Endodontics · single question
During debridement of the root canal, the patient reports sudden severe pain in the area. Profuse bleeding from the canal and swelling of the gingiva are noted. Which of the following most likely explains the symptoms?
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Correct answer: B. Root perforation
Sudden severe pain with profuse bleeding from the canal AND gingival swelling during root canal instrumentation is classic for root perforation. The file has perforated through the root wall into the periodontal ligament or bone, causing communication with blood vessels, sudden pain, and swelling. Irrigant extravasation would cause pain without bleeding from the canal.
- A. INCORRECT. Irrigant extravasation (e.g., NaOCl accident) causes sudden severe pain and swelling but the canal does not typically bleed profusely from this cause.
- B. CORRECT. Root perforation occurs when the file or bur inadvertently perforates the root wall, communicating with the PDL or bone. This causes immediate severe pain, profuse bleeding (from the PDL), and gingival swelling.
- C. INCORRECT. Root fracture is usually asymptomatic during instrumentation or causes different symptoms; profuse bleeding from the canal is not characteristic.
- D. INCORRECT. A broken file within the canal may cause clinical concerns and does not cause profuse bleeding or gingival swelling.