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Hakam Rabi: BSC., DDS, MSC
Hakam Rabi: BSC., DDS, MSC
Hakam Rabi: BSC., DDS, MSC
Hakam Rabi
BSc., DDS, MSc.
Pain Pain
When a patient complains of toothache it may be
arising from a variety of different structures and may
be classified as follows:
Pulpal pain
Periapical/Periradicular pain
Non-dental pain
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Mobility Palpation
Mobility of teeth increases by the decrease in bone Palpation of the buccal sulcus next to a painful tooth
support (e.g due to periodontal disease or an epical can help to determine if there is an associated apical
abscess) abscess
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Radiographs Bitewings
Bitewings
Examine crowns of teeth
Interdental bone
Caries
Restorations
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Treatment
Drainage, dressing, then RCT
If not successful then extraction
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Referred Pain
Pericoronitis is caused by injury and infection of the Referred Pulp Pain
pericoronal tissue associated with erupting molars, The term referred or reflected pain, denotes the pain
usually mandibular third molars. felt in the body part which is remote from the place
of stimulation or tissue damage.
The tissue may be injured during eating by trauma
A reflected pain originates in one place (e.g. the
from food such as peanuts or bread crust. lower first molar), and is felt in the other (e.g. ear)
Or food and plaque can get accumulated under the The 2 types of sensory nerve fibers in the pulp are
operculum myelinated A fibers (A-delta and A-beta fibers)
The infection begins under the operculum and extends and unmyelinated C fibers
with attendant swelling around the entire unerupted The C fibers are located in the core of the pulp, or
crown the pulp proper, and extend into the cell-free zone
underneath the odontoblastic layer
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The A-delta fibers have a small diameter and The key location of the phenomenon of the reflected
therefore a slower conduction velocity than other pain is the spinal core of the trigeminal nerve
types of A fibers, but are faster than C fibers. The mechanism of the referred pain is explained by
The A fibers transmit pain directly to the the theory of convergence.
thalamus, generating a fast, sharp pain that is Aferrent nociceptive nerve fibers which conduct the
easily localized. stimuli from different parts of the head and neck
The C fibers are influenced by many modulating converge in the area of the second neuron of the
interneurons before reaching the thalamus, sensory pathway of pain in subnucleus caudalis of the
resulting in a slow pain, which is characterized as spinal core of the trigeminal nerve
dull and aching
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Maxillary incisors may refer pain to frontal The maxillary second premolar and first
area. molar may refer pain to the maxilla and back to the
temporal region.
Maxillary canine and first premolar may Maxillary second and third molars may refer pain
refer pain into the nasolabial area and orbit to mandibular molar area and occasionally into the ear
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