Diagnosis of Dental Pain (2)

Oral Diagnosis Dent423

Dr.Reem Azzam BDs, MSc. Oral Medicine, Jordan Board

Pain of Dental origin

Pulpal pain

Periodontal pain Gingival pain Bone pain Pain associated with denture bases

Periodontal Pain
Acute apical periodontitis of pulpal origin Traumatic periodontitis Chronic apical periodontitis (apical granuloma) Acute periodontitis of gingival origin (lateral periodontitis) Perio-endo lesions

Periodontal pain 1- Acute apical periodontitis of pulpal origin

Cause: Extension of infection from necrotic pulp. Symptoms:
Pain
Severe Throbbing Localized May interfere with sleep

Tenderness to biting May feel high

Periodontal pain 1- Acute apical periodontitis of pulpal origin

Signs Diagnostic tests
Percussion: tenderness Pulp vitality: non-vital Radiography:

Management:

Acute periapical abscess

Parulis (gum boil)

Palatal abscess

Periodontal pain 2- Traumatic periodontitis

Cause: inflammation (not infection) of PDL

Periodontal pain 2- Traumatic periodontitis

Cause: inflammation (not infection) of PDL

Symptoms:
Pain
Severe Throbbing Localized

Tenderness to biting May feel high

Periodontal pain 2- Traumatic periodontitis

Signs Diagnostic tests
Percussion: tenderness Pulp vitality: vital Radiography: Articulating paper: determine the premature contact

Periodontal pain 2- Traumatic periodontitis

Signs Diagnostic tests
Percussion: tenderness Pulp vitality: vital Radiography: Articulating paper: determine the premature contact

Management
Occlusal adjustment

Periodontal pain 3- Chronic apical periodontitis ( apical granuloma or cyst)

Cause: Extension of infection from necrotic pulp. Symptoms
No pain

Periodontal pain 3- Chronic apical periodontitis (apical granuloma or cyst)

Diagnostic tests
Percussion: no or little tenderness Pulp vitality: non-vital Radiography

Periodontal pain 3- Chronic apical periodontitis (apical granuloma or cyst)

Diagnostic tests
Percussion: no or little tenderness Pulp vitality: non-vital Radiography

Management:
RCT (+apicoectomy) Extraction

Failed RC filling with periapical granuloma

Pariapical cyst excised

Periodontal pain 4- Acute periodontitis of gingival origin (lateral periodontitis)

Pt might be diabetic or immune suppressed. Symptoms
Pain
Throbbing Continuous Localized

Altered taste and halitosis

Intraoral swelling
Tenderness on biting

Periodontal pain 4- Acute periodontitis of gingival origin (lateral periodontitis)

Signs
Deep pocket Percussion (lateral): tenderness Mobile tooth Calculus Pus

Diagnostic tests
Pulp vitality: vital Radiography: generalized bone loss

Periodontal pain 4- Acute periodontitis of gingival origin (lateral periodontitis)

Management:
Pus drain Periodontal treatment and hygiene instructions Hot salt water mouth rinse

Acute periodontal abscess

Periodontal pain 5- Perio-endo lesions

Origin: perio
Deep pocket Recession to lateral or furcation canal

Periodontal pain 5- Perio-endo lesions

Origin: endo
Apical lesion PDL gingival crevice Pulpal lesion lateral or furcation canal

Periodontal pain 5- Perio-endo lesions

Origin: endo
Apical lesion PDL gingival crevice Pulpal lesion lateral or furcation canal Root perforation during RCT Root fracture

Gingival Pain
Traumatic gingivitis ANUG Acute pericoronitis Teething Desquamative gingivitis

Gingival pain 1- Traumatic gingivitis

Gingival pain 2- ANUG

Cause: fuso-spirochaetes Predisposing factors:

Signs Diagnostic tests: Deep gingival smear

Gingival pain 2- ANUG

Management:

1X3X5

Gingival pain 3- Acute pericoronitis

Cause: bacterial infection of tissue around partially erupted tooth Symptoms:
Pain
Throbbing Localized

Difficulty opening the mouth Bad odor and altered taste Lymphadenitis

Gingival pain 3- Acute pericoronitis

Gingival pain 3- Acute pericoronitis

Management

Teething
tumbuh gigi

Gingival pain 4- Desquamative gingivitis

A clinical term Differential diagnosis
Erosive LP MMP PV DLE Linear IgA

Dermatitis herpetiformis

(but 1st exclude contact allergy)

Bone Pain
Dry socket Osteomyelitis Infected cyst Trauma, fracture

Bone pain 1- Dry socket

History of recent extraction Symptoms
Pain
Severe Continuous Dull throbbing

Tenderness to touch Bad odour