Dental pain

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Dental pain

  1. 1.  Dental pain:-unpleasant sensation felt by the pt. in relation to odontological cause.  Assessment of pt. suffering from orofacial pain:-electing as much information as possible I. The nature of the pain II. When the pain first start III. Duration of pain. IV. The site affected. V. Initiating factors.
  2. 2. I. Precipitating factors. II. Exacerbating factors. III. Reliving factors.. IV. Associated signs &symptoms. Previous investigation  Previous treatment.  Relevant history
  3. 3. Dentine sensitivity Pulpitis Abscess  • caries • trauma • Reversible(hyperemia) • Irreversible-acute. • -chronic. • Periapical • Periodontal Pericronities. -Cracked tooth syndrome. -Dry socket.
  4. 4. Dentine sensitivity: S&S: The pain is best described as a sensation of sudden shock and is sharp in nature. It is never spontaneous in onset. Precipitating by a noxious stimulus, either hot or cold, sweet or sour, or touch.  Localized &last for short time.  Diagnosed by inspection or by x-ray…..etc.  Management:-removal of caries & isolation of dentine.
  5. 5. Pericoronitis: an inflammation of the operculum around the crown of partially erupted a tooth (usually the third molar).
  6. 6.  S&S:- radiating pain in back of the mouth and the inability to comfortably open or close the jaw. Not only is it painful to close against the inflamed operculum behind the erupting mandibular molar.  sever pain & inflammation .  Trismus  Halitosis Management:I. Preservative: irrigation ,anti-inflammatory &analgesic . II. Surgical:  Operculectomy.  Tooth extraction.
  7. 7. Dry socket:-failure of formation or maintenance of blood clot in extraction socket leaving bare bone.  S&S: sever pain.  Halitosis..  Bare bone. Management: Irrigation under L.A. II. Alveogel or an abundant material is placed in the socket III. M.W&analgesic. I.
  8. 8. Pulpitis:-I-Reversible pulpitis  Causes: 1. trauma 2. thermal shock 3. chemical 4. caries  symptoms  sharp pain with stimuli (esp cold)  subside within seconds after its removal
  9. 9.  diagnosis  1-pain for short duration  2-visual checking for caries or fracture  3- percussion -ve  4-vitaltity test +ve  Treatment:  Conservative treatment
  10. 10. II-Irreversible pulpitis: Cause: 1. trauma 2. Thermal shock 3. Chemical irritation  Symptoms: 1. Pain with food impaction &cold & sweet food and may be spontaneous intermitted or continuous.
  11. 11.  The pain persist after removal of the stimuli and increase when the patient lies down or bend over and relived with cold  The pain may referred to adjacent teeth or to ear or tmj area  Diagnosis: 1. Visual deep cavity or secondary caries. 2. probing will cause pain. 3. Percussion +ve. 4. Vitality test hyperplasia respond of the pulp (esp. cold) which persist after its removal. 5. In late stage cold relief the pain.  Treatment :  Rct or extraction
  12. 12. Abscess:Point of comparison Periapical abscess Periodontal abscess Periodontal pocket no Yes Vitality test - ve Sensitivity to percussion Yes radiographicaly sweling +ve May or may not Angular bone Changes in apical area loss and furcation rl Localized to Gingival tissue apex
  13. 13. Trigeminal neuralgia  Sharp, stabbing episodes, last for sac to 2min.  Initiating when trigger zone is touched.  >50 year &more in female.  Absence of associated signs &symptoms. Management:I. Medical: carbamazepine II. Surgical: • MVD. - Gama knife stereotactic surgery. • Neurectomy. • L.A. injection :provide temporary relief &also confirming the diagnosis.
  14. 14. Preherpatic neuralgia  Continuous Aching or burning pain mimic chronic pulpitis.  Limited to the distribution of the divisionof the trigeminal nerve in which the lesion of H.Z. developed.  May be localized by the pt. to a particular tooth or teeth.
  15. 15.  Special investigation: Vitality test & x-ray to exclude dental pathology..  Also history of H.Z. • Medical management:- • Treatment of H.Z.by appropriate antiviral.
  16. 16. Atypical odontalgia  The pt. localized the pain to a tooth or group of teeth are clinically and radiographically normal.  The pt. may have already undergone dental treatment in an attempt to alleviate their symptoms, including the extraction of one or more tooth, with only temporary relief of symptoms.  The dentist must resist extracting healthy tooth in such pt.

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