Presenting Complaint
Patient attended as an emergency reporting severe throbbing pain from lower right first molar (LR6), pain score 8/10, worsening over 48 hours and disturbing sleep.
History of Presenting Complaint (HPC)
- Onset: 2 days ago, increasing in intensity.
- Character: Throbbing, constant, radiates towards right ear.
- Exacerbating factors: Hot drinks, chewing, lying flat at night.
- Relieving factors: Minimal relief with paracetamol.
- Associated symptoms: Difficulty sleeping due to pain.
Medical History / Checks
Medical history checked and updated. No contraindications to treatment provided today. Consent to examination and emergency treatment obtained.
Clinical Examination (O/E)
Extraoral: NAD. No facial asymmetry. No obvious lymphadenopathy. TMJ WNL.
Intraoral: Localised buccal swelling adjacent to LR6. Soft tissues otherwise healthy.
LR6 findings: Large DO restoration present. Tender to percussion (++). Crack suspected at disto-buccal cusp. Tooth symptomatic and clinically consistent with pulpal/apical pathology.
Investigations
- Periapical radiograph of LR6 taken.
- Justification recorded: assess periapical status and extent of recurrent disease.
- Quality: diagnostic / acceptable.
- Findings: periapical radiolucency associated with LR6 roots, recurrent caries/restoration failure evident.
Diagnosis
Symptomatic irreversible pulpitis with acute apical involvement / abscess associated with LR6.
Discussion / Options / Consent
Discussed options including root canal treatment, extraction, and no treatment (not advised). Risks, benefits, costs, and prognosis explained in plain language.
Patient elected emergency extirpation / open-and-dress to relieve symptoms today, with plan to proceed to definitive RCT if restorable.
Treatment Provided Today
- Local anaesthesia administered (ID block + long buccal infiltration).
- Rubber dam isolation placed.
- Access cavity prepared and pulp chamber entered.
- Drainage achieved. Canals located and irrigated appropriately.
- Intracanal dressing placed.
- Temporary restoration placed to seal access.
- Occlusion checked and adjusted.
Post-Operative Instructions
- Analgesia advice provided.
- Avoid chewing on treated side until numbness has fully worn off.
- Return urgently if swelling increases, pain worsens, or systemic symptoms develop.
Follow-Up
Review booked in 2 weeks for completion of root canal treatment / reassessment of restorability. Written and verbal advice given. Patient understood and agreed.