Where Is The Swelling Really Coming From – A Case Study
Dentistry is often detective work, like an oral Sherlock Holmes. Often things are not what they seem, such as referred pain.This case is not all swellings are what they appear to be. The patient presented with the two upper molar teeth (teeth with 3 roots on it) with temporary dressings. The last (or second) molar already had a root canal treatment started. The first molar (second last tooth) had a very deep dressing placed almost onto the nerve. The patient was unable to come for her next visit for a while. She then presented with a large swelling within the cheek side gum.
I tapped on the first molar, which was not painful, in fact all the back teeth were not tender to tapping on. So I started to remove the temporary filling in the first molar to see if it felt anything…. and it did!
There was and opening in the swelling where pus was drainng out. So I used a root canal filling material that looks like a thread (a point) made out of a material (gutta percha) that can be seen on an Xray. i.e. a gutta perch point. Shown in the xray above. The gutta percha point curved to the single tooth root of the tooth in front. The xray showed a deep, intact filling near the nerve. So I removed the filling without anaesthetic and the patient felt nothing. In fact there was a large amout of decay. Once the decay was removed, the root canal was exposed with no blood supply and the smell of a bateria filled canal.
So I began root canal treatment by placing a file inside the root canal and began cleaning the dead tissue and bacteria out of the canal, both mechanically and chemically.
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Where Is The Swelling Really Coming From - A Case Study - Treatment