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Lec. 4 Pain in Endodontcs ALDAWLA
Lec. 4 Pain in Endodontcs ALDAWLA
4 5th Level
•“Pain in Endodontcs”
Mohammed Aldawla
Department of Conservative Dentistry,
Faculty of Dentistry
Terminology
Pain is unpleasant sensory and emotional experience
with actual or potential tissue damage.
Pain is always subjective…..
Pain threshold is “the least stimulus that can cause pain
to an individual”.
Generally pain threshold is affected by:
1. Age and sex.
2. Psychological status and experience of the individual.
3. Physical status of individual.
Orofacial pain
Causes
Odontogenic
Odontogenic
salivary glands
bone lesions
Pulpitis
musculoskeletal origin
Primary vascular disorder Periapical pathosis
Neuralgias
cracked tooth
lesions of nose and ear
Psychogenic periodontal
generalized pain syndroms
others
FIG. 3-2 A graphic depiction of the trigeminal nerve entering the brainstem. The primary afferent
neuron synapses with a second-order neuron in the trigeminal nucleus. The second-order neuron
carries pain information to the thalamus from which it is sent to the cerebral cortex for
interpretation.
FIG. 3-3 Illustration of pain that is referred from an area innervated by one nerve (C2) to an area
innervated by a different nerve (V2). Note that this phenomenon occurs secondary to the
convergence of different neurons onto the same second-order neuron in the trigeminal nucleus.
The sensory cortex perceives two locations of pain. One area is the trapezius region that
represents the source of pain. The second area of perceived pain is felt in the temporomandibular
joint area, which is only a site of pain, not a source of pain. This pain is heterotopic (referred).
FIG. 3-4 Illustration of the laminated pattern of innervation from orofacial structures into the
trigeminal nucleus. These laminated patterns commonly reflect the patterns of referred pains felt
in the orofacial structures.
Pain Type
Cardiac Origin
Other Tooth
Phenomena Complicating the Diagnosis of Dental Pain
Referred Pain (Maxillary sinusitis)
The close proximity of the maxillary sinuses to the maxillary teeth can make the diagnosis of
pain in these segments difficult.
The distinction between pain of dental origin and sinusitis may be helped by the presence of
obvious dental disease, or a typical acute or recurrent sinusitis with nasal discharge.
Acute sinusitis rarely occurs without preceding symptoms of „a cold‟, and tenderness to
pressure of a whole quadrant of teeth is characteristic.
Periapical infection of premolar or molar teeth may lead to purulent discharge into the sinus
with associated pain.
A further consideration is the risk of penetration of the sinus wall or even the sinus lining by
endodontic instruments, or during apical surgery. This may result in acute sinusitis from
bacterial contamination.
Phenomena Complicating the Diagnosis of
Dental Pain
Spreading Pain
Inflammation progress & Chemical mediators lead to
spread to adjacent tissues accompanied by spread of pain
to wider area.
The Pain may not be localized because the origin is
somewhere within the area.
Masticatory dysfunction may occur spasm of
muscle of mastication pain (2ry spreading pain)
Phenomena Complicating the Diagnosis of
Dental Pain
Psychogenic Pain
Pain may originate in higher centers in the brain without
input from peripheral nerves, whoever the patient indicates
a painful site.
Patterns
– No identifiable origin
– Multiple (may be bilateral) pain sites
– No predictable response to therapy (especially analgesics)
– Unusual, inconsistent, nonanatomically logical pain patterns
– No demonstrable etiology for the pain
– Patient focus on social and emotional problems when giving their
history
Phenomena Complicating the Diagnosis of
Dental Pain
Headaches
Are the most common painful entities of the head and neck
Pain may referred to teeth
Classification
– Functional
Migraine headaches
Cluster headaches
Tension headaches
– Organic
Phenomena Complicating the Diagnosis of
Dental Pain
Functional Headaches
Causes: vascular, musculoskeletal, and emotional disturbances
Migraine Headaches
– Classic migraine is readily daignosd by unilateral throbbing
pain associated with photophobia and nausea
– History of recurrent episodes
– May refer to teeth (maxillary canines and premolars)
– Atypical variations may confuse diagnosis
Phenomena Complicating the Diagnosis of
Dental Pain
Functional Headaches
Cluster Headaches (sever pain)
– The pain is usually limited to the distribution of the 1st and
2nd divisions of the trigeminal nerve and may manifest in the
maxillary and occasionally the mandibular teeth.
– Patient may suffer from daily one hour episodes for 2-3
month period.
Phenomena Complicating the Diagnosis of
Dental Pain
Functional Headaches
Tension Headache
History
Ability to
Source of pain Character of pain Pain intensified by
localize
Evoked doesn't outlast
Dentinal Poor Hot, cold, sweet, sour
stimulus; brief
Usually
Mucosal Burning, sharp Sour, sharp, and hot food
good
Characteristics of Oral Pain
History
Source of pain Pain intensity Associated signs Pain duplicated by
Erosive or ulcerative
Mucosal Mild to moderate Palpation of lesion
lesions, redness
Summery
Summery
Demo: PainControl2009.pdf