Emergency Extirpation of Tooth EG

Specialty: Dentist **Emergency Extirpation of Tooth EG** **Chief Complaint** Patient presented with severe, throbbing pain in the upper right quadrant, constant for the past 24 hours, rating it 8/10 on a pain scale. Associated swelling noted. **History of Presenting Complaint** Pain started suddenly yesterday evening, described as sharp and radiating to the ear. Aggravated by hot and cold stimuli, slightly relieved by cold water. Patient reports a history of a deep filling placed on tooth #16 (upper right first molar) approximately 6 months ago. **Pre-Procedure Discussion / Consent** Risks discussed with patient including: pain, swelling, infection, difficulty locating canals, flare-ups, potential need for further treatment, risk of fracture, or eventual extraction. Patient informed extirpation is an emergency palliative treatment, not definitive care. Full root canal treatment or extraction will be required. Patient provided opportunity to ask questions. Verbal consent obtained. **Examination & Investigations** E/O: Mild facial swelling noted in the right infraorbital region. No trismus. Submandibular lymph nodes palpable and slightly tender. I/O: Deep carious lesion noted on the occlusal aspect of tooth #16 with an existing composite restoration. Slight buccal swelling present adjacent to tooth #16. Significant percussion tenderness on tooth #16. Vitality tests: Negative to cold test on tooth #16. Radiographic findings: Periapical radiograph of tooth #16 shows a deep carious lesion extending close to the pulp chamber. Widened PDL space noted at the mesial root apex. No periapical radiolucency visible. Diagnosis: Symptomatic irreversible pulpitis with acute apical periodontitis. **Procedure** Anaesthesia: 2 cartridges of 2% Lidocaine with 1:80,000 adrenaline administered via buccal and palatal infiltration. Rubber dam isolation achieved. Access cavity prepared on tooth #16. Canals located: MB1, MB2, DB, and Palatal canals found. Canals instrumented to working length using hand files. Canals irrigated with sodium hypochlorite and saline. Extirpation completed. Dressing placed: Ledermix applied into canals. Temporary seal: Cavit placed over access and covered with Fuji Pink for reinforcement. Haemostasis and occlusion checked. **Post-Operative Instructions** Explained possible post-operative pain, flare-ups, and swelling. Analgesia advice: Ibuprofen 400mg every 6-8 hours as needed, and Paracetamol 500mg every 4-6 hours as needed, alternating if necessary. Antibiotics: Amoxicillin 500mg three times daily for 7 days prescribed. Patient instructed to return if symptoms worsen. **Outcome / Follow-Up** Patient reported significant pain relief and reduction of pressure at completion of procedure. Next visit planned: Definitive root canal treatment appointment booked for 1 November 2024. **Other Notes** Patient tolerated the procedure well. Discussed the importance of returning for definitive treatment to prevent further complications.