Pain from an acute apical abscess is due to pressure under the tooth - the tooth is locked in the bone and there is no room for swelling. The pus in and around the root causes pain. The source of the infection is coming from the root canal but the actual cause of pain is the swelling under the tooth.
To alleviate this pressure under the tooth you NEED to drain the pus and therefore pressure. Incision of the swelling is extremely effective - if you can drain pus using this then you do not need to open the canal and drain necessarily BUT IF you can this is obviously better because then you simultaneously treat the bacteria in the canals and create an additional path for drainage of the pus.
Antibiotic pills NEITHER drain the swelling NOR clean the root canals. They are helpful if the infection is spreading and should be considered for immune suppressed or for systemically unwell patients BUT ALWAYS AS AN ADJUNCT txt with incision and drainage or access of the canals NEVER AS A SOLE TREATMENT because they simply do not accomplish what we need to do to relieve pain quickly for our patients !!!
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