Pain history

Question 1

When taking a pain history, what does S mean in socrates?

Answer 1

Site - where about’s in the mouth is the pain?

Question 2

When taking a pain history, what does O mean in socrates?

Answer 2

Onset:
• When did the pain start?
• Is the pain spontaneous or stimulated? eg: provoked by stimuli (hot/cold/sweet)

Question 3

When taking a pain history, what does C mean in socrates?

Answer 3

Character: what does the pain feel like?
• Sharp (usually sign of decay/crack/fracture)
• Dull/throbbing (could be sign of bacterial infection to periodontal/periapical tissues

Question 4

When taking a pain history, what does R mean in socrates?

Answer 4

Radiation: does the pain spread to other areas?

Question 5

When taking a pain history, what does A mean in socrates?

Answer 5

Associated factors:
• swellings?
• sinus?
• systemic involvement (fever/bad breath/bad taste)

Question 6

When taking a pain history, what does T mean in socrates?

Answer 6

Timing:
• how long does the pain last? (seconds/hrs/minutes)
• worse at particular time of day?
• does it keep you awake at night?

Question 7

When taking a pain history, what does E mean in socrates?

Answer 7

Exacerbating/relieving factors?
• Does anything make it better or worse?
• Are you taking painkillers? Do they help?

Question 8

When taking a pain history, what does the last S mean in socrates?

Answer 8

Severity: on a scale of 1-10 how bad is the pain?

Question 9

What are the 3 sources of dental pain?

Answer 9

dentinal tubular fluid flow
raised pulpal pressure
periodontal inflammation

Question 10

What can cause exposure of dentinal tubules can cause sensitivity?

Answer 10

Gingival recession
Caries
Trauma
Erosion, abrasion, attrition

Question 11

What are some features of reversible pulpitis?

Answer 11

• sharp pain
• lasts a few seconds
• worse with hot/cold/sweet foods

Question 12

What are some features of irreversible pulpitis?

Answer 12

• spontaneous dull pain

* pain lasts several mins

Question 13

Why can a restoration not treat irreversible pulpitits?

Answer 13

the pulp will remain inflamed and continue to cause pain

Question 14

If the pain is keeping the pt up at night it would likely indicate which type of pulpitits?

Answer 14

Irreversible

Question 15

If pain killers help which type of pulpitis is it likely to be?

Answer 15

Reversible

Question 16

If cold drinks alleviate the pain which type of pulpitis is it likely to be?

Answer 16

Irreversible

Question 17

If irreversible pulpitis is left untreated, what can it progress to?

Answer 17

pulpal necrosis

Question 18

What has happened to the infection in acute apical periodontitis?

Answer 18

the bacteria will travel to the periapical tissues

Question 19

Why would a pt get pain on biting with acute apical periodontitis?

Answer 19

periodontal ligament is inflamed and biting stimulates the pain and pressure sensitive fibres in the area

Question 20

What happens if toxins are leached through the apex?

Answer 20

causes a chronic inflammatory response which leads to bone resorption
(may be seen as apical radiolucency)

Question 21

If symptomatic apical periodontitis is left to progress, what can it become?

Answer 21

chronic apical periodontitis
(chronic inflammation and destruction of the periodontium)
• visible on x-ray as larger well defined radiolucency
–> can become symptomatic apical periodontitis again!!

Question 22

Once an infection has the potential to go through the apex what can form?

Answer 22

Abscess (pus filled swelling which can cause severe, spontaneous pain and extreme tenderness to touch)

Question 23

Why does abscess cause pain?

Answer 23

it is causing there to be a lot of pressure in the area which is why draining the abscess can lead to pt feeling less pain

Question 24

Why does abscess cause pain?

Answer 24

it is causing there to be a lot of pressure in the area which is why draining the abscess can lead to pt feeling less pain

Question 25

what are some features of dentine hypersensitivity?

Answer 25

• short sharp pain
• worse with hot/cold/sweet things
• hard to locate
• only present when stimulus is present
look for exposed dentine (lost restorations, gingival recession or fractured teeth)
• tooth should be +ve to tests and not TTP