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[Clinical skills] Root Canal Always Oozing? These 3 Methods are Worth Trying

01 Common symptoms and causes of root canal medullary bleeding


1) When the young permanent teeth and pulpitis are severely congested, the bleeding will not stop as soon as the pulp is opened, making it difficult to seal the inactivating agent.

2) Extraction of the pulp under local anesthesia, incomplete extraction of the pulp, bleeding from the root pulp section.

3) There is residual marrow in some root canals, cotton twists have been seen in the root canal sealant, and the paper tip has bleeding.

the reason

1) Exclusion: systemic organic diseases, blood-type diseases (although there are few, but the brain must pay attention to this string), the consequences are very serious. I’ve heard of unlucky doctors who had had hemophilia after excision of the spinal cord; leukemia when washing their teeth!

2) Exclusion: The bottom and side penetrations of the medullary root canal (this is not in the scope of this article!) Acute pulpitis, pulp congestion is severe, do not be afraid, generally there is a lot of blood even within 5-10 minutes after the pulp is opened. Is pus outflow. I think it’s a good time to reduce inflammation. After 5–10 minutes, bleeding will decrease or stop.

02 Treatment methods commonly used by primary dentists

Open decompression

On the same day, the local anesthesia was opened, the pressure was decompressed, and a loose CP cotton ball was placed. The patient was asked to return to the clinic for 1 to 2 days. Seal the inactivating agent at the follow-up visit.

Reason: I think that there is too much bleeding in the medullary cavity, and it is necessary to decompress. Direct sealing will make the patient more painful!


1) Although open decompression is good, the vital pulp can be exposed to the mouth after the open pulp. Patients dare not touch the affected teeth. When they return, they often complain of increased pain and increased patient suffering.

2) Exposure to the oral environment can easily re-contaminate the root canal, increasing the trouble of subsequent treatment.

3) Increase the number and time of patient visits.

Direct pulp extraction

Reason: Demyelination directly, in one step


1) There are many doctors who are fine with pulling a single large pulp. When it comes to two small tubes, the pulp of the three tubes is large, and it is always unclean.

2) The number of root canals must be acknowledged. The curvature varies greatly, and sometimes it is difficult to pull out, including me!

3) Grassroots doctors are still accustomed to using inactivating agents, which are related to various factors such as economics, environment, fees, and personal proficiency. It is impossible for everyone to go to a tertiary hospital for further studies and eat fat at a stretch.

03 Improved method


Many people see the bleeding, and immediately use the injection of epinephrine cotton balls to oppress. But the effect is not good. After being pressed for a few minutes, the pulp wound was no longer bleeding. But when you do the next step, you start bleeding again. (The principle of hemostasis of adrenaline: It is mainly through the use of drugs to shrink small blood vessels to produce temporary hemostatic effects. Once the amount of drug and the effect time elapses, the small blood vessels re-dilate to the original condition, and stop bleeding!)

Is there a better way?

After the pulp is opened, the pulp cavity is opened for a few minutes, and the “blood accumulation” in the pulp cavity is released. When there is still bleeding after a few minutes, use the most common FC (formaldehyde cresol). A small cotton ball covered with FC is gently pressed on the pith hole for 2–5 minutes, the bleeding will be reduced or no longer, the effect is significant! After the FC cotton ball is pressed to stop bleeding for 2-5 minutes, the next operation can be performed. Such as sealing inactivators. No bleeding interference!

Reason analysis

FC is often used for disinfection of gangrene or severely infected root canals, and it can also be used to treat the root section of the pulp during the treatment of dry pulp. The dental pulp is sterilized and fixed, and a drug “cautery” is formed on the dental pulp wound (this cauterization is painless for the patient), forming a wound covering, which is effective for no longer bleeding.

Root canal oozing, the treatment idea is to remove the root canal. Under local anesthesia, the marrow of bleeding can be removed without hesitation.

Precautions after inactivation

1) Explain the time of follow-up, the importance of follow-up! Do not tell patients that the drug is toxic, just say that the drug has a prescribed time! If you want to say, you can only say “it’s a drug that is three points poison.”

2) You can eat only 2 hours after sealing the medicine, it is best not to eat on the affected side that day!

3) No discomfort after sealing. Some people feel that it is normal to feel sullen and uncomfortable after taking anesthetic. If you feel uncomfortable, you can prepare a fen in advance! eat! (Many people with gastrointestinal discomfort cannot take fen, and can prescribe proprietary Chinese medicines, Yuanhu painkillers.) Be careful not to prescribe painkillers to others, very allergic! It is said that there are only 30-40 uncomfortable people in 100 people. 100-200 people will have one or two people who have severe pain after sealing the medicine. With that said, the patient will understand you. Avoid patients coming to your door.

Supplement 1

Improved pulp extraction needle: When it is inconvenient to use the pulp extraction operation for posterior teeth, directly cut the handle of the most common pulp extraction needle with a vise or snap ring pliers about 2 cm. If not, just use your fingers. Hold the extraction needle deep into the posterior tooth and extract the pulp! In addition, how to minimize the patient’s response after sealing the inactivation agent?

Supplement 2

Sealing medicine is best to use slow-drying pure zinc oxide. It has no commercial fast-drying zinc oxide but has rosin and other ingredients. It has a slow setting time and long operating time. It can be used in the morning after mixing. Economy, only about 20 yuan for 500 grams. It is sealed well and can be used for a long time. After the medicine is sealed, it is soft and generally has no bite height. Patients are more comfortable! (The book says that some people have compared 7 kinds of temporary sealing materials, and the sealing performance of zinc oxide is the best! You can check the new chapter “Endodontics” sealing related chapters)

Supplement 3

Make proper jaw adjustments for the affected teeth and avoid occlusal heights! Very important! Many people often forget! A drop of CP or clove oil on a small cotton ball of inactivating agent will do! Put a dry cotton ball on top for cushioning.

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