Management of Dental Pain Flashcards
Define Diagnosis
identifying the nature of an illness or othre problems by examining the signs and symptoms
why may patients complain between appointments? (4)
- pain
- lost restorations
- swellings
- difficulties in eating
what are the common areas for pain?
tooth
periodontium
mucosa
what are the common reasons for toothache
- dentine hypersensitivity
- reversible pulpitis
- irreversible pulpitis
- cracked tooth syndrome
- cavity/lost restoration
- trauma
what are the common reasons for periodontium pain
acute gingivitis
symptomatic apical peridootnics
periodonal abcess
NUG
high restoration
food packing
acute periapical abescess
what are the common reasons for mucosa pain
denture related
pathology
trauma
what are the common reasons for other
infection
referred pain
muscoulo-skeletal
txrigemimal neuraligai
atypical facial pain
rarer conditions - pain
describe HPC?
use SOCRATES
Site - where is the pain?
Onset - what brought the pain on?
Characteristic - what does the pain feel like?
Radiation - spread? or one place?
Associations
Time
Exacerbating factors - what makes it worse/better
Severity - 1-10
what investigations can you do on teeth?
- vitality tests - ethyl chloride, EPT
- radiographs
how can a ethyl chloride test produce false results?
false positive - patient aware of the coldness on the gum not on the tooth
false negative - too much insulation from secondary dentine, restorative materials or patients with high pain threshold
how can an EPT produce false results?
false positive - patient nervous of electric shocks and anticipate it
false negative - too much insulation to electric current
the actual number may not actual relate to the actual condition of the pulp
describe dentine hypersensitivity
S
O
C - sharp
R
A
T - short
E - hot/cold/sweet
S
- associated with exposed dentine
why does sweet things cause hypersensitivity?
causes fluid to run out of the dentinal tubules
how is dentine hypersensitivity treated?
aim to block the dentinal tubules
- fluoride varnish
- bonding agents
- dress cavities
home care
- desensitising toothpastes
- mouthwashes
- should go with time - peritubular dentine lays down
how can there be exposed dentine?
lost resoraitons
TSL
fractured teeth
gingival recession
what is the common fluoride varnish?
duraphat - 22,600ppm (2.26% sodium fluoride)
- contains colophony and alcohol
- apply every 6 months for high caries risk
contraindications of duraphat fluoride varnish
ulcerative gingivitis
stomatitis
bronchial asthmas
what fluoride varnish is used on clinic?
Tri-Calcium Phosphate
- 5% sodium fluoride
- contains calcium and phosphate, also alcohol
instructions to give patients for fluoride varnish
no eat or drink for 30 mins
soft diet for the rest of the day
describe reversible pulpitis
short, sharp pain
with hot and cold, cold usually worse
radiographic findings
- none, caries may be present
vitality test = positive
describe irreversible pulpitis
S - poorly localised
O - spontaneous
C - throbbing pain
R
A
T - long duration
E - worse with hot, cold can ease it
S
radiographic findings
- caries may be present
- some PDL widening
vitality test = positive
describe pulpal necrosis
likely symptom free
discolouration
radiographic findings
- widening of PDL
vitality test = negative
describe acute apical periodontitis
C - TTP
radiographic findings
- widening of PDL
vitality test = negative
describe chronic apical periondontiis
symptom free
occasional mild ache
radiographic findings
- may have periapical radiolucency
vitality test = negative
