toothache
Introduction
Introduction Toothache is one of the most common symptoms of dental diseases in dentistry. It is characterized by redness and swelling of the gums, painful heat and cold, and swelling of the cheeks. Most of the toothache is caused by gingivitis, periodontitis, cavities or fractured teeth leading to infection of the pulp (dental nerve). Toothache is an external reaction of tooth disease. It may be that the gums around the caries, pulp or canines are infected. Cracks in the front caries can also cause toothache. Sometimes only the chips are stuck in the teeth and cause discomfort. In addition, toothache may also be caused by sinusitis.
Cause
Cause
Cause of toothache
There are many reasons for toothache, and common causes are:
1, acute pulpitis: more common in patients with deep caries, the bacteria from the cavity into the pulp cavity, causing congestion and inflammation of the teeth. Toothache is often spontaneous, and the pain at night is aggravated. The pain is more severe after hot and cold stimulation. Pain can also be radiated to the face, ankles and ears. In the case of suppurative pulpitis, the patient experiences heat irritation and the pain is aggravated, while the cold irritation pain is reduced or disappeared.
2, acute apical inflammation: caused by the development of acute pulpitis or trauma and other factors. The sick tooth is persistently painful, has a floating feeling, and does not dare to chew. The patient can correctly point out the sick tooth. For example, if the sick tooth is damaged, the nerve is necrotic and there is no stimulating pain.
3, acute periodontitis: the nature of toothache is similar to acute periapical inflammation. The sick teeth not only have chewing pain and floating feeling, but also have formed periodontal pockets and loose teeth. Repeated swelling and bleeding can occur in the gum tissue.
4, periodontal abscess: further development of periodontal tissue inflammation can cause suppurative inflammation. Pain is severe when the abscess is formed, and local fluctuations occur after the abscess is formed. After the formation of periodontal abscess, the pain can be significantly alleviated or alleviated.
5, tooth allergy: often due to atrophy of the gums, dentin exposure of the tooth neck and tooth defects. At this time, cold, heat, sweetness, acid and other stimuli can cause pain, but the pain can disappear after the stimulation stops.
6, food embedding pain: the gap between the teeth and the teeth can be caused by food congestion and cause toothache, known as food embedding pain.
7, dry trough: more than 2 to 4 days after tooth extraction, can cause spontaneous persistent severe pain. During the examination, the blood clot in the tooth extraction wound was found to have an odor.
8, other: In addition, such as gums, jaw tumors and trigeminal neuralgia, can also cause pain in the corresponding areas of the ipsilateral teeth.
Examine
an examination
Related inspection
Endodontic temperature test (cold and hot diagnosis) Oral endoscopic oral X-ray examination of plasma fluoride
Toothache check
1. Ask your medical history carefully to understand the nature, extent and timing of your toothache. Is sharp pain or dull pain, soreness; spontaneous pain or pain; pain or persistent pain, no night pain; local limitations or release. Can you clearly indicate the tooth?
Sharp spontaneous pain: seen in acute pulpitis, periapical periodontitis, periodontal abscess, sputum papillitis and pericoronitis; trigeminal neuralgia, medullary, maxillary sinusitis and dry trough.
Spontaneous dull pain: seen in chronic gingivitis, traumatic jaw.
Excites pain: seen in dentin hypersensitivity, 2-3 degrees sputum, pulp congestion.
Occlusal pain: seen in the galvanic effect of acute and chronic apical periodontitis, traumatic jaw, and different metal restorations.
2, check the teeth, with or without sputum, pay attention to the adjacent side and the buccal side of the upper jaw eight, the distal neck of the lower jaw seven and other hidden parts. There are no cracks, high wear, wedge-shaped defects, central deformity of the deformity, acute lingual fossa, deep sacral filling without the bottom, traumatic exposed pulp and so on.
1. In acute apical periodontitis, the teeth are loose and the pain is obvious.
2, chronic pulpitis, acute pulpitis and chronic apical periodontitis, marginal periodontitis, traumatic rhinitis, may have mild pain.
3, periodontal and nearby, sputum papillitis has phlegm redness and food embolism; pericoronitis more common in the impacted teeth, sputum red swelling, suppuration; periodontal abscess, retrograde pulpitis can be found in deep periodontal pocket Dry trough disease, the ball in the dental socket is necrotic, the bone surface is exposed, and the rancid smell.
4, chronic apical periodontitis can have fistula.
5, acute alveolar abscess, periodontal abscess, pericoronitis range block can be swollen, fluctuating, swelling near the face and face.
6, local maxillary sinusitis tenderness, purulent sputum. The maxillary sinus tumor is partially bulged, and multiple teeth are loose and bloody nose.
3, pulp vitality examination to determine the condition of the pulp; X-ray has important value for the diagnosis of dental caries, periapical lesions, myelite, tumors, and ambushed teeth.
Diagnosis
Differential diagnosis
Toothache is often the subjective diagnosis of patients. A variety of dentinal and non-dental diseases can cause toothache, so clinical identification is important. Comprehensive judgment and analysis should be made on the cause, nature, time, location and general condition of the patient's toothache.
1. Squat: clinical manifestations of cold and heat stimulation of transient pain, deduction, detection of the bottom of the hole sensitive, no spontaneous pain, effective treatment with capping.
2. Dentin hypersensitivity: The general patient is older, has a severe maxillofacial abrasion, a wedge-shaped defect in the neck or a different degree of gingival recession.
3. Acute and chronic pulpitis: acute pulpitis may have spontaneous, paroxysmal, radiation pain and can not be positioned, hot and cold stimulation, may have pain or discomfort. Chronic pulpitis may have a history of long-term toothache, and more can locate the teeth, with a little pain or discomfort.
4. Periapical periodontitis: There are spontaneous hip pain that can be positioned, bite pain, do not dare to chew food with teeth, severe pain, no effect on pulp vitality test, redness, pain, looseness, and looseness of the root of the corresponding tooth. Can induce interstitial infections, swollen lymph nodes and systemic symptoms.
5. Wisdom tooth pericoronitis: limited to the redness of the third molar, may have difficulty in chewing and swallowing, limited mouth opening, mandibular lymphadenopathy, tenderness and elevated body temperature.
6. Dry trough: There is a history of tooth extraction. Generally, after 2-3 days, there are spoiled blood clots in the tooth socket, odor, gray-white fake film covering, severe pain, and there may be slight pain in the teeth.
7. Periodontal abscess: the abscess is near the temporal margin, and the periodontal pocket is loose. The X-ray shows alveolar bone resorption, corresponding lymph node tenderness, elevated body temperature, and general malaise.
8. papillitis: spontaneous pain, can have cold and heat stimulation, history of food impaction, facial paralysis or poor prosthesis. The nipple redness and swelling are easy to hemorrhage and the pulp activity is normal.
9. Maxillary sinusitis: no obvious tooth disease, multiple gum pain in the maxillary sinus area, history of cold, history of purulent sinus and maxillary sinusitis, pus in maxillary sinus puncture.
10. Trigeminal neuralgia: There is a trigger point, paroxysmal electric shock like severe pain, heavy during the day, hot and cold stimulation is normal, oral carbamazepine is effective.
11. Coronary heart disease, toothache caused by high blood pressure: unable to find tooth lesions, history of coronary heart disease and history of angina pectoris.
12. Atypical toothache: Mostly due to tooth extraction, after root canal treatment, or patients with depression or anxiety, antidepressant treatment is effective for toothache.
