Pains that are common in dental clinic

1. " Pain in The Dental Office"

2. An unpleasant sensory and emotional experience associated with:nPai
actual or potential tissue damage or described in terms of such damage .
The trigeminalis pain within the trigeminal system.:Orofacial pain
.mouthandface, scalp,nerve supplies general sensorysupply to
in Dental OfficeainP
I. Oral Pain
1. “ Fractured Tooth Pain characteristics “ :
- pain when chewing - sensitivity to heat, cold, or sweetness.
- pain that comes and goes, but is rarely continuous.
- swelling of the gum around the affected tooth.
2. “ Atypical Odontolagia / Phantom tooth pain “ :-
#Etiology:- Idiopathic
# Clinical features
- Toothache with no detectable cause
- Pain is unaffected by endodontic therapy or even extraction of the tooth
3. ” Pericoronitis “ :
# Pain commonly arises from the supporting gingiva and mucosa when
infection arises from an erupting tooth, This is the most common cause
for the removal of third molar teeth (wisdom teeth). The pain may be

3. constant or intermittent, but is often evoked when biting down with
opposingmaxillary teeth.
# Management
- Ibuprofen
- Paracetamol, if ibuprofen is contraindicated or unsuitable and for
pregnant women or breastfeeding
- NSAIDs , if paracetamol and ibuprofen together does not provide
enough pain relief
- Antibiotic only prescribed for people who are systemically unwell or if
there are signs of severe infection
4. “Dental Pulpitis “ :
# It may be due to infection from dental caries close to the pulp or by
inflammation from chemical or thermal insult subsequent to dental
treatment. It may be reversible or irreversible. Intermittent sharp,
shooting pains are also symptomatic of trigeminal neuralgia, so care must
be taken not to mistakenly label toothache as neuralgia.
# If the insult persists the pulpitis will become irreversible. The increased
pulpal vascularity results in a rise in intra pulpal pressure, which induces
ischaemia and sensitivity, with prolonged pain to heat. Once necrosis of
the dental pulp has occurred, the infection spreads through the apex of the
tooth into the surrounding bone and periodontal membrane, initiating
periodontal inflammation and eventually a dental abscess causing
spontaneous long lasting pain and pain on biting on the tooth. Typically
the pain associated with an abscess is described as spontaneous aching or
throbbing lasting hours sometime days. Associated swelling in the jaw,
trismus or lymphadenopathy may be indicative of an acute spreading
infection.
# Management
- Excavation of the tooth decay with restoration (filling) for reversible
pulpitits.
- pulpectomy (pulp removal) and rootcanal treatment will be required for
irreversible pulpitis
- Acute spreading infection may require additional drainage intra or
extraorally via drainage of involved tissue tissue spaces.

4. 5. “ Sinusitis “ :
# It`s usually following a cold .
# Maxillary sinusitis pain is felt in relation to the upper molars which
may be tender to percussion .
# Management
- Decongestant & saline nasalwashes for simple sinus infection, but don`t
useit morethan 3 days becauseit will increase congestion.
- Antibiotics with more worsecongestion for 10 to 14 days.
6. “ Sialadenitis “ :
# Etiology:- salivary gland obstruction (stones, fibrosis)
# pain characteristics:- swelling associated usually with eating
# Management:- Hydration, antibiotics (oral versus parenteral), warm
compresses and massage, Sialogogues
7. “ Dry socket ” :
# It`s develop aftera toothextraction, it`s uncomfortablebuteasy to be
treated.
# Etiology:- Dislodged orDissolve of the blood clot formed in the socket
within a coupleofdays after the extraction. Thatleaves the boneand nerve
exposedto air, food,fluid, and anything else that enters the mouth. This can
lead to infection and severepain that can last for5 or6 days.
# Management
- Clean the toothsocket, removingany debris fromthe hole, and then fill the
socketwith a medicated dressingora specialpasteto promotehealing.
- Antibiotics to preventthe socketfrombecominginfected, rinse with salt
water ora special mouthwashevery day.
8. “Jaw Popping”
#Sometimes jaw popping can arise from:
-overextending the jaw, such as by opening the mouth too wide when
yawning or eating.
it results from problems in the functioning of the temporomandibular-
joints that connect the jawbone to the sides of the skull.joints or the

5. #The cause of jaw popping is not completely understood.
#Causes : -Grinding The Teeth. -Biting the inside of The
Cheek or Lip.
-Chewing Gum regularly or excessively.
-Nail-Biting -Clenching The Jaw.
#Symptoms : -Pain and discomfort. -Difficulty Eating.
-Difficulty Opening The Mouth wide. -Tenderness in The Face or Jaw
-Facial Swelling. -Tooth, Head, Neck & Ear ache.
#Management :
.NSAIDsNaproxen, ibuprofen, or-Avoid hard or crunchy foods.-
-Night Guard
-Surgery, if the medications and reassessment doesn`t relief pain yet.
9. “Periodontitis”
#It`s a common infection that damages the soft tissue and bone
supporting the tooth.
:Symptoms#
-Inflamed or Swollen Gums & Recurrent Swelling in The Gums.
-Bright red, sometimes Purple Gums. -Pain when The Gums are
Touched.
-Receding Gums, which make The Teeth look longer.
-Extra Spaces appearing between The Teeth. -Pus between The Teeth &
Gums.
-Bleeding when brushing Teeth or flossing. -Metallic taste in The
Mouth.
-Halitosis, or Bad Breath. -LooseTeeth.
#Management:
-Antimicrobial Mouth Rinse, such as ‘Chlorhexidine’.
-Antibiotic, as ‘Minocycline’.

6. 10.“ Gingivitis “:
#It means inflammation of the gums, or gingiva.
#Cause : - Because a Film of Plaque or Bbacteria accumulates on The
Teeth.
-Vitamin-C Deficiency -Smoking -Drugs as ‘Dilatin’
.Menopause,PubertyduringChanges in Hormones-
ofhigher riskparents have had gingivitis have awhose parent or-
developing it too.
-Some diseases: Cancer, diabetes, and HIV.
:Symptoms#
-Bright red or Purple Gums.
-tender gums that may be painful to the touch.
-Bleeding from The Gums when brushing or flossing.
-Inflammation, or Swollen Gums. -Halitosis, or Bad Breath.
-Receding Gums. -Soft Gums.
#Management :
-Brush Teeth at least twice a day. -Use an Electric Toothbrush.
-Floss Teeth at least oncea day. -Treatment of Badly Broken Teeth
-Regularly Rinse Mouth with an Antiseptic Mouthwash.
II. Facial Pain
1. ” Trigeminal Neuralgia ” :-
# Severe, sharp, paroxysmal shocking pain related to the distribution of
the trigeminal nerve affects it`s maxillary and mandibular divisions,
Lasts from few seconds to few minutes, Appears and disappears
suddenly, Episodic attacks ranges from several per day to few per year,
Between the intervals the patient is completely free, Stimulated by

7. shaving, washing, smoking and eating , After each episode, there is a
refractory period where stimulation of trigger zone will not induce pain
# it may be :
- Primary: Idiopathic -Secondary: due to Trauma or CNS lesions
# Clinical features
- Sex: female > male (2:1). - Side: right > left.
- Site: 2nd & 3rd division CN. - Age: 60-70 years.
# Management
Medicaments : Carbamazepine, Baclofen, Phenytoin.
Surgical : it`s done in cases refractory to medications.
2. “ Atypical Trigeminal Neralgia ”:-
# pain is more continuous rather than separate attacks and triggered by
Warmth .
# Trigeminal Neuralgia may change it`s characters from intermittent to
more continuous .
Management#
- strong responsetoward Carabamazepine & Antidepressant .
3. “ Glossopharyngeal Neuralgia ” :-
# Rare condition, paroxysmal pain.
# less severe than trigeminal neuralgia, affecting the Glossopharyngeal
nerve. (9th C.N.) .
# Affects the throat and ears and the post 1/3 of the tongue and pharynx .
# Provoked by swallowing or talking, chewing .
4. “ peripheral neuritis ” :-
# it`s burning, localized pain in the peripheral distribution of the affected
nerve, it may affect sensory or motor or autonomic system due to

8. - Metabolic Disorder ( Diabetes Mellitus ), Toxic Disorder ( Haevy Metal
Intoxication ), Vitamin B1 deficiency ( Beriberi )
5. “ PostHerpetic Neuralgia “ :-
# A complication of Herpes Zoster which follows it, mainly in elderly
patients
# Persistence of neuralgic pain after resolution of the rash for weeks or
months results from inflammation and fibrosis of the affected nerve,
continuous burning severe pain.
6. “Post Traumatic Pain” :-
#Etiology:- pain follow trauma or surgery due to crushing of the nerve .
# pain characteristics:- Burning , Localized and Persistent .
7. “ Atypical Facial Pain “ :-
# Persistent facial pain that does not have the characteristics of the
neuralgias and is not associated with physical signs
# Present daily and persists most of the day.
# It is confined at onset to a limited area on one side of the face and may
spread to the upper and lower jaws or other areas of the face or neck.
# It is deep and poorly localized, Chronic, intermittent dull aching, the
patient is unable to define location of pain.
# It gets worse with fatigue and stress, but doesn'tinterfere with
eating or sleeping.
# Responds poorly to analgesics.
# Emotional breakdown, tears are common.
# Clinical picture
- Sex: female > male (9:1). -Site: Maxilla & Mandibule & Tongue
8. “ Myofacial Pain Dysfunction “:-
# It is a chronic disorder characterized by unilateral dull pain in front of
the ear that is worst on awakening, clicking and limitation of mouth
opening in absenceof pathological abnormality in TMJ .

9. -Etiology:#
leads toimproper prosthetic appliance,Bilateral loss of posterior teeth-
thatand over extensioncontractionMuscle over&outhover closur of M
.muscle fatiguecause
-Clinical features :#
- Unilateral dull pain in the ear or preauricular area which is worse on
awakening, and there may be vague pain affecting the whole side of the
face.
- Tenderness of muscles of mastication on palpation .
- Limitation or deviation of mandible on opening to the affected side.
- Clicking in TMJ. -Trismus (locking or inability to open the mouth).
- Radiating pain to masseter muscle, occipitally, cervically to the neck or
to the angle of the mandible
- Patients frequently grind or clench their teeth or develop other Para
functional habits e.g. pencil chewing and so on clinical examination
there are:
- Wear facets on teeth.
- Ridging of tongue margins and buccal mucosa at the occlusal line.
# Trigger point may occur in ( Muscles of mastication & Cervical muscle
‘ sterno-mastoid ’) .
# Management
- Elimination of the cause -Muscle Excersice
- Occlusal Splints ( Night Guard , Bite Raiser )
- Patient Reassurance . -NSAIDs, Diazepam
9. “ Burning Mouth Syndrome “ :-
# It`s ongoing (chronic) or recurrent burning in the mouth without an
obvious cause that makes treatment more challenging .
# It can appear suddenly or develop gradually over time
# This discomfortmay affect the tongue, gums, lips, inside of your
cheeks, roof of your mouth or widespread areas of the mouth.

10. # The burning sensation can be severe.
# Clinical Features:-
- A burning or scalded sensation that most commonly affects tongue, but
may also affect lips, gums, palate, throat or whole mouth
- A sensation of dry mouth with increased thirst
- Taste changes, such as a bitter or metallic taste and it may loss
10. Bell’s Palsy
# Unilateral dysfunction of facial nerve and rapid onset
whichresults in paralysis of facial muscles.
# The patient may wake up with fully developed facial palsy .
# Sometimes preceded by facial pain especiallyat the angle of the
jaw .
# Unilateral talking & smiling and deviation of the face to the
unaffected side .
# Food retention in upper and lower buccal and labial vestibules .
# Weakness of buccinator muscle .
# The patient is unable to raise the eye brow or close the eye unable
to whistle or retract the angle of the mouth .
# Change in facial expressions .
# Drop of the angle of the mouth and drooling of saliva .
# Etiology:-
- Idiopathic, affecting any age and sex .
- Enclosement of the bony canal of the 7th cranial nerve cause it`s
demyelination .
# Clinical Features:-

11. - Drooping eyelid , inability to close eye
- Drooping mouth , inability to smile or pucker .
- Inability to puff cheeks , no muscl tone & Inability to wrikle brow.
References
 Book of the department of Oral Diagnosis & Orofacial Pain in
ERU Dentistry
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590084
 https://www.medicalnewstoday.com/articles/241721.php?fbclid=
IwAR3c3WmSwsi-Q9Td7xjOda-
MduGYlN546jHwjHlymwCwFejqDZyi9SugYNs
 https://www.medicalnewstoday.com/articles/242321.php?fbclid=
IwAR3CAy4L1fuC6cVvgMwsuaQLzoBRg-
j9lN3mpsmWx8HJ_mI_iqYckcIQSEI
 https://www.medicalnewstoday.com/articles/319888.php