Presentation1 [Autosaved].pdf diagnosiss

What is periodontal pain?
Pain originating from the
supporting structures of
the teeth (gingiva,
alveolar bone,
periodontal ligament).
Gingiva

CAUSES
OF P.P
Poor Oral Hygiene:
Inadequate brushing and flossing lead to
plaque and tartar buildup, causing gum
irritation and inflammation.

CAUSES
OF P.P
Systemic Conditions:
like diabetes, immune disorders, or hormonal
changes can worsen the gingival disease.

CAUSES
OF P.P
Improper Bite:
An uneven bite or excessive pressure
on certain teeth ( bruxism) can cause
stress on periodontal tissues.

Smoking:
Smoking impairs healing and increases the
risk of periodontal disease.
CAUSES
OF P.P

CAUSES
OF P.P
Dental
Procedures:
cleaning,surgery,or
other dental
treatments

CAUSES
OF P.P
plaque build up
and gingivnal
recession

HEALTHY
GINGIVA
The periodontal tissues are intact
and free from inflammation

HEALTHY
GINGIVA
It involves inflammation of
gingiva without affecting the
underlying bone structure

HEALTHY
GINGIVA
Starting to damage
the supporting
structure of the teeth

HEALTHY
GINGIVA
Symptoms are more pronounced
which increased destruction of
the supporting structure

HEALTHY
GINGIVA
the advanced stage, significant
damage to the supporting
structures of the teeth, including
extensive bone loss and severe
gingiva recession

Can be acute or chronic:
• Acute: Sudden onset, often
due to a periodontal abscess.
• Chronic: Gradual onset,
commonly associated with
chronic periodontitis.
Acute conditions: Pain is
usually short-lived but intense.
Chronic conditions:Pain can
persist for weeks to months,
often fluctuating in intensity.
Onset

Can be acute or chronic:
• Acute: Sudden onset, often
due to a periodontal abscess.
• Chronic: Gradual onset,
commonly associated with
chronic periodontitis.
Acute conditions: Pain is
usually short-lived but intense.
Chronic conditions:Pain can
persist for weeks to months,
often fluctuating in intensity.
Duration

Usually described as dull,
throbbing, or aching.
Can be sharp or stabbing in
cases like a periodontal
abscess.
Character

Usually described as dull,
throbbing, or aching.
Can be sharp or stabbing in
cases like a periodontal
abscess.
Mild to moderate in chronic cases.
Severe in acute conditions like
abscesses.
Severity

localized around a tooth.
Affects the gingiva, periodontal
ligament, or alveolar bone
surrounding the affected teeth.
Mild to moderate in chronic cases.
Severe in acute conditions like
abscesses.
Location
and Site

localized around a tooth.
Affects the gingiva, periodontal
ligament, or alveolar bone
surrounding the affected teeth.
Acute: Sudden onset, severe and
Rapid progression of symptoms.
Chronic: Gradual progression.
Course

Acute apical
periodontitis
Acute
periapical
abscess
Acute
periodontal
abscess
Chronic
apical
periodontitis
Chronic
Periapical
Abscess
Acute
Exacerbation
Of Chronic
Periapical
Abscess

Acute apical periodontitis
inflammation of the periodontium as a result of trauma ,pulpal disease.
Diagnosis:
• Pain on percussion, pain dull and
throbbing.
• usually described as severe and localized.
• Tooth may be elevated in its socket.
• Radiographs may be No significant
changes visible .
• Negative to vitality test.
• Cold may relief pain.
Treatment:
• Root Canal
Treatment.
• Analgesics and
Antibiotics.

Acute periapical abscess
Diagnosis:
• soft tissue swelling associated
with an endodontically involved
tooth , pus at apex.
• sensitive to percussion, pain
dull and throbbing.
• Periapical radiolucency , Loss of
lamina dura .
• Mobility May be increased
Treatment:
• Drainage of the Abscess
• Root Canal Treatment.
• Analgesics and
Antibiotics.

Acute periodontal abscess:
Diagnosis:
• pain dull ,localized and
throbbing.
• Pus ,bad breath and fever.
• Positive to vitality test.
• sensitivity to hot or cold.
• Deep periodontal pocket
and increased mobility.
Treatment:
• Periodontal abscess
drainage.
• Antibiotics.
• Root canal treatment.
• Tooth extraction.

Chronic apical periodontitis:
Diagnosis:
• painless on Percussion.
• Periapical radiolucency and
Loss of lamina dura around
the root apex.
• contains granulation tissue.
a long-standing inflammation of the periapical tissues caused by
persistent irritation
Treatment:
• Analgesics and
Antibiotics.
• Follow-Up Care

Chronic Periapical Abscess:
Diagnosis:
• Radiolucent area around the
apex of the tooth.
• tenderness on percussion.
• Presence of a draining sinus
tract.
• Necrotic pulp.
Treatment:
• Drainage
• Antibiotics.
• Follow-Up.

Acute Exacerbation Of Chronic Periapical Abscess:
Diagnosis:
• Severe pain and swelling.
• Fever and foul taste.
• Radiolucent at the apex of the
tooth.
• Necrotic pulp.
• Pus drainage.
Treatment:
• Drainage.
• Antibiotics.
• Follow-Up.
• Pain Management.
• Possible Tooth Extraction.

Presented by
Amira Hassan
Merna Karam
Salma Talal
Omnia Gouda
Created by
Omnia Gouda

PULPAL PAIN
Basmala Hassan
Mohamed ibrahim
Halla mostafa

Sources of pain of pulp
The dental pulp is richly innervated by both myelinated
(A-fibers) and unmyelinated (C-fibers) axons.
A-fibers seem to be responsible for the sensitivity of
dentin. They respond to stimuli that induce sharp pain
in human teeth, for example, drilling of dentin and
drying of dentin with air blasts (fast).
* C-fibers are activated only when the stimuli used
reach the pulp proper. dull pain is induced at a
temperature level corresponding to the heat thresholds
of intradental C-fibers. (slow )

Pulpitis can be acute occurs when a stimulus (usually cold
or sweet) is applied to the tooth. When the stimulus is
removed, the pain ceases within 1 to 2 seconds.
and can be chronic pulpitis occurs spontaneously or
lingers minutes after the stimulus (usually heat, less
frequently cold) is removed.
the pulp is poorly localised
Caracterized of pulp pain

Types of pain
1 Dentinal sensitivity
2 Reversible pulpitis
3 Irreversible pulpitis
4 necrotic pulp

Dentinal sensitivity
fluid movements within exposed dentinal tubules
According to hydrodynamic theory.
Characterized by:
may induce short sharp pain even with only minor
provocation
Gentle touch, mild cold or hot, chemical (acidic or sweet
fruits, foods, drinks) and air-flow stimuli can induce short
sharp pain that may affect daily activities including eating,
drinking, speaking and tooth brushing.

Treatment:
Desensitisers have different ingredients,
such as fluoride, hydroxyethyl
methacrylate, glutaraldehyde, oxalate and
potassium nitrate, as well as a combination
of these ingredients.

Reversible pulpitis
Called pulp hyperemia Occur due to deep
caries or by replaced of metallic restoration
without applied base.

Pain type : sharp and momentary pain which
ceases after stimulus is removed
Stimulus: External stimulus, for example, heat,
cold, and sugar
Pain at night : no
Pain localization : Only with applied cold stimulus
or PDL inflammation
Referred pain : usually not found
Diagnosis:

Diagnosis:
Percussion/occlusion
If due to occlusion, percussion test is positive, otherwise
normal.
Vitality test response: exaggerated, brief
a. Tooth respond more severely than healthy teeth and at
lower level of stimulation.
b. Pain lasts for less than 15 second after removal of
stimulus.
c. Tooth responds more to cold than heat stimulation.

Treatment
Remove the irritant or repair tooth structure (caries,
exposed dentin, defective restoration).
Continue to monitor the patient's symptoms.
Advise patient to return if symptoms persist or worsen.

Irreversible pulpitis has two types
Acute pulpitis and chronic pulpitis

Treatment:
Complete removal of pulp tissue
,root canal treatment.

Symptoms of Necrotic Pulp
Thermal:
No response.
Sweets:
No response.
:
Biting Pressure
Usually moderate to severe pain not symptom of necrotic
pulp, but rather periapical inflammation.
Moderate to severe spontaneous pain usually dull and
throbbing; associated with periapical area

Diagnosis of Necrotic Pulp
Distinguishing features:
-No response to cold.
-No response to pulpal test.
Caveats
-Decreased sensitivity to cold/ept may be from of insulating effects
of additional dentin.
-Fluid in canal space conducting electrical current can give false-
positive.

Pulp necrosis
Death of the pulp may result from an untreated irreversible pulpitis or
from traumatic injury that disrupts the blood supply to the pulp.
It can be partial N. which gives similar symptoms to irreversable pulpitis
or total N. which is asymptomatic.
If not treated it will spread beyond the apical foramen causing
inflammation of the periodontal ligament; result in thickening of
periodontal ligament, which may be quit sensitive to percussion

Treatment of
necrotic pulp
Complete removal of
pulp tissue ,root canal
treatment

Presentation1 [Autosaved].pdf diagnosiss

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