diagnosis of dental pain ii
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Diagnosis of Dental Pain IIAceil Al-Khatib DDS, MS, Diplomat
ABOM
Chronic Pulpitis; Symptoms Intermittent, mild pain over a long period
(months or years)
Pain is poorly localized
Pain may be limited to occasional
hypersensitivity to heat
Is rarely the patients chief complaint
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Large restoration
Carious lesion
Fractured or discoloured tooth
The tooth may be tender to percussion (in
later stages)
Chronic Pulpitis; Signs
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Vitality Gradual reaction leading to anexaggerated reaction to heat,reduced response to cold and EPT
Percussion There may be minor and dullness TTP
Radiograph
ic
May reveal sclerosis of the pulp
chamber and root canal , some lossof PA lamina dura and there may besclerosis of PA bone
Chronic Pulpitis; Diagnostic Tests
Chronic Hyperplastic Pulpitis
A lump in the mouthSymptomsA pulp polyp within a carious tooth
Destruction of coronal tooth tissueSignsRadiographs: Large apical foraminaDiagnostic tests
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Galvanism; Cause & Symptoms Caused by production of an electrical current
(dissimilar metals + saliva)
Intermittent pain
Pain occurs only after placement of a new
metal restoration
Pain is well localized and does not refer
Usually pain diminishes over a few days
AerodontalgiaReduced atmospheric pressure ,possible
sinusitis and recent restorationCauseSharp acute pulpitis like pain only during
flying at high altitudeSymptoms
Recent restoration, aerosinusitis ifmaxillary teeth are involvedSignsNo apical pathologyDiagnostic
tests
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Periodontal Pain
Acute apical periodontitis of pulpal origin
Traumatic periodontitis
Chronic apical periodotitis (apical granuloma)
Acute periodontitis of gingival origin
(lateral periodontal abscess)
Periodontal-endodontic lesion
Acute Apical Periodontitis Of PulpalOrigin
Trauma
Large restoration or carious cavity
Pins involving the pulp
Defective endodontics
Causes
Unilateral, localized severe, continuous
dull/throbbing pain of rapid onset ( may awakenat night)
Soft and puffy soft tissue swelling
Patient does not look well
Iimited mouth opening ( if posterior teeth are
involved)
Facial swelling and eye closure (if anterior upper
teeth are involved
Symptoms
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Acute Apical Periodontitis Of Pulpal
Origin; Signs
Large restoration, caries..
Discharge of pus
Inflamed surrounding gingival tissue
Tender and enlarged regional lymph nodes
Fever and malaise
Soft tissue swelling at the apex, there may be asinus
Extruded and mobile tooth
Palpation of swelling may reveal : Soft (localedema) or firm and erythematous (cellulitis)
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Acute Apical Periodontitis Of Pulpal
Origin; Diagnostic Tests
TT apical percussion, with dull tonePercussionNegative; sometimes unreliable: pus may
conduct the stimulus
In multi rooted teeth
May respond to heat as a result of
expansion of gases in the pulp
Cold may relieve pain
Vitality
Widening of periodontal ligament withloss of lamina dura
Periapical radiolucency
* Signs may be delayedRadiography
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Traumatic Periodontitis This condition is reversible
Caused by trauma :
Recent high restoration:
Excessive loading during ortho tx
Excessive loading after the fitting of a
partial denture
Well localized pain on biting or on
pressure
Tooth feel high and may feel looseSymptoms
Normal response to heat, cold and
EPTVitality
Minor TTP and dull percussion
notePercussion
Occlusal contacts can be identifiedArticulating paper
Traumatic Periodontitis; DiagnosticTests
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Chronic Apical Periodotitis (Apical
Granuloma)Trauma
Large restoration or carious cavity
Pins involving the pulp
Defective endodontics
Causes
Pain is unusual
Patient may report occasional
dischargeA sinus may be present
Symptoms
Chronic Apical Periodotitis (ApicalGranuloma); Diagnostic Tests
Mild TTP and mild dull percussion
notePercussion
Negative, heat may cause a responseVitality testsApical well defined radiolucency,
defective root canal filling
Radiography
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Tracking of PusPus points into the buccal sulcusPost max teethInto the palate. Rarely to the floor of the sinus
or the nosePalatal root ofupper 6Into the labial sulcus, rarely into the noseUpper centralsInto the anterior palateUpper lateralsInto the buccal sulcusMost lower
teeth
Pus may track lingually, or into the neckLower 7&8Into the buccal sulcus or chinLower anterior
teethPus may point onto the faceLower 6 &
upper 3 &
upper 6
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Can be traced totheir root of origin
by inserting a GP
point into the
opening to its
origin and taking
an X-ray
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Approximately 80% of cutaneous sinus of dental
origin are associated with mandibular teeth and 20%
with maxillary teeth.
Extraoral cutaneous sinus tract of mandibular left canine
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