Do general dental practitioners leave teeth on ‘open drainage’?

The dental pulp is essentially enclosed in a solid tube (Figure 1). When the pulp becomes infected it sparks the body's inflammatory processes with numerous consequences. First, there is an increase in blood flow to the pulp; this excites sensory nerve fibres and eventually results in the formation of micro-abscesses and leads to pulp necrosis. Once pulpal necrosis has occurred, it is speculated that invading bacteria produce gases that increase the pressure inside the pulpal space or ‘tube’. This pressure causes the intense pain described by many of our patients as unbearable. Understanding this process makes it easier to see why heat (which increases pressure) can exacerbate the pain and cold (which can lower pressure) can ease the toothache.