Diagnosis of Dental Pain III

8/13/2019 Diagnosis of Dental Pain III

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Diagnosis of Dental Pain IIIAceil Al-Khatib DDS, MS, Diplomat

ABOM

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


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Acute Periodontitis Of Gingival Origin

(Lateral Periodontal Abscess)

Predisposing factors:

Diabetes mellitus

Immunosuppression

Gingival disease

Dental neglect


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Well localized continuous, dull and throbbing

pain

The affected tooth may be loose

Abad taste or smell with discharge

Intraoral swelling ( rarely extraoral swelling)

Tooth may feel high with pain on biting

Acute Periodontitis Of Gingival Origin;

Symptoms

Tooth is mobile with deep pocketing

Poor oral hygiene

A sinus or pus may be present

Pus on probing

Tooth may be in supra-occlusion

Acute Periodontitis Of Gingival Origin;Signs


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Tenderness to lateralpercussion

Dull note, due to fluid in the

periodontal ligament spacePercussion

Percussion

notePositiveVitality testsGeneralized horizontaland/or

vertical bone loss

Radiography

Acute Periodontitis Of Gingival Origin;

Signs


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Periodontal-endodontic Lesion

More common in molars ( lateral and

furcation canals)

May be primarily periodontal in origin

May be primarily endodontic in origin


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*Deep pocket to apex

*Recession or scaling

instrumentation involving

lateral/furcation canals

Periodontal in

origin

*Apical lesion tracking through theligament

*Root perforation during treatment

*Vertical or horizontal root fracture

*Periodontal and apical lesions may

coexist ( unusual )

Endodontic inorigin

Periodontal-endodontic Lesion;Etiology


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A vertical root fracture.

Tenderness to percussion

Dull percussion notePercussionPercussionnote

Positiveif of periodontal origin.

Negativeif of pulpal originVitality tests

Guttal percha point in pocket reaches

abscess

Radiography

Periodontal-endodontic Lesion;Diagnostic Tests


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Primary endodontic lesion

Primary periodontal lesion


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(a)Diffuse radiolucency around distal root in a

40-year-old man. (b) Just 6-weeks after the

treatment, remarkable healing of the lesion is

seen . (c) One-year follow-up x-ray showingcomplete healing

http://www.jcd.org.in/article

Gingival Pain Traumatic gingivitis

Acute necrotizing ulcerative gingivitis

Acute pericoronitis

Desquamative gingivitis


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Traumatic Gingivitis A localized gingival inflammation caused by:

Physical Trauma: tooth brush, fish bone

Chemical: aspirin burn

Electrical trauma: rare


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Acute Necrotizing Ulcerative

Gingivitis An infective disease, characterized by rapidly

progressive ulceration of the interdental

papillae

Aaerobic Gram negative organisms are

involved

More common in young males

It is uncommon in healthy children

Smoking >95% cases may be dose related

Heavy drinking

Psychological stress

Immune suppression

Upper respiratory tract infection

Poor oral hygiene and dental neglect

Acute Necrotizing UlcerativeGingivitis; Prediposing Factors


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Moderate to severe gingival tenderness with

eating and brushing

Pain is dull, boring

Halitosis

Unpleasant metallic taste

Spontaneous gingival bleeding

Acute Necrotizing Ulcerative

Gingivitis; Symptoms

Smear

Blood tests for severe cases to exclude

leukemia and other causes of immune

suppression, and nutritional deficiencies

Acute Necrotizing UlcerativeGingivitis; Investigations


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Necrotizing Ulcerative Stomatitis

Necrotizing Ulcerative Stomatitis


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Acute Pericoronitis A bacterial infection of pericoronal tissue

around a partially erupted tooth

Mandibular third molars are most commonly

involved

Trauma from a maxillary molar biting on the

operculum is a major contributing factor


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Dull throbbing localized pain

Swelling

Difficulty in opening the mouth and pain on

swallowing (intraoral examination is difficult

due to trismus)

Patient feels unwell

Neck and jaw pain may be present

Fever and lymphadenopathy

Acute Pericoronitis; Symptoms


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Bone Pain Dry socket

Osteomyelitis

Infected dental cyst

Trauma, fracture

Pain Associated With Dental Bases Ill fitting bases

Overextended bases

Occlusal errors

Pressures on bony projections

Pressure on nerves ( mental nerve)

Pressure on teeth or roots erupting under the

denture base


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Pain of Non- dental Origin Pain of neurogenic origin

Pain of vascular origin

Pain associated with lesions of the maxillary

sinus

Pain associated with salivary glands

Pain associated with mucosal lesions

Referred pain

Pain of Non- dental Origin;Neurogenic

Trigeminal, glossopharyngeal and post-herpetic neuralgia

Multiple sclerosis

Intracranial tumors

Causalgia Bells palsy

Ramsay-Hunt syndrome

HIV disease


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Pain of Non- dental Origin; Vascular

Pain

Migraine

Periodic migrainous neuralgia, Paroxysmal

facial hemicrania

Giant cell arteritis

Referred pain ( e.g. cardiac ischaemia)

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Diagnosis of Dental Pain III