Treatment should center on the principles of minimizing swelling, controlling pain and preventing secondary infection. Reassuring the patient is of prime importance. Use of cold packs externally is recommended for the first one to two days to minimize edema. Once drainage is established, the cold packs should be replaced by warm compresses in an attempt to promote liquefaction of the hematoma and dissolution of the soft-tissue swelling. Pain control often requires narcotic analgesics. Appropriate antibiotic therapy is highly recommended for two reasons: the possibility of infection’s being forced from the root canals into the periapical tissues with the NaOCl irrigation, and the subcutaneous presence of significant amounts of necrotic tissue and dead space, which can promote secondary infection.
