Differential diagnostics of pain in the Head and Neck region.

Detecting, monitoring pain

• Which number sign of your pain? • Which number represent the pain strongest and lightness

cases?Which number represent the pain now?

• Which number represent the tolerable level of pain?• 0 = No pain

1-3 = Mild pain: Only a little modify the everyday life 4-6 = Middle pain: Every day life much more difficult7-10 = Severe pain: The pain is the strongest effect in your life

Important questions• Localization• When started?• How changed it?• Is there any change of intensity in a time of day?• Continious or fluctuating the pain?• What kind of your pain? Sharp or blunt, deep or

superficial, convulsive, burning? • When stronger the pain? Moving, sitting, in bed,

bend forward, sport?• Which factors can eliminate the pain : hot, cold,

drogs, massage?

Examination

• Extraoral and intraoral inspectio. Signs of the inflammation. Tumor calor, rubor, functio laesa.

• Palpation of the laesion, lymphatic nodes, TMJ, periapical areas

• Biting, cold, hot, percussion, bend forward

Caries

Pain - food penetration - esthetic disorder - bad smell and taste - gingivitisBig lesion - X-ray, fiberoptic - change of tha approximal contour

Pulpal painReversible alteration in the pulp :1. Before pulpitis (hyperaemic pain)

- sharp pain for stimuli. It stop immediately when the stimulus stop.- hot cold and osmotic sensitivity

no spontaneous and night pain2. Reversible acute pulpitis (partial, serous)

- spontaneous and stimulated pain with sharp caracter, wich no eliminate immediately after stimuli stop radiating pain, hard to localisation

- no sensitivity to percussion- more sensitive to cold- no pain at night

Pulpal painIrreversible alterations1. Irreverzible acute pulpitis

- specific pain for pulpitis, mainly at night, radiating pain- pain for percussion, and biting- more sensitive for hot (purulent)

2. chronic pulpitis- mild, long time pain with billowy charecter (hot!)- pulpitis chr. ulcerosa, polyposa

3. Gangraena of the pulp (simplex or complicata)- No spontaneous pain, but sensitivity for hot and percussion

Pulpal painAfter gangrena:1. Periodontitis acuta (parodontitis apicalis acuta)

- spontaneous pain and sensitivity for biting, well localisation (it seems longer than the other tooth)

- discoloration, sensitivity for hot, but not alive - we can see symtoms of general inflammation

2. Periodontitis chronica (parodontitis apicalis chronica)- discolorated, non vital, no symptoms, but X-ray!- fistula and focal infection can appear

3. Periostitis és submucosus abscessus- serious general and local inflammation, with symptoms- pain can eliminate by forming abscessus

Jég -20oCSpray -40oCSzénsavhó -70oC

TMI

The burning mouth syndrome

• Long history (months, years) of burning sense and pain mainly on the tongue (just like scald with something –without pyhisical injuries).

• The patients are mainly women after menopause. • No visible alteration exept of less saliva, thin

mucosa.• Reasons are unclear. (immune-hormone-nerve

system)• Therapy B vitamins, reassurance.