Management of Dental Pain

Question 1

Define Diagnosis

Answer 1

identifying the nature of an illness or othre problems by examining the signs and symptoms

Question 2

why may patients complain between appointments? (4)

Answer 2

• pain
• lost restorations
• swellings
• difficulties in eating

Question 3

what are the common areas for pain?

Answer 3

tooth
periodontium
mucosa

Question 4

what are the common reasons for toothache

Answer 4

• dentine hypersensitivity
• reversible pulpitis
• irreversible pulpitis
• cracked tooth syndrome
• cavity/lost restoration
• trauma

Question 5

what are the common reasons for periodontium pain

Answer 5

acute gingivitis
symptomatic apical peridootnics
periodonal abcess
NUG
high restoration
food packing
acute periapical abescess

Question 6

what are the common reasons for mucosa pain

Answer 6

denture related
pathology
trauma

Question 7

what are the common reasons for other

Answer 7

infection
referred pain
muscoulo-skeletal
txrigemimal neuraligai
atypical facial pain
rarer conditions - pain

Question 8

describe HPC?

Answer 8

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

Question 9

what investigations can you do on teeth?

Answer 9

• vitality tests - ethyl chloride, EPT
• radiographs

Question 10

how can a ethyl chloride test produce false results?

Answer 10

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

Question 11

how can an EPT produce false results?

Answer 11

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

Question 12

describe dentine hypersensitivity

Answer 12

S
O
C - sharp
R
A
T - short
E - hot/cold/sweet
S

• associated with exposed dentine

Question 13

why does sweet things cause hypersensitivity?

Answer 13

causes fluid to run out of the dentinal tubules

Question 14

how is dentine hypersensitivity treated?

Answer 14

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

Question 15

how can there be exposed dentine?

Answer 15

lost resoraitons
TSL
fractured teeth
gingival recession

Question 16

what is the common fluoride varnish?

Answer 16

duraphat - 22,600ppm (2.26% sodium fluoride)
- contains colophony and alcohol

• apply every 6 months for high caries risk

Question 17

contraindications of duraphat fluoride varnish

Answer 17

ulcerative gingivitis
stomatitis
bronchial asthmas

Question 18

what fluoride varnish is used on clinic?

Answer 18

Tri-Calcium Phosphate
- 5% sodium fluoride
- contains calcium and phosphate, also alcohol

Question 19

instructions to give patients for fluoride varnish

Answer 19

no eat or drink for 30 mins
soft diet for the rest of the day

Question 20

describe reversible pulpitis

Answer 20

short, sharp pain

with hot and cold, cold usually worse

radiographic findings
- none, caries may be present

vitality test = positive

Question 21

describe irreversible pulpitis

Answer 21

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

Question 22

describe pulpal necrosis

Answer 22

likely symptom free
discolouration

radiographic findings
- widening of PDL

vitality test = negative

Question 23

describe acute apical periodontitis

Answer 23

C - TTP

radiographic findings
- widening of PDL

vitality test = negative

Question 24

describe chronic apical periondontiis

Answer 24

symptom free
occasional mild ache

radiographic findings
- may have periapical radiolucency

vitality test = negative

Question 25

describe chronic apical apical periodontitis with acute exacerbation

Answer 25

C - dull throbbing, TTP

radiographic findings
- periapical radiolucency

vitality test = negative

Question 26

describe periapical abscess

Answer 26

swelling
throbbing pain

radiographic findings
- may have periapical radiolucency

vitality test = negative

Question 27

what is the purpose of TTP?

Answer 27

to identify if the PDL around the tooth is inflamed

Question 28

how much depth does GIC need to be in the root chamber to create a good seal during temp visits on a RCT?

Answer 28

at least 5mm only in the root chamber

Question 29

what does a tooth sleuth do?

Answer 29

ask patient to bite down on it
then to open mouth

pain may be triggered on release of bite

= allows you to find a suspected crack

Question 30

how can cracked tooth syndrome be identified?

Answer 30

shine with UV light - may see the crack
tooth sleuth

Question 31

how is cracked tooth syndrome managed?

Answer 31

• assess extent of crack
• remove restorations if necessary

options
- can create internal splint w/ composite
- external splint w/ orthodontic band
- onlay - quite destructive
- inlay - very destructive

long term - onlay or a crown