Incision to establish drainage is the only surgical endodontic procedure which may be undertaken when acute inflammation is present. The principal indication is the presence of a collection of pus which points from a fluctuant abscess in the soft tissues. Establishing drainage to help bring the infection under control is essential, and should always be obtained through the root canal and soft tissues in preference to administering antibiotics alone. The
soft-tissue swelling should be examined to see if it is fluctuant. Where the swelling is pointing intra-orally, copious amounts of surface analgesia should be applied, for example ethyl chloride or topical lignocaine ointment. Regional anaesthesia may not be effective due to the presence of pus, and the administration of a local analgesic solution may spread the infection further into the tissues. Incise the swelling with a Bard Parker No. 11 or 15 scalpel blade, or aspirate, using a widebore needle and disposable syringe. It may be possible to aspirate the abscess via the root canal as well. The advantage of this technique is that the sample can be sent for bacteriological examination if required. It is not usually necessary to insert a drain, but if it is thought necessary then a piece of quarter-inch or half-inch selvedge gauze may be used. The same criteria apply when extra-oral drainage is indicated, and it may be possible to use the same technique of aspiration with a wide-bore needle and disposable syringe. However, if an extra-oral incision is considered necessary, as in Figure 7, it is wise to refer the patient to an oral surgeon for this particular procedure.
soft-tissue swelling should be examined to see if it is fluctuant. Where the swelling is pointing intra-orally, copious amounts of surface analgesia should be applied, for example ethyl chloride or topical lignocaine ointment. Regional anaesthesia may not be effective due to the presence of pus, and the administration of a local analgesic solution may spread the infection further into the tissues. Incise the swelling with a Bard Parker No. 11 or 15 scalpel blade, or aspirate, using a widebore needle and disposable syringe. It may be possible to aspirate the abscess via the root canal as well. The advantage of this technique is that the sample can be sent for bacteriological examination if required. It is not usually necessary to insert a drain, but if it is thought necessary then a piece of quarter-inch or half-inch selvedge gauze may be used. The same criteria apply when extra-oral drainage is indicated, and it may be possible to use the same technique of aspiration with a wide-bore needle and disposable syringe. However, if an extra-oral incision is considered necessary, as in Figure 7, it is wise to refer the patient to an oral surgeon for this particular procedure.