Referring Doctors

Case of the Month

Patient C.C. is a 45 y.o. male who presented on an emergency basis with a chief complaint "I had a toothache over the weekend and thought it was because I had a cavity.  I saw my dentist and had a filling done.  I woke up this morning with severe pain and with my face swollen so I went back to my dentist and he said I had an abscess."

Medical History: 

No reported history of any medical disorders.  Drug allergies - None.  No current medications.

Dental History:

Patient has a history regular dental treatment throughout life; visits GP biannually for examination & cleanings; Deep occlusal restoration placed one day previously; 5 day history of mild spontaneous pain in the maxillary right quadrant; 1 day history of intraoral and extraoral buccal space swelling adjacent to tooth # 3;  Pain to percussion, palpation and biting pressure.

Clinical Examination: 

• Tooth # 2:  Endo Ice - normal, percussion - normal, palpation - normal,

Tooth sleuth – normal.  Perio probings all 3 mm or less.

• Tooth # 3:  Endo Ice – no response, percussion – moderately painful, palpation – positive

            Tooth sleuth – mild pain to biting.  Perio probings all 3 mm or less.

• Tooth # 4:  Endo Ice - normal, percussion - normal, palpation – normal

            Tooth sleuth – normal.  Perio probings all 3 mm or less.

• Tooth # 5:  Endo Ice - normal, percussion - normal, palpation – normal

            Tooth sleuth – normal.  Perio probings all 3 mm or less.

Radiographic Examination:

Tooth # 3 exhibits severe pulpal calcification, periapical radiolucencies associated with all 3 roots and severe dilaceration of the mesiobuccal root.

Diagnosis:

Tooth # 3 pulpal necrosis with acute apical abscess

Treatment Plan:

Conventional non-surgical root canal therapy

Alternative treatment option:  Extraction

Restorative:  Cotton and Cavit.  Patient to return to GP for full coverage restoration

Prognosis:  Good