Acute apical periodontitis

In emergency treatment of acute apical periodontitis the main emphasis is on 1) effective pain control, 2) inhibition of the spread of infection, and 3) ensuring good long term prognosis. The preferred treatment of acute apical periodontitis is as follows:

1) Anesthesia: Often, anesthesia is not needed because the pulp is necrotic. However, occasionally part of the pulp tissue may be vital, the tooth is periostitic or placement of the rubber dam necessitates administration of a local anesthetic agent.

2) The optimal treatment comprises complete preparation of the whole canal system. Apical patency may be checked with #10 or 15 file (avoiding overinstrumentation) to allow drainage of pus. Following the cleaning and shaping procedure, the canals are filled with a non-setting calcium hydroxide paste and the access cavity is sealed with a temporary restoration. Control of occlusion is essential.

3) If an abscess present, drainage of pus should be established by surgical incision following local anesthesia to the surface mucosa. A piece of rubber dam may be sutured to hold the incision open for a few days. Good knowledge about anatomy is required to ensure thet nerves and blood vessels in the region are not damaged.

4) Antibiotics are prescribed only when there are general indications for such treatment (e.g. fever, malaise, dangerous location or spreading of the infection, certain risk patients).

5) Drainage of pus from the canal seldom lasts for more than five minutes. In such rare cases, the patient is examined again later the same day.

---