(9) Dental Pain II

7/30/2019 (9) Dental Pain II

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Diagnosis of Dental Pain

(2)Oral Diagnosis Dent423

Dr.Reem Azzam

BDs, MSc. Oral Medicine, Jordan Board


2/42

Pain of Dental origin

Pulpal pain

Periodontal pain

Gingival pain

Bone pain

Pain associated with denture bases


3/42

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


4/42


5/42

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
http://images.search.yahoo.com/images/view;_ylt=A0PDoTATE6xOnGgA3SmJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=tooth+percussion+test&fr2=piv-web&tab=organic&ri=5&w=400&h=235&imgurl=www.scritube.com/files/limba/engleza/health/166_poze/image066.jpg&rurl=http://www.scritube.com/limba/engleza/health/ENDODONTICS-AND-ESTHETIC-DENTI1821422710.php&size=11.6+KB&name=Figure+19-19:+The+second+percussion+is+a+gentle+tap+with+a+mirror+...&p=tooth+percussion+test&oid=a0d932fdd6e4503a388e3b5ca2ae53c8&fr2=piv-web&fr=&tt=Figure+19-19:+The+second+percussion+is+a+gentle+tap+with+a+mirror+...&b=0&ni=32&no=5&tab=organic&ts=&sigr=12phcmpi8&sigb=131nf474v&sigi=12199s893&.crumb=ayKf2g/UVwG


6/42

Periodontal pain

1- Acute apical periodontitis of pulpal

origin Signs

Diagnostic tests

Percussion: tenderness Pulp vitality: non-vital

Radiography:

Management:
http://images.search.yahoo.com/images/view;_ylt=A0PDoYBhWNJO00kAH5SJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=gross+caries+class+ii&n=30&ei=utf-8&b=1&tab=organic&w=480&h=360&imgurl=i.ytimg.com/vi/gRx7TsDyATc/hqdefault.jpg&rurl=http://www.portaldemisterios.com/videos/yt-A5BMa_Dfsfc&size=10.3+KB&name=...+:+Using+a+Dual-Shade+Technique+to+Perform+a+Class+II+Restoration&p=gross+caries+class+ii&oid=9fb2de31bb14e7c4e92f5db10734ae14&fr2=&fr=&tt=...+:+Using+a+Dual-Shade+Technique+to+Perform+a+Class+II+Restoration&b=0&ni=28&no=2&tab=organic&ts=&sigr=11mrbpblh&sigb=132vg72dn&sigi=1184278p0&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX213sdOoQcA71GJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=ditching+amalgam&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=524&h=400&imgurl=www.meridiandentalcenters.com/wp-content/gallery/amalgam/bad_amalgams.jpg&rurl=http://www.meridiandentalcenters.com/amalgam-silver-fillings-replaced/&size=136+KB&name=Should+Amalgam+(Silver)+Fillings+be+Replaced?+-+Meridian+Dental+Simi+...&p=ditching+amalgam&oid=307a45eaf82f3ad1395a759048bc6a45&fr2=sg-gac&fr=&tt=Should+Amalgam+(Silver)+Fillings+be+Replaced?+-+Meridian+Dental+Simi+...&b=0&ni=28&no=0&tab=organic&ts=&sigr=126vj0pf5&sigb=13fjcu68k&sigi=129h3d90e&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTCsONFOKAYA.ySJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=discolored+non+vital+tooth&n=30&ei=utf-8&b=1&tab=organic&w=656&h=859&imgurl=www.prestige-dental-care.com.my/blog/wp-content/uploads/2011/02/Walking-bleach.jpg&rurl=http://www.prestige-dental-care.com.my/blog/aesthetic-dentistry/non-vital-bleaching.html&size=18.5+KB&name=Yellow-brown+discoloration+of+tooth+after+RCT+treatment+and+the+...&p=discolored+non+vital+tooth&oid=a3fa0f1e410dd29852ea9eff623e2613&fr2=&fr=&tt=Yellow-brown+discoloration+of+tooth+after+RCT+treatment+and+the+...&b=0&ni=28&no=3&tab=organic&ts=&sigr=12o1iu726&sigb=13791g4d9&sigi=12iivt2c0&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTA2ONFOhAUAziGJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=widening+of+periodontal+ligament&fr2=piv-web&b=1&tab=organic&w=475&h=457&imgurl=www.nycdentist.com/images/atlas/181730451740914a42799701.41659594.JPG&rurl=http://www.nycdentist.com/dental-photo-detail/2125/169/165/gum-disease-x-ray-periodontal-xray-xrays-of-gums-bone-loss-radiograph&size=33.3+KB&name=ray+xray+pdl,+periodontal+ligament+tooth+movement,+mobility,+gums+...&p=widening+of+periodontal+ligament&oid=d2e94ced888d8c3dcaad144cc88ee72c&fr2=piv-web&fr=&tt=ray+xray+pdl,+periodontal+ligament+tooth+movement,+mobility,+gums+...&b=1&ni=28&no=1&tab=organic&ts=&sigr=140rh734p&sigb=13bkvmnu0&sigi=1259nohoh&.crumb=ayKf2g/UVwG


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Acute periapical abscess
http://images.search.yahoo.com/images/view;_ylt=A0PDoYDaItJOMX4A5aaJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=intraoral+swelling&n=30&ei=utf-8&b=1&tab=organic&w=442&h=292&imgurl=www.ispub.com/ispub/ijds/volume_7_number_2_20/dentigerous-cysts-of-inflammatory-origin-a-case-report/cyst-fig1.jpg&rurl=http://www.ispub.com/journal/the_internet_journal_of_dental_science/volume_7_number_2_20/article_printable/dentigerous-cysts-of-inflammatory-origin-a-case-report.html&size=15+KB&name=Figure+1.+intraoral+view+of+the+swelling&p=intraoral+swelling&oid=20863bca57fb9c0b8cd4d0767db49686&fr2=&fr=&tt=Figure+1.+intraoral+view+of+the+swelling&b=0&ni=28&no=0&tab=organic&ts=&sigr=15620ksd2&sigb=12v9m54ju&sigi=13i486ntl&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX8dItJO_1UAOa.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=acute+periapical+abscess&n=30&ei=utf-8&b=1&tab=organic&w=500&h=375&imgurl=www.rootcanaldrs.com/questions_files/image002.jpg&rurl=http://www.rootcanaldrs.com/questions.htm&size=13.9+KB&name=30-year-old+female+presented+with+buccal+swelling.+There+was+no+...&p=acute+periapical+abscess&oid=3f9650417ee82526789d1aa50a4f134c&fr2=&fr=&tt=30-year-old+female+presented+with+buccal+swelling.+There+was+no+...&b=0&ni=28&no=24&tab=organic&ts=&sigr=119vik208&sigb=135gi0u9q&sigi=11h8310bf&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX8dItJO_1UAJK.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=acute+periapical+abscess&n=30&ei=utf-8&b=1&tab=organic&w=258&h=246&imgurl=www.identalhub.com/images/images/tooth6.JPG&rurl=http://www.identalhub.com/article_understanding-abscessed-tooth-204.aspx&size=10.6+KB&name=Acute+Alveolar+Abscess&p=acute+periapical+abscess&oid=2bdb761056f0b0eb256d7e6f4f3fc9d6&fr2=&fr=&tt=Acute+Alveolar+Abscess&b=0&ni=28&no=3&tab=organic&ts=&sigr=1287905fc&sigb=135gi0u9q&sigi=11ba4q7ue&.crumb=ayKf2g/UVwG


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9/42

Parulis (gum boil) Palatal abscess
http://images.search.yahoo.com/images/view;_ylt=A0PDoTGP989O4nsA0COJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=palatal+abscess&n=30&ei=utf-8&b=1&tab=organic&w=800&h=797&imgurl=www.ghorayeb.com/files/Dental_Abscess_Palate_1345_SQ_Dec_2005.jpg&rurl=http://www.ghorayeb.com/PalateAbscess.html&size=47.3+KB&name=This+palatal+abscess+started+as+a+dentoalveolar+abscess+of+the+...&p=palatal+abscess&oid=8216af6ac2e6ced6cf9290df1e78573c&fr2=&fr=&tt=This+palatal+abscess+started+as+a+dentoalveolar+abscess+of+the+...&b=0&ni=28&no=1&tab=organic&ts=&sigr=11abstmmt&sigb=12sbc5hh5&sigi=1216qb4t8&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX7y9s9OFhAAeveJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=tracking+of+dental+pus&fr2=piv-web&b=1&tab=organic&w=150&h=167&imgurl=www.bestboilstreatment.com/wp-content/uploads/2010/02/Gum-Boils-Treatment.jpg&rurl=http://www.bestboilstreatment.com/gum-boils-treatment.html&size=8.1+KB&name=Learn+How+to+Cure+Gum+Boils+and+Get+Your+Life+Back+on+Track&p=tracking+of+dental+pus&oid=edf12bf1490c9ff912eedaf0021dd43d&fr2=piv-web&fr=&tt=Learn+How+to+Cure+Gum+Boils+and+Get+Your+Life+Back+on+Track&b=0&ni=28&no=10&tab=organic&ts=&sigr=11qer19m5&sigb=13140nrot&sigi=12djihq62&.crumb=ayKf2g/UVwG


10/42
http://images.search.yahoo.com/images/view;_ylt=A0PDoTGP989O4nsA1SOJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=palatal+abscess&n=30&ei=utf-8&b=1&tab=organic&w=429&h=270&imgurl=www.accentu8dental.com.au/attachments/Image/Oral%20Diseases/Palatal%20exostosis.JPG&rurl=http://www.accentu8dental.com.au/page41.php&size=28.1+KB&name=Palatal+exostosis&p=palatal+abscess&oid=5e83c7c3f482a20fa933e7b99dc0e707&fr2=&fr=&tt=Palatal+exostosis&b=0&ni=28&no=6&tab=organic&ts=&sigr=11br2ob63&sigb=12sbc5hh5&sigi=12jh7pid9&.crumb=ayKf2g/UVwG


11/42
http://images.search.yahoo.com/images/view;_ylt=A0PDoYDaItJOMX4A7aaJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=intraoral+swelling&n=30&ei=utf-8&b=1&tab=organic&w=400&h=326&imgurl=www.mja.com.au/public/issues/179_10_171103/aqu10203_fm-2.jpg&rurl=http://www.mja.com.au/public/issues/179_10_171103/aqu10203_fm.html&size=24.3+KB&name=Right+submandibular+swelling+secondary+to+an+abscess+of+the+lower+...&p=intraoral+swelling&oid=9400dd10489f0619fc44f9705de467e3&fr2=&fr=&tt=Right+submandibular+swelling+secondary+to+an+abscess+of+the+lower+...&b=0&ni=28&no=8&tab=organic&ts=&sigr=122qa3stl&sigb=12v9m54ju&sigi=11skurrm5&.crumb=ayKf2g/UVwG


12/42

Periodontal pain

2- Traumatic periodontitis

Cause: inflammation (not infection) of PDL
http://images.search.yahoo.com/images/view;_ylt=A0PDoS7IANFOikMARZqJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=partial+denture&n=30&ei=utf-8&b=1&tab=organic&w=400&h=290&imgurl=www.addesigns.net/images/prosthodontic-services/partial-dentures/03.jpg&rurl=http://www.addesigns.net/partial-dentures.php&size=36.7+KB&name=Partial+Denture+in+Position&p=partial+denture&oid=5fd07e2740e56dd604e584c8a39a3be0&fr2=&fr=&tt=Partial+Denture+in+Position&b=0&ni=28&no=7&tab=organic&ts=&sigr=11dj6atrp&sigb=12s25ktco&sigi=127u6pbfd&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX1YANFOO3kA2TWJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=premature+occlusal+contact&n=30&ei=utf-8&b=1&tab=organic&w=700&h=463&imgurl=www.step.es/~jlarena/graficos/cpbig.jpg&rurl=http://www.step.es/~jlarena/fotos8ing.htm&size=49.4+KB&name=Premature+contact&p=premature+occlusal+contact&oid=bd35bc9b91d141831282aa42476c38f0&fr2=&fr=&tt=Premature+contact&b=0&ni=28&no=0&tab=organic&ts=&sigr=11980reip&sigb=137nsl1bf&sigi=117ju748v&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX0u9stOTRkAD2KJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=high+amalgam+filling&n=30&ei=utf-8&b=1&tab=organic&w=300&h=200&imgurl=douglarsondds.com/go/wp-content/uploads/2010/04/amalgam_300x200.jpg&rurl=http://douglarsondds.com/go/category/dental-amalgams-good-or-bad/&size=17.1+KB&name=do+my+silver+fillings+harm+me+what+is+dental+amalgam&p=high+amalgam+filling&oid=30cd6cebef1b420cef53072dce4f976a&fr2=&fr=&tt=do+my+silver+fillings+harm+me+what+is+dental+amalgam&b=0&ni=28&no=12&tab=organic&ts=&sigr=121jku5s8&sigb=1311v8mja&sigi=123okbig2&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS_x9ctO3n4AR2uJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=orthodontics+braces&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=480&h=249&imgurl=www.aso.org.au/Images/Orthodontics/braces_diagram.jpg&rurl=http://www.zimbio.com/Dentistry/articles/d9c1TMdPe--/braces+retainer+teeth+tooth&size=51.9+KB&name=Orthodontic+Appliances+Braces&p=orthodontics+braces&oid=9a9e5c484e162cd073e3017941c86859&fr2=sg-gac&fr=&tt=Orthodontic+Appliances+Braces&b=0&ni=28&no=25&tab=organic&ts=&sigr=12gm5h789&sigb=13if1f0rt&sigi=11lfjn6b5&.crumb=ayKf2g/UVwG


13/42

Periodontal pain


Cause: inflammation (not infection) of PDL

Symptoms: Pain

Severe Throbbing

Localized

Tenderness to biting

May feel high
http://images.search.yahoo.com/images/view;_ylt=A0PDoS7IANFOikMARZqJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=partial+denture&n=30&ei=utf-8&b=1&tab=organic&w=400&h=290&imgurl=www.addesigns.net/images/prosthodontic-services/partial-dentures/03.jpg&rurl=http://www.addesigns.net/partial-dentures.php&size=36.7+KB&name=Partial+Denture+in+Position&p=partial+denture&oid=5fd07e2740e56dd604e584c8a39a3be0&fr2=&fr=&tt=Partial+Denture+in+Position&b=0&ni=28&no=7&tab=organic&ts=&sigr=11dj6atrp&sigb=12s25ktco&sigi=127u6pbfd&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX1YANFOO3kA2TWJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=premature+occlusal+contact&n=30&ei=utf-8&b=1&tab=organic&w=700&h=463&imgurl=www.step.es/~jlarena/graficos/cpbig.jpg&rurl=http://www.step.es/~jlarena/fotos8ing.htm&size=49.4+KB&name=Premature+contact&p=premature+occlusal+contact&oid=bd35bc9b91d141831282aa42476c38f0&fr2=&fr=&tt=Premature+contact&b=0&ni=28&no=0&tab=organic&ts=&sigr=11980reip&sigb=137nsl1bf&sigi=117ju748v&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX0u9stOTRkAD2KJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=high+amalgam+filling&n=30&ei=utf-8&b=1&tab=organic&w=300&h=200&imgurl=douglarsondds.com/go/wp-content/uploads/2010/04/amalgam_300x200.jpg&rurl=http://douglarsondds.com/go/category/dental-amalgams-good-or-bad/&size=17.1+KB&name=do+my+silver+fillings+harm+me+what+is+dental+amalgam&p=high+amalgam+filling&oid=30cd6cebef1b420cef53072dce4f976a&fr2=&fr=&tt=do+my+silver+fillings+harm+me+what+is+dental+amalgam&b=0&ni=28&no=12&tab=organic&ts=&sigr=121jku5s8&sigb=1311v8mja&sigi=123okbig2&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS_x9ctO3n4AR2uJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=orthodontics+braces&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=480&h=249&imgurl=www.aso.org.au/Images/Orthodontics/braces_diagram.jpg&rurl=http://www.zimbio.com/Dentistry/articles/d9c1TMdPe--/braces+retainer+teeth+tooth&size=51.9+KB&name=Orthodontic+Appliances+Braces&p=orthodontics+braces&oid=9a9e5c484e162cd073e3017941c86859&fr2=sg-gac&fr=&tt=Orthodontic+Appliances+Braces&b=0&ni=28&no=25&tab=organic&ts=&sigr=12gm5h789&sigb=13if1f0rt&sigi=11lfjn6b5&.crumb=ayKf2g/UVwG


14/42

Periodontal pain


Signs

Diagnostic tests

Percussion: tenderness Pulp vitality: vital

Radiography:

Articulating paper: determine the premature

contact
http://images.search.yahoo.com/images/view;_ylt=A0PDoTAHANFOUhYA4yOJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=widening+of+periodontal+ligament&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=248&h=417&imgurl=oralradiology.files.wordpress.com/2011/06/widened-pdl-circle.jpg?w=248&h=417&rurl=http://oral-radiology.org/radiographic-interpretation/pulpalapical-findings/apical-findings-inflammatory/widened-periodontal-ligament-space/&size=52.5+KB&name=Widened+Periodontal+Ligament+Space+%C2%AB+Dr.+G&http://images.search.yahoo.com/images/view;_ylt=A0PDoTCh_9BO3BUA3CKJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=articulating+paper&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=160&h=121&imgurl=image.made-in-china.com/2f1j00qBwESpudSMoe/Articulating-Paper-I-5-.jpg&rurl=http://susan660225.en.made-in-china.com/product/PoNJQedvkDcO/China-Articulating-Paper-I-5-.html&size=3.7+KB&name=Articulating+Paper+(I-5)+-+China+Articulating+Paper,Dental+Paper+...&p=articulating+paper&oid=5a4ac705e5e0316d5f1624d81598c02b&fr2=sg-gac&fr=&tt=Articulating+Paper+(I-5)+-+China+Articulating+Paper,Dental+Paper+...&b=0&ni=28&no=16&tab=organic&ts=&sigr=12vjm0sq4&sigb=13h8bm9pl&sigi=12622lrse&.crumb=ayKf2g/UVwG


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16/42

Periodontal pain

3- Chronic apical periodontitis ( apical

granuloma or cyst)

Cause: Extension of infection from necrotic

pulp. Symptoms

No pain
http://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwALxuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=201&h=313&imgurl=patoral.umayor.cl/lperip/gprx2.jpg&rurl=http://patoral.umayor.cl/lperip/lperip.html&size=5.7+KB&name=periapical+con+dos+lesiones+radiol%C3%BAcidas+compatibles+con+granuloma+...&p=periapical+granuloma&oid=e7d4f14eb1b369728898c950b44b3c7b&fr2=sg-gac&fr=&tt=periapical+con+dos+lesiones+radiol%C3%BAcidas+compatibles+con+granuloma+...&b=0&ni=28&no=8&tab=organic&ts=&sigr=11ba3mmu4&sigb=13jabmdlk&sigi=112bd8te1&.crumb=ayKf2g/UVwG


17/42


18/42

Periodontal pain

3- Chronic apical periodontitis (apical

granuloma or cyst)

Diagnostic tests

Percussion: no or little tenderness Pulp vitality: non-vital

Radiography
http://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwALBuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=240&h=210&imgurl=i.quizlet.net/i/6d52xxoxd5KtkOwV3z6xCA_m.jpg&rurl=http://quizlet.com/3349744/dr-miller-exam-2-flash-cards/&size=12.3+KB&name=Periapical+granuloma&p=periapical+granuloma&oid=d153815c45b8d36a150b6ec9b9f424ec&fr2=sg-gac&fr=&tt=Periapical+granuloma&b=0&ni=28&no=5&tab=organic&ts=&sigr=11oqqb3ba&sigb=13jabmdlk&sigi=11cp139ej&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwAKxuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=351&h=500&imgurl=farm4.static.flickr.com/3366/3584752667_272746e00e_z.jpg&rurl=http://www.flickr.com/photos/21711359@N08/3584752667/&size=132.4+KB&name=Periapical+area+-+granuloma+|+Flickr+-+Photo+Sharing!&p=periapical+granuloma&oid=ba7683c690585b8d33cfb1e6fad770aa&fr2=sg-gac&fr=&tt=Periapical+area+-+granuloma+|+Flickr+-+Photo+Sharing!&b=0&ni=28&no=4&tab=organic&ts=&sigr=11lovcaav&sigb=13jabmdlk&sigi=11ohrlhcr&.crumb=ayKf2g/UVwG


19/42

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
http://images.search.yahoo.com/images/view;_ylt=A0PDoYCeZtNO1VcALs6JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=apicectomy&n=30&ei=utf-8&b=29&tab=organic&w=248&h=207&imgurl=www.rcsed.ac.uk/journal/vol47_5/4750008.jpg&rurl=http://www.rcsed.ac.uk/journal/vol47_5/47500002.html&size=19.6+KB&name=The+changing+role+of+the+apicectomy+operation+in+dentistry&p=apicectomy&oid=9fad4273e41c676a365fc6d45d227332&fr2=&fr=&tt=The+changing+role+of+the+apicectomy+operation+in+dentistry&b=29&ni=28&no=31&tab=organic&ts=&sigr=11k891mki&sigb=12osl3ach&sigi=11bguu131&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwALBuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=240&h=210&imgurl=i.quizlet.net/i/6d52xxoxd5KtkOwV3z6xCA_m.jpg&rurl=http://quizlet.com/3349744/dr-miller-exam-2-flash-cards/&size=12.3+KB&name=Periapical+granuloma&p=periapical+granuloma&oid=d153815c45b8d36a150b6ec9b9f424ec&fr2=sg-gac&fr=&tt=Periapical+granuloma&b=0&ni=28&no=5&tab=organic&ts=&sigr=11oqqb3ba&sigb=13jabmdlk&sigi=11cp139ej&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwAKxuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=351&h=500&imgurl=farm4.static.flickr.com/3366/3584752667_272746e00e_z.jpg&rurl=http://www.flickr.com/photos/21711359@N08/3584752667/&size=132.4+KB&name=Periapical+area+-+granuloma+|+Flickr+-+Photo+Sharing!&p=periapical+granuloma&oid=ba7683c690585b8d33cfb1e6fad770aa&fr2=sg-gac&fr=&tt=Periapical+area+-+granuloma+|+Flickr+-+Photo+Sharing!&b=0&ni=28&no=4&tab=organic&ts=&sigr=11lovcaav&sigb=13jabmdlk&sigi=11ohrlhcr&.crumb=ayKf2g/UVwG


20/42

Failed RC filling with periapical granuloma
http://images.search.yahoo.com/images/view;_ylt=A0PDoTA3.M9O4A8ArsCJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&norw=1&n=30&ei=UTF-8&fr2=sp-qrw-corr-top&b=1&tab=organic&w=219&h=164&imgurl=www.zoodent.com/images/photos/clinical/odontocetes/dolphin06.jpg&rurl=http://www.zoodent.com/clinical/odontocetes/dolphins.html&size=15.2+KB&name=Extracted+teeth+demonstrating+apical+granulomas.&p=periapical+granuloma&oid=92fa04c223151d72a9ef7c3fa676dec7&fr2=sp-qrw-corr-top&fr=&tt=Extracted+teeth+demonstrating+apical+granulomas.&b=0&ni=28&no=16&tab=organic&ts=&norw=1&sigr=11pjhftl6&sigb=13sk2gc1c&sigi=120hp4vf3&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS5j9stOkjwAPhuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=180&h=258&imgurl=www.bicon.com/cases/wp-content/gallery/NI/thumbs/thumbs_NI03.jpg&rurl=http://www.bicon.com/cases/case-study/maxillary-second-bicuspid-restored-with-an-extra-orally-cemented-crown/&size=6.6+KB&name=Failed+root+canal+treated+tooth+with+periapical+granuloma.&p=periapical+granuloma&oid=e0e60e213a99d1d3b0e33ce1898aa63e&fr2=sg-gac&fr=&tt=Failed+root+canal+treated+tooth+with+periapical+granuloma.&b=0&ni=28&no=23&tab=organic&ts=&sigr=13djq3c8f&sigb=13jabmdlk&sigi=120ngrkb8&.crumb=ayKf2g/UVwG


21/42

Pariapical cyst excised
http://images.search.yahoo.com/images/view;_ylt=A0PDoX_o9stOcjsAFM6JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=periapical+granuloma&n=30&ei=utf-8&fr2=sg-gac&b=29&tab=organic&w=397&h=261&imgurl=www.waybuilder.net/sweethaven/MedTech/Dental/OMPath/fig0103.jpg&rurl=http://www.waybuilder.net/sweethaven/MedTech/Dental/OMPath/default.asp?iNum=0105&size=17+KB&name=Figure+1-3.+Periapical+cyst,+excised.&p=periapical+granuloma&oid=905cb0a63e2381e0c08e4bc9db9696b6&fr2=sg-gac&fr=&tt=Figure+1-3.+Periapical+cyst,+excised.&b=29&ni=28&no=50&tab=organic&ts=&sigr=12gphh0dk&sigb=13diivsvn&sigi=11vsp2u26&.crumb=ayKf2g/UVwG


22/42

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


23/42

Periodontal pain


(lateral periodontitis) Signs

Deep pocket

Percussion (lateral): tenderness Mobile tooth

Calculus

Pus

Diagnostic tests

Pulp vitality: vital

Radiography: generalized bone loss


24/42

Periodontal pain


(lateral periodontitis) Management:

Pus drain

Periodontal treatment and hygiene instructions

Hot salt water mouth rinse


25/42

Acute periodontal abscess
http://images.search.yahoo.com/images/view;_ylt=A0PDoS5n98tO0UAAPjGJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=parodontal+abscess&n=30&ei=utf-8&b=1&tab=organic&w=216&h=163&imgurl=www.dent.ucla.edu/pic/members/antibiotics/abscess/acute.jpg&rurl=http://www.dent.ucla.edu/pic/members/antibiotics/abscess/abscess.html&size=12.9+KB&name=...+Acute+Periodontal+Abscess+Figure+2.+Chronic+Periodontal+Abscess&p=parodontal+abscess&oid=c4f6b0003dee12099c369fb7c624f40b&fr2=&fr=&rw=periodontal+abscess&tt=...+Acute+Periodontal+Abscess+Figure+2.+Chronic+Periodontal+Abscess&b=0&ni=28&no=1&tab=organic&ts=&sigr=1257ooqfv&sigb=12vrcq29m&sigi=11rhs8aha&.crumb=ayKf2g/UVwG


26/42

Periodontal pain

5- Perio-endo lesions

Origin: perio

Deep pocket

Recession to lateral or furcation canal
http://images.search.yahoo.com/images/view;_ylt=A0PDoX.u98tOfzoAu_CJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=perio+endo+lesion&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=300&h=241&imgurl=www.dentalindia.com/vip1.jpg&rurl=http://www.dentalindia.com/vipin.html&size=5+KB&name=Endo+Perio-+Courtesy+ROOTS&p=perio+endo+lesion&oid=fdbe14e884e57f8303bc7881e818f10d&fr2=sg-gac&fr=&tt=Endo+Perio-+Courtesy+ROOTS&b=0&ni=28&no=9&tab=organic&ts=&sigr=1154p4cjb&sigb=13gaon7sc&sigi=10sknkoa2&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTAn.8tOByAAaXWJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=perio+endo+lesion&n=30&ei=utf-8&fr2=sg-gac&b=29&tab=organic&w=271&h=400&imgurl=www.odontologia-online.com/casos/part/ADO/ADO01/lesion.jpg&rurl=http://odontologia-estomatologia.blogspot.com/2010/01/periodoncia-enfermedad-periodontal-y.html&size=17.3+KB&name=Imagen+3:+Lesi%C3%B3n+Endoperiodontal&p=perio+endo+lesion&oid=c8ca58b8e5e8e6897e09c27b645f2fec&fr2=sg-gac&fr=&tt=Imagen+3:+Lesi%C3%B3n+Endoperiodontal&b=29&ni=28&no=38&tab=organic&ts=&sigr=12v0l1396&sigb=13aa8afqs&sigi=11qo8nkpo&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX5vA9BOFRIAwGeJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=molar+with+lateral+canals&n=30&ei=utf-8&b=1&tab=organic&w=252&h=160&imgurl=www.saintgiles-dental.co.uk/wp-content/themes/stgilesdental/images/right-col/rct-before.jpg&rurl=http://www.saintgiles-dental.co.uk/treatments/root-canal-treatment/&size=35.6+KB&name=molar+with+four+root+canals+before+treatment&p=molar+with+lateral+canals&oid=6c6f15ccc678dc09484953e6670afcf4&fr2=&fr=&tt=molar+with+four+root+canals+before+treatment&b=0&ni=28&no=18&tab=organic&ts=&sigr=1238c5g3o&sigb=136a1jd9c&sigi=12rgt2dag&.crumb=ayKf2g/UVwG


27/42

Periodontal pain


Origin: endo

Apical lesion PDL gingival crevice

Pulpal lesion lateral or furcation canal
http://images.search.yahoo.com/images/view;_ylt=A0PDoX5vA9BOFRIAwGeJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=molar+with+lateral+canals&n=30&ei=utf-8&b=1&tab=organic&w=252&h=160&imgurl=www.saintgiles-dental.co.uk/wp-content/themes/stgilesdental/images/right-col/rct-before.jpg&rurl=http://www.saintgiles-dental.co.uk/treatments/root-canal-treatment/&size=35.6+KB&name=molar+with+four+root+canals+before+treatment&p=molar+with+lateral+canals&oid=6c6f15ccc678dc09484953e6670afcf4&fr2=&fr=&tt=molar+with+four+root+canals+before+treatment&b=0&ni=28&no=18&tab=organic&ts=&sigr=1238c5g3o&sigb=136a1jd9c&sigi=12rgt2dag&.crumb=ayKf2g/UVwG


28/42

Periodontal pain


Origin: endo

Apical lesion PDL gingival crevice

Pulpal lesion lateral or furcation canal Root perforation during RCT

Root fracture
http://images.search.yahoo.com/images/view;_ylt=A0PDoTGYk9BOXzAAaJ2JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=vertical+root+fracture&n=30&ei=utf-8&b=1&tab=organic&w=320&h=256&imgurl=bp3.blogger.com/_2ZYSBrPeYzY/Rok6laCf0qI/AAAAAAAAACs/oe1icDQsE8A/s320/jshaped.JPG&rurl=http://www.theendoblog.com/2007/06/vertical-root-fracture.html&size=11.8+KB&name=The+Endo+Blog:+Vertical+Root+Fracture&p=vertical+root+fracture&oid=944d35111704f727b7ee2b134848c110&fr2=&fr=&tt=The+Endo+Blog:+Vertical+Root+Fracture&b=0&ni=28&no=22&tab=organic&ts=&sigr=11u4fo1q6&sigb=133d6q717&sigi=12hahimma&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoYAxk9BO_BMAUA.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=root+fracture&n=30&ei=utf-8&b=1&tab=organic&w=133&h=181&imgurl=www.sanedentist.com/wp-content/uploads/2010/03/Vertical-root-fracture.jpg&rurl=http://www.sanedentist.com/help-me-my-tooth-is-cracked.html&size=3.4+KB&name=Vertical+root+fracture&p=root+fracture&oid=150018d0faeac4a2eaef14c52bf35899&fr2=&fr=&tt=Vertical+root+fracture&b=0&ni=28&no=3&tab=organic&ts=&sigr=11rsh40iv&sigb=12qj37lr1&sigi=1297k58gh&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoYAxk9BO_BMAUg.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=root+fracture&n=30&ei=utf-8&b=1&tab=organic&w=160&h=259&imgurl=www.endomail.com/images/buirootfractures03.gif&rurl=http://www.endomail.com/articles/yb06rootfractures.html&size=41+KB&name=Root+Fractures&p=root+fracture&oid=89db2d1fff24adb526c3350af519c21b&fr2=&fr=&tt=Root+Fractures&b=0&ni=28&no=5&tab=organic&ts=&sigr=11n8f8sbj&sigb=12qj37lr1&sigi=11e2bp3l0&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoYAxk9BO_BMATg.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=root+fracture&n=30&ei=utf-8&b=1&tab=organic&w=264&h=364&imgurl=www.tgsendo.com/site/Portals/0/rootfracture1.gif&rurl=http://www.tgsendo.com/site/Endodontics/Procedures/TraumaticDentalInjuries/RootFractures/tabid/110/Default.aspx&size=8.5+KB&name=Root+Fractures&p=root+fracture&oid=7b0e360c0d49d59be663be165477ce40&fr2=&fr=&tt=Root+Fractures&b=0&ni=28&no=1&tab=organic&ts=&sigr=13fsji8ls&sigb=12qj37lr1&sigi=11guotksq&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX.dktBO8AgA2ASJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=root+perforation&fr2=piv-web&b=1&tab=organic&w=170&h=256&imgurl=www.oralhealthgroup.com/issues/image.aspx?src=/daily_images/65570-41523.jpg&size=170&rurl=http://www.oralhealthgroup.com/news/a-radiographic-study-regarding-the-negative-effects-of-posts/1000194329/?type=Print+Archives&size=9.4+KB&name=FIGURE+2A+&+B--Root+perforations.&p=root+perforation&oid=ba75bf94519807e70d273aedc20294ed&fr2=piv-web&fr=&tt=FIGURE+2A+&+B--Root+perforations.&b=0&ni=28&no=13&tab=organic&ts=&sigr=140jlnenb&sigb=12rm6taug&sigi=12oqjo0tf&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX.dktBO8AgAywSJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=root+perforation&fr2=piv-web&b=1&tab=organic&w=382&h=524&imgurl=www.uic.edu/depts/endo/Yaara2.jpg&rurl=http://www.uic.edu/depts/endo/Berdan1.html&size=46.9+KB&name=...+Preoperative+radiograph+of+tooth+http://images.search.yahoo.com/images/view;_ylt=A0PDoX5vA9BOFRIAwGeJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=molar+with+lateral+canals&n=30&ei=utf-8&b=1&tab=organic&w=252&h=160&imgurl=www.saintgiles-dental.co.uk/wp-content/themes/stgilesdental/images/right-col/rct-before.jpg&rurl=http://www.saintgiles-dental.co.uk/treatments/root-canal-treatment/&size=35.6+KB&name=molar+with+four+root+canals+before+treatment&p=molar+with+lateral+canals&oid=6c6f15ccc678dc09484953e6670afcf4&fr2=&fr=&tt=molar+with+four+root+canals+before+treatment&b=0&ni=28&no=18&tab=organic&ts=&sigr=1238c5g3o&sigb=136a1jd9c&sigi=12rgt2dag&.crumb=ayKf2g/UVwG


29/42

Gingival Pain

Traumatic gingivitis

ANUG

Acute pericoronitis Teething

Desquamative gingivitis


30/42

Gingival pain

1- Traumatic gingivitis
http://images.search.yahoo.com/images/view;_ylt=A0PDoX5TltBOqCEA0RiJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=salt+and+water&n=30&ei=utf-8&b=1&tab=organic&w=500&h=376&imgurl=0.tqn.com/d/exoticpets/1/0/f/i/calibrate3500.JPG&rurl=http://exoticpets.about.com/od/herpresources/ss/hygrometer_3.htm&size=24.1+KB&name=How+to+Calibrate+a+Hygrometer+-+Mix+Salt+and+Water&p=salt+and+water&oid=012a459ad26848d453df3662b77052f0&fr2=&fr=&tt=How+to+Calibrate+a+Hygrometer+-+Mix+Salt+and+Water&b=0&ni=28&no=23&tab=organic&ts=&sigr=120h1691q&sigb=12r0e3ibe&sigi=11ge40rnr&.crumb=ayKf2g/UVwG


31/42
http://images.search.yahoo.com/images/view;_ylt=A0PDoTG6ltBO_TIAcN.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=ANUG&n=30&ei=utf-8&b=1&tab=organic&w=540&h=359&imgurl=s3.amazonaws.com/readers/2010/08/07/necrotizingulcerativegingivitis1_1.jpg&rurl=http://healthmad.com/conditions-and-diseases/acute-necrotizing-ulcerative-gingivitisanug/&size=16.3+KB&name=Acute+Necrotizing+Ulcerative+Gingivitis(anug)+|+Healthmad&p=ANUG&oid=c9b50b9a2cd8c4af375da0d78efb9062&fr2=&fr=&tt=Acute+Necrotizing+Ulcerative+Gingivitis(anug)+|+Healthmad&b=0&ni=28&no=12&tab=organic&ts=&sigr=12p65rs84&sigb=12hll9tp4&sigi=12asin9nv&.crumb=ayKf2g/UVwG


32/42

Gingival pain

2- ANUG

Cause: fuso-spirochaetes

Predisposing factors:

Signs

Diagnostic tests: Deep gingival smear
http://images.search.yahoo.com/images/view;_ylt=A0PDoS9j89BOPloAb5eJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=alcohol&n=30&ei=utf-8&b=1&tab=organic&w=701&h=468&imgurl=akisqnuk.org/clc/images/Alcohol.jpg&rurl=http://akisqnuk.org/clc/Addictions2.html&size=55.6+KB&name=Alcohol&p=alcohol&oid=c68f0b427e0b0e31f49d753ae3e49fc0&fr2=&fr=&tt=Alcohol&b=0&ni=28&no=0&tab=organic&ts=&sigr=118jiesji&sigb=12kgr2qnu&sigi=113egje55&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX2K8tBOFwsAouSJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=immune+deficiency&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=140&h=140&imgurl=mens-en-gezondheid.infonu.nl/artikel-foto/ziekten/2072-aids-acquired-immune-deficiency-syndrome.jpg&rurl=http://mens-en-gezondheid.infonu.nl/ziekten/52262-aids-acquired-immune-deficiency-syndrome.html&size=3+KB&name=...+en+Gezondheid+>+Ziekten+:+AIDS:+Acquired+Immune+Deficiency+Syndrome&p=immune+deficiency&oid=9af083cfe7129bd5ba4b6a47146d23c1&fr2=sg-gac&fr=&tt=...+en+Gezondheid+>+Ziekten+:+AIDS:+Acquired+Immune+Deficiency+Syndrome&b=1&ni=28&no=15&tab=organic&ts=&sigr=12vo58urh&sigb=139ihm6vh&sigi=133g8apoh&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX1y8dBOYgYA_OWJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=calculus+teeth&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=540&h=267&imgurl=images.stanzapub.com/readers/2009/06/24/800pxmandibularanteriorcalculus_1.jpg&rurl=http://healthmad.com/conditions-and-diseases/somewhat-unusual-weirdest-stone-formation-in-human-body/4/&size=15+KB&name=dental+calculus&p=calculus+teeth&oid=949959030853885fc8d7a5c42de00030&fr2=sg-gac&fr=&tt=dental+calculus&b=0&ni=28&no=22&tab=organic&ts=&sigr=137haelb4&sigb=13dpm2da0&sigi=12dcbff6s&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX4O39BO0yYANn2JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=stress&n=30&ei=utf-8&b=1&tab=organic&w=600&h=400&imgurl=eliminatingstress.org/wp-content/uploads/2010/03/work-stress.jpg&rurl=http://eliminatingstress.org/&size=37.5+KB&name=Anxiety+And+Stress+%E2%80%93+Eliminate+Environment+Factor+With+Diet&p=stress&oid=9f0f91badc7667bac841ec2e06c4dc91&fr2=&fr=&tt=Anxiety+And+Stress+%E2%80%93+Eliminate+Environment+Factor+With+Diet&b=0&ni=28&no=23&tab=organic&ts=&sigr=10t0vgu3l&sigb=12jn5dil5&sigi=1206973j8&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX.g3tBO5XEAycyJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=smoking&fr2=piv-web&b=1&tab=organic&w=800&h=600&imgurl=www.humanforsale.com/images/smoking.jpg&rurl=http://www.humanforsale.com/smoking.asp&size=70.9+KB&name=Mmmm...+smoking.&p=smoking&oid=fe9342e9ff6e750476d1479c9b15018a&fr2=piv-web&fr=&tt=Mmmm...+smoking.&b=0&ni=28&no=2&tab=organic&ts=&sigr=1174njcrt&sigb=12ip97a0r&sigi=117pvaf1v&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTG6ltBO_TIAcN.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=ANUG&n=30&ei=utf-8&b=1&tab=organic&w=540&h=359&imgurl=s3.amazonaws.com/readers/2010/08/07/necrotizingulcerativegingivitis1_1.jpg&rurl=http://healthmad.com/conditions-and-diseases/acute-necrotizing-ulcerative-gingivitisanug/&size=16.3+KB&name=Acute+Necrotizing+Ulcerative+Gingivitis(anug)+|+Healthmad&p=ANUG&oid=c9b50b9a2cd8c4af375da0d78efb9062&fr2=&fr=&tt=Acute+Necrotizing+Ulcerative+Gingivitis(anug)+|+Healthmad&b=0&ni=28&no=12&tab=organic&ts=&sigr=12p65rs84&sigb=12hll9tp4&sigi=12asin9nv&.crumb=ayKf2g/UVwG


33/42

Gingival pain

2- ANUG

Management:

1X3X5
http://images.search.yahoo.com/images/view;_ylt=A0PDoTHi.NBOfCoAwb6JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=trench+mouth+disease&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=680&h=322&imgurl=byebyedoctor.com/wp-content/uploads/2011/01/trench-mouth-3.jpg&rurl=http://byebyedoctor.com/trench-mouth/&size=44.9+KB&name=Trench+Mouth+%E2%80%93+Symptoms,+Treatment,+Pictures,+Causes&p=trench+mouth+disease&oid=598da495224660b6d927ba936aa7b240&fr2=sg-gac&fr=&tt=Trench+Mouth+%E2%80%93+Symptoms,+Treatment,+Pictures,+Causes&b=0&ni=28&no=2&tab=organic&ts=&sigr=115s90hae&sigb=13jdskkla&sigi=11u3tc9hu&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTCa99BOp38ABn.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=gingival+scaling&n=30&ei=utf-8&b=1&tab=organic&w=213&h=142&imgurl=www.dentalimplantsla.com/images/procedures/root-scaling2/1.jpg&rurl=http://www.dentalimplantsla.com/root-scaling-planning.asp&size=5.3+KB&name=instruments+can+be+used+to+remove+the+sub+gingival+calculus&p=gingival+scaling&oid=7a6718830c34dccac90dde786686a10b&fr2=&fr=&tt=instruments+can+be+used+to+remove+the+sub+gingival+calculus&b=0&ni=28&no=27&tab=organic&ts=&sigr=11pigi6hc&sigb=12t7b48q4&sigi=11uv329ma&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoYA39tBOcjAAdYeJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=hydrogen+peroxide+mouthwash&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=200&h=200&imgurl=livingwithchemicals.homestead.com/hydrogen_peroxide_bottle.jpg&rurl=http://livingwithchemicals.homestead.com/HydrogenPeroxideAndItsManyUses.html&size=3.9+KB&name=As+an+Mouthwash+-+Use+Peroxide+as+a+less+expensive+mouthwash+...&p=hydrogen+peroxide+mouthwash&oid=bf99ba45e612f01401d0a57dacc8b574&fr2=sg-gac&fr=&tt=As+an+Mouthwash+-+Use+Peroxide+as+a+less+expensive+mouthwash+...&b=0&ni=28&no=7&tab=organic&ts=&sigr=12cil7u86&sigb=13q91en6k&sigi=11ubbpcn5&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX8C9tBOcAsASo.JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=flagyl+200&n=30&ei=utf-8&b=1&tab=organic&w=300&h=275&imgurl=www.allrealmeds.com/images/Flagyl%20200%20mg.jpg&rurl=http://www.allrealmeds.com/flagyl-brand-dasmetrol-metrogyl-p-980.html&size=65.2+KB&name=Purchase+Flagyl+200+(brand)+aka+Dasmetrol,+Metrogyl+-+200+mg+All+Real+...&p=flagyl+200&oid=9bd103880d416780db861fcd67177653&fr2=&fr=&tt=Purchase+Flagyl+200+(brand)+aka+Dasmetrol,+Metrogyl+-+200+mg+All+Real+...&b=0&ni=28&no=0&tab=organic&ts=&sigr=125evg5jg&sigb=12nh7qnil&sigi=11gcp9lqq&.crumb=ayKf2g/UVwG


34/42

Gingival pain

3- Acute pericoronitis

Cause: bacterial infection of tissue aroundpartially erupted tooth

Symptoms: Pain

Throbbing

Localized

Difficulty opening the mouth

Bad odor and altered taste

Lymphadenitis
http://images.search.yahoo.com/images/view;_ylt=A0PDoS.V_c9OxiAAAmuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=pericoronitis&n=30&ei=utf-8&b=1&tab=organic&w=323&h=256&imgurl=www.dentiadental.com/dtimg/artgibungsu4a.jpg&rurl=http://www.dentiadental.com/articles/gigi-geraham-bungsu-perlukah-dicabut/&size=17.7+KB&name=gbr+3+pericoronitis&p=pericoronitis&oid=392d9ccdf5589b0fd942767acccc3af5&fr2=&fr=&tt=gbr+3+pericoronitis&b=0&ni=28&no=4&tab=organic&ts=&sigr=12a54bod6&sigb=12qpenhvo&sigi=11cvb40ph&.crumb=ayKf2g/UVwG


35/42

Gingival pain

http://images.search.yahoo.com/images/view;_ylt=A0PDoTGF_dBOJSsALDSJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=radiography+erupting+molar&n=30&ei=utf-8&b=1&tab=organic&w=160&h=106&imgurl=drkamaldmello.com/yahoo_site_admin/assets/images/xray.244122608.jpg&rurl=http://www.drkamaldmello.com/extraction__oral_surgery&size=2.6+KB&name=Dental+Speciality+Clinic+-+Oral+Surgery+/+Extractions&p=radiography+erupting+molar&oid=3a74ed05a2d0bec36a21cca5a483556c&fr2=&fr=&tt=Dental+Speciality+Clinic+-+Oral+Surgery+/+Extractions&b=0&ni=28&no=5&tab=organic&ts=&sigr=11l51hf5h&sigb=137cksouo&sigi=123ohq8hl&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS73.dBOSkAA1bmJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=pericoronitis&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=271&h=315&imgurl=drhosseinally.com/conditions/Pericoronitis3.jpg&rurl=http://drhosseinally.com/conditions/pericoronitis.htm&size=11.8+KB&name=Pericoronitis+/+Erupting+3rd+Molar+(+Ledent+Sagesse+)&p=pericoronitis&oid=d64c4a1ecd2751d916de44c64a4d9cf1&fr2=sg-gac&fr=&tt=Pericoronitis+/+Erupting+3rd+Molar+(+Ledent+Sagesse+)&b=0&ni=28&no=9&tab=organic&ts=&sigr=11l0l8n9c&sigb=13cubbqcl&sigi=11fjq1som&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS.V_c9OxiAAAmuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=pericoronitis&n=30&ei=utf-8&b=1&tab=organic&w=323&h=256&imgurl=www.dentiadental.com/dtimg/artgibungsu4a.jpg&rurl=http://www.dentiadental.com/articles/gigi-geraham-bungsu-perlukah-dicabut/&size=17.7+KB&name=gbr+3+pericoronitis&p=pericoronitis&oid=392d9ccdf5589b0fd942767acccc3af5&fr2=&fr=&tt=gbr+3+pericoronitis&b=0&ni=28&no=4&tab=organic&ts=&sigr=12a54bod6&sigb=12qpenhvo&sigi=11cvb40ph&.crumb=ayKf2g/UVwG


36/42

Gingival pain


Management
http://images.search.yahoo.com/images/view;_ylt=A0PDoX_jAdFOlQwAbxaJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=operculectomy&n=30&ei=utf-8&b=1&tab=organic&w=250&h=134&imgurl=2.bp.blogspot.com/_jYKdlW0DN14/TDdc4JVch7I/AAAAAAAAAhE/j4TW4-94Y1E/s320/operculectomy-01.jpg&rurl=http://prestigetreatmentoption.blogspot.com/2010/06/impacted-wisdom-teeth.html&size=7.3+KB&name=Extraction+-+Removing+the+wisdom+tooth+(surgery+or+without+surgery)&p=operculectomy&oid=28f829d2695b6aab7ffc21275c7793e6&fr2=&fr=&tt=Extraction+-+Removing+the+wisdom+tooth+(surgery+or+without+surgery)&b=0&ni=28&no=2&tab=organic&ts=&sigr=12ea9b7dd&sigb=12qjk4o92&sigi=12spq7h5h&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX38_tBOMQQAPoyJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=dental+irrigation+syringe&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=282&h=284&imgurl=www.adamdental.com.au/images/monojet-irri-syringes.jpg&rurl=http://www.adamdental.com.au/index.php?main_page=product_info&products_id=108&size=16.1+KB&name=Irrigation+Syringes+[(MONIS)]+-+$63.25+:+Adam+Dental&p=dental+irrigation+syringe&oid=eef909e0d58762539666ab1a68526ebd&fr2=sg-gac&fr=&tt=Irrigation+Syringes+[(MONIS)]+-+$63.25+:+Adam+Dental&b=0&ni=28&no=3&tab=organic&ts=&sigr=12h6342sq&sigb=13oif3ljl&sigi=11mentsp4&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoX5TltBOqCEA0RiJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=salt+and+water&n=30&ei=utf-8&b=1&tab=organic&w=500&h=376&imgurl=0.tqn.com/d/exoticpets/1/0/f/i/calibrate3500.JPG&rurl=http://exoticpets.about.com/od/herpresources/ss/hygrometer_3.htm&size=24.1+KB&name=How+to+Calibrate+a+Hygrometer+-+Mix+Salt+and+Water&p=salt+and+water&oid=012a459ad26848d453df3662b77052f0&fr2=&fr=&tt=How+to+Calibrate+a+Hygrometer+-+Mix+Salt+and+Water&b=0&ni=28&no=23&tab=organic&ts=&sigr=120h1691q&sigb=12r0e3ibe&sigi=11ge40rnr&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoTGF_dBOJSsALDSJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=radiography+erupting+molar&n=30&ei=utf-8&b=1&tab=organic&w=160&h=106&imgurl=drkamaldmello.com/yahoo_site_admin/assets/images/xray.244122608.jpg&rurl=http://www.drkamaldmello.com/extraction__oral_surgery&size=2.6+KB&name=Dental+Speciality+Clinic+-+Oral+Surgery+/+Extractions&p=radiography+erupting+molar&oid=3a74ed05a2d0bec36a21cca5a483556c&fr2=&fr=&tt=Dental+Speciality+Clinic+-+Oral+Surgery+/+Extractions&b=0&ni=28&no=5&tab=organic&ts=&sigr=11l51hf5h&sigb=137cksouo&sigi=123ohq8hl&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS73.dBOSkAA1bmJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=pericoronitis&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=271&h=315&imgurl=drhosseinally.com/conditions/Pericoronitis3.jpg&rurl=http://drhosseinally.com/conditions/pericoronitis.htm&size=11.8+KB&name=Pericoronitis+/+Erupting+3rd+Molar+(+Ledent+Sagesse+)&p=pericoronitis&oid=d64c4a1ecd2751d916de44c64a4d9cf1&fr2=sg-gac&fr=&tt=Pericoronitis+/+Erupting+3rd+Molar+(+Ledent+Sagesse+)&b=0&ni=28&no=9&tab=organic&ts=&sigr=11l0l8n9c&sigb=13cubbqcl&sigi=11fjq1som&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoS.V_c9OxiAAAmuJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=pericoronitis&n=30&ei=utf-8&b=1&tab=organic&w=323&h=256&imgurl=www.dentiadental.com/dtimg/artgibungsu4a.jpg&rurl=http://www.dentiadental.com/articles/gigi-geraham-bungsu-perlukah-dicabut/&size=17.7+KB&name=gbr+3+pericoronitis&p=pericoronitis&oid=392d9ccdf5589b0fd942767acccc3af5&fr2=&fr=&tt=gbr+3+pericoronitis&b=0&ni=28&no=4&tab=organic&ts=&sigr=12a54bod6&sigb=12qpenhvo&sigi=11cvb40ph&.crumb=ayKf2g/UVwG


37/42

Teething

tumbuh gigi
http://images.search.yahoo.com/images/view;_ylt=A0PDoYBs.8tOJGQA9rWJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=teething&n=30&ei=utf-8&b=1&tab=organic&w=267&h=312&imgurl=www.newbornbabyzone.com/wp-content/uploads/2010/09/baby-teething.jpg&rurl=http://www.newbornbabyzone.com/health-safety/watch-out-for-the-5-most-common-teething-symptoms/&size=14.6+KB&name=Effects+of+teething+symptoms+may+vary+from+each+baby%E2%80%99s+adaptability+...&p=teething&oid=32408ceaa155d70004b0a072190d91ca&fr2=&fr=&tt=Effects+of+teething+symptoms+may+vary+from+each+baby%E2%80%99s+adaptability+...&b=0&ni=28&no=27&tab=organic&ts=&sigr=12v4brqn1&sigb=12lug734b&sigi=1243acheu&.crumb=ayKf2g/UVwGhttp://images.search.yahoo.com/images/view;_ylt=A0PDoYBs.8tOJGQA27WJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=teething&n=30&ei=utf-8&b=1&tab=organic&w=4368&h=2912&imgurl=upload.wikimedia.org/wikipedia/commons/b/b4/Teething_2.jpg&rurl=http://en.wikipedia.org/wiki/File:Teething_2.jpg&size=3.2+KB&name=File:Teething+2.jpg+-+Wikipedia,+the+free+encyclopedia&p=teething&oid=62bd39300a8bd345d2203a7e9cd4788c&fr2=&fr=&tt=File:Teething+2.jpg+-+Wikipedia,+the+free+encyclopedia&b=0&ni=28&no=0&tab=organic&ts=&sigr=11g6bekqe&sigb=12lug734b&sigi=11q81d3m9&.crumb=ayKf2g/UVwG


38/42

Gingival pain

4- Desquamative gingivitis

A clinical term

Differential diagnosis

Erosive LP

MMP

PV

DLE

Linear IgA

Dermatitis herpetiformis

(but 1st exclude contact allergy)
http://images.search.yahoo.com/images/view;_ylt=A0PDoS68.8tO9z0AOweJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yahoo.com/search/images?p=desquamative+gingivitis&sado=1&n=30&ei=utf-8&fr2=sg-gac&b=1&tab=organic&w=440&h=290&imgurl=www.bmj.com/content/321/7252/36/F9.medium.gif&rurl=http://www.bmj.com/content/321/7252/36.full&size=76.3+KB&name=Periodontal+disease+--+Coventry+et+al.+321+(7252):+36+--+bmj.com&p=desquamative+gingivitis&oid=856dfed9c7258a5ea2ab2f35e355e37a&fr2=sg-gac&fr=&tt=Periodontal+disease+--+Coventry+et+al.+321+(7252):+36+--+bmj.com&b=0&ni=28&no=6&tab=organic&ts=&sigr=11bv2gu10&sigb=13me8nvkq&sigi=11d9fa67c&.crumb=ayKf2g/UVwG


39/42

Bone Pain

Dry socket

Osteomyelitis

Infected cyst

Trauma, fracture


40/42

Bone pain

1- Dry socket

History of recent extraction

Symptoms

Pain

Severe

Continuous

Dull throbbing Tenderness to touch

Bad odour
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(9) Dental Pain II

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