tooth. The toothache disappeared after the first treatment, and a preformed crown restoration was performed 2 weeks later to restore the tooth form. After active treatment, the child returned to normal eating and sleeping.
Basic information】Male, 4 years old
Disease Type】Acute attack of chronic pulpitis
Hospital】Nebraska Women’s and Children’s Hospital
Date of consultation】November 2021
Treatment plan] Root canal treatment + preformed crown restoration
[Treatment Period] Outpatient root canal treatment, 2 weeks later return to the hospital for pre-crown restoration
Treatment effect】Good results, no nighttime toothache, good sleep and diet
I. Initial consultation
The parents brought their tearful child to the dental clinic, complaining that the child had not slept all night yesterday and said he had toothache. After careful questioning of the parents, we learned that the child had occasionally complained of toothache 2 weeks ago, but the parents did not care about it. The parents introduced that the child started to brush his teeth only at the age of 2 years old, and usually brushed his teeth very haphazardly, and nursed at night until he was more than 2 years old, and sometimes slept with his nipples all night. The parents found small black spots on the child’s teeth, but did not come to the stomatology department for examination. On examination, the child’s left posterior mandibular tooth (dentition) was found to have a large area of blackness, and a preliminary diagnosis of “acute attack of chronic pulpitis” was made on the basis of dental film examination and medical history. The child had no systemic chronic diseases and was usually in good health.
II. Treatment process
Before treatment, we first communicated with the parents in detail, taking into account the child’s nervousness and lack of sleep the night before, and then combined with the condition, the pulpitis was really painful, so we first used epinephrine injection for the child for painless anesthesia, and after the anesthesia took effect, the child’s tooth pain was relieved and he was willing to cooperate with the treatment, and the decay was cleaned out. After 1 week of follow-up, the child was given root canal treatment for the papillary tooth and was observed for 2 weeks before the restoration of the posterior tooth with a preformed crown.
III. Treatment results
Before the treatment, the child could not sleep due to toothache, but after the treatment, the child resumed normal sleep. Before the treatment, there was often food embedded in the cavity, but after the treatment, the symptom improved significantly. The normal tooth shape was lost before treatment, and after treatment, the tooth shape and chewing function were restored by pre-crowning of the baby teeth. Parents were instructed to bring their children for follow-up check-ups every 3 months, and the treatment has been effective with no abnormalities in the affected teeth since the follow-up visit.
IV. Notes
We are glad that the child’s symptoms have improved after treatment, but for this child’s condition, we need to remind the parents that they should consult the doctor as soon as possible if they find the child’s tooth has become black, so as not to delay the condition, because the tooth is caries at the beginning, but without timely treatment, it may develop into pulpitis. After treatment, we should pay attention to brush the teeth correctly and effectively, use fluoride toothpaste reasonably, and floss correctly to clean the food residues embedded in the teeth. Control the frequency and quantity of sugary foods, such as chocolate and nougat. Visit the dentistry department every 3 months for follow-up examinations to check whether there is any breakage of the preformed crowns of the milk teeth, as well as any abnormalities of the gums, occlusal relationship and tooth development.
V. Personal insight
The condition of this child is representative, at first there are only small black spots, but there is no obvious pain and discomfort, the parents did not take it seriously when brushing the child’s teeth, and did not bring the child to the doctor in time, in the process of delay and waiting let a caries gradually develop into pulpitis. We hope to remind parents through this case that they should brush their children’s teeth carefully, and when they find small black spots and holes on teeth, they should not wait any longer, and they should consult the stomatology department for examination and treatment as soon as possible.