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)