Once access and initial drainage have been achieved, a rubber dam should be applied to the tooth to complete the operation. Before any further instrumentation is carried out, the pulp chamber should be thoroughly irrigated with a solution of sodium hypochlorite to remove as much superficial organic and inorganic debris as possible. This in itself may bring considerable pain relief and will make subsequent instrumentation easier. Having debrided the canals to the best possible extent with frequent changes of irrigant, the canals should be dried with paper points and a dry sterile cotton wool pledget placed in the pulp chamber to prevent ingress of the temporary dressing. The access cavity is then sealed to prevent re-infection of the canals from the oral cavity. If complete debridement was not possible the patient must be recalled within 48 hours. At this time it will usually be possible to complete instrumentation and place a calcium hydroxide dressing in the canals.
The temptation to leave the tooth open to drain must be resisted at all costs.
The microbial flora of the canal will be changed, making treatment more difficult and lowering the longterm prognosis. Furthermore, this treatment contravenes the prime objective of treatment: to disinfect the root canal. If the clinician does not have sufficient time to carry out adequate treatment when opening the tooth, good clinical practice would suggest re-appointing the patient to the end of the treatment session when time is available.
Antibiotics are only required when there is systemic spread of the infection, the patient is unwell and has a raised temperature. Antibiotics are not an alternative to appropriate cleaning and disinfection of the root canal.
There is a serious tendency to over prescription of antibiotics in situations where they are not indicated. If, however, there is a clinical reason for their use, amoxycillin is usually the agent of choice, prescribing 250 mg three times a day until the infection is under control and root canal therapy initiated. Metronidazole is a useful alternative where the penicillins are contraindicated.
The temptation to leave the tooth open to drain must be resisted at all costs.
The microbial flora of the canal will be changed, making treatment more difficult and lowering the longterm prognosis. Furthermore, this treatment contravenes the prime objective of treatment: to disinfect the root canal. If the clinician does not have sufficient time to carry out adequate treatment when opening the tooth, good clinical practice would suggest re-appointing the patient to the end of the treatment session when time is available.
Antibiotics are only required when there is systemic spread of the infection, the patient is unwell and has a raised temperature. Antibiotics are not an alternative to appropriate cleaning and disinfection of the root canal.
There is a serious tendency to over prescription of antibiotics in situations where they are not indicated. If, however, there is a clinical reason for their use, amoxycillin is usually the agent of choice, prescribing 250 mg three times a day until the infection is under control and root canal therapy initiated. Metronidazole is a useful alternative where the penicillins are contraindicated.