Doctor, yesterday I started root canal treatment on tooth 23 in a patient with an abscess beginning in the canine fossa. I irrigated thoroughly, enlarged the canal and tried to establish drainage. There was no drainage. I dried the canal, placed calcium hydroxide and closed it. I did not prescribe antibiotics because I thought I had eliminated the cause. However, the patient returned today with increased swelling, and the eyelids were also affected by peripheral edema. Whenever I try to avoid prescribing antibiotics unnecessarily, I end up regretting not prescribing them.

Why might this have happened?

Question

Doctor, yesterday I started root canal treatment on tooth 23 in a patient with an abscess beginning in the canine fossa. I irrigated thoroughly, enlarged the canal and tried to establish drainage. There was no drainage. I dried the canal, placed calcium hydroxide and closed it. I did not prescribe antibiotics because I thought I had eliminated the cause. However, the patient returned today with increased swelling, and the eyelids were also affected by peripheral edema. Whenever I try to avoid prescribing antibiotics unnecessarily, I end up regretting not prescribing them.

Why might this have happened?

Doç. Dr. İsmail Davut Çapar · Accepted Answer

If there is insufficient drainage through the canal, combination antibiotic therapy is necessary for canine fossa abscesses. Even if the cause has been eliminated, when there is no drainage, the initial intervention can increase the inflammation further, and canine fossa abscesses can develop into a dangerous situation.