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Endodontics · single question

What is the appropriate management of a draining sinus tract (parulis) originating from a necrotic/chronically infected tooth?

  1. Surgically incise and drain the sinus tract itself
  2. Treat the source: perform root canal treatment (or retreatment/apical surgery) on the offending tooth — the tract will resolve once the infection source is removed
  3. Long-term antibiotics alone, without addressing the tooth
  4. Extraction is always required, regardless of restorability
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Correct answer: B. Treat the source: perform root canal treatment (or retreatment/apical surgery) on the offending tooth — the tract will resolve once the infection source is removed

A sinus tract is the body's own drainage pathway for a chronic infection — incising it does nothing for the underlying cause. Definitive treatment (root canal therapy/retreatment, or extraction only if the tooth is non-restorable) eliminates the source, after which the tract closes on its own, generally without the need for antibiotics in an otherwise healthy patient.

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