Visual Examination (Zoom 100% – Clinical Findings)

Tooth involved:

• Lower posterior molar (likely first or second molar)

Observed conditions:

• Extensive crown destruction due to advanced dental caries

• Open pulp chamber clearly visible

• Dark brown to black necrotic dentin

• Two exposed root canal orifices

• Food debris and bacterial biofilm present

• Surrounding gingiva appears inflamed

• Strong likelihood of active bacterial infection

Odor source:

• Caused by anaerobic bacteria breaking down necrotic pulp tissue

• Produces sulfur compounds → foul smell

 Primary Diagnosis

 Advanced Dental Caries With Pulp Necrosis

Complicated by:

• Symptomatic irreversible pulpitis → progressing to pulp necrosis

• Possible acute apical periodontitis

• High risk of periapical abscess formation

 Why the Tooth Is Painful and Smelly

 Time Frame to Heal (If Treated Properly)

 With Immediate Treatment

• Pain relief: 24–72 hours

• Infection control: 5–7 days

• Root canal completion: 7–14 days

• Final crown placement: 2–4 weeks

 If Delayed or Ignored

• Infection may spread within 7–14 days

• Bone loss around tooth root

• Facial swelling or jaw infection

• Tooth may become non-restorable

 Recommended Treatment Process

Step 1: Emergency Assessment

• Digital X-ray (periapical)

• Vitality testing

• Infection extent evaluation

Step 2: Infection Control

• Start antibiotics only if swelling/systemic symptoms present

• Pain management

Step 3: Definitive Treatment (Choose One)

 Option A: Root Canal Treatment (Preferred if tooth is restorable)

• Complete canal debridement

• Disinfection

• Root filling

• Post & crown restoration

 Option B: Tooth Extraction

• Required if:

  • Roots are fractured

  • Severe bone loss

  • Infection is uncontrollable

• Followed by:

  • Dental implant

  • Bridge

  • Partial denture

 What Will Scale Up If Untreated

• Dental abscess

• Jawbone infection (osteomyelitis)

• Facial cellulitis

• Sinus involvement (upper teeth)

• Bad breath becomes chronic

• Tooth loss

• Risk of systemic infection (rare but serious)

 Clinical Comments

This tooth is beyond simple filling repair. The pulp is already compromised. Home remedies, mouthwash, or antibiotics alone will not cure this condition. Definitive dental intervention is required immediately.

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