"KB wants to speak to you," says the receptionist at my dental practice at 1730 hours. Considering the long saga of her root canal therapy(RCT), I was wondering what it could possibly be. And I was seeing her first thing tomorrow morning.
KB tells me that she thinks it maybe time to lance the abscess! "Wonderful!" I reply. Yes, the swelling in her gum had localised and it was fluctuant. It had been a hard diffuse swelling over the last few days. Now that the abscess was drainable, she might get some pain relief from it. I tell her to come in immediately!
This problem tooth was her upper right lateral incisor. She first came to me about 4 weeks ago - the tooth was very painful. RCT was started 13 months ago, but she did not return after that first appointment.
At my first appointment, it took a lot of local anaesthetic to numb the tooth, even that - it wasn't completely numb. KB returned a few days later, the pain had gotten worse. Over the last 4 weeks, the tooth has played up and settled down, and played up and settled down, her face swelled up and resolved (never completely) repeatedly. I don't believe she's actually had one good night's sleep in the last 4 weeks.
Apparently "laterals" have a funny tendency to be troublesome. It's been hit with systemic antibiotics, and the root canal (only 1 canal) has been thoroughly debrided. What more can I do?
To complicate matters, she found out that she was pregnant. Dental treatment should be minimised in the first trimester of pregnancy - if it can be helped (not in this case!) I was not going to take it further - KB and I and JP (another dentist) agreed that the tooth should go. It was the cause of pain and infection for KB, and wasn't good for the unborn baby either. BTW, it is to be her sixth child.
That's why she was booked in to see me tomorrow; to get that tooth extracted and an immediate upper denture placed to replace that FRONT TOOTH. Anyway, she came in today and yippeeee - the abscess was pointing (we had been waiting for this for some time now). I incised into it with a sterile scalpel and out poured pus and blood. It was going to be better tomorrow.
The questions is: should we still keep the tooth if things were improving. No, because it could flare-up again, and she is now 8 weeks pregnant. I hope we can get sufficient anaesthesia tomorrow - we haven't been able to in the past. Local anaesthesia does not work in an area of acute infection and swelling. There was no way we could have extracted the tooth in the past 2 weeks especially, it would taken a general anaesthetic to do it.
I really admire KB for dealing with this problem tooth so well. Of course, she's kicking herself for not returning 13 months ago before the infection got out of hand.