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The purpose of this retrospective study was to determine the effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth. One hundred twenty-four emergency patients participated and each had a clinical diagnosis of a symptomatic necrotic tooth with an associated periapical radiolucency. The occurrence of drainage upon access was timed and recorded. After endodontic treatment, patients received ibuprofen, acetaminophen with codeine (30 mg), and a 6-day diary to record pain, percussion pain, swelling, and number and type of pain medication taken. The majority of patients with symptomatic necrotic teeth had significant postoperative pain and required analgesic medication to manage this pain. Obtaining short-term drainage upon access (average of 1.85 min) did not significantly (p > 0.05) reduce pain, percussion pain, swelling, or the number of analgesic medications taken for symptomatic necrotic teeth with periapical radiolucencies.