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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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