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Differential diagnostics of pain in the Head and Neck region.

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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 difficult 7-10 = Severe pain: The pain is the strongest effect in your life

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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?

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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

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

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Pulpal pain Reversible 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 pain 2. 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

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Pulpal pain Irreversible alterations 1. 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

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Pulpal pain After 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 s submucosus abscessus - serious general and local inflammation, with symptoms - pain can eliminate by forming abscessus

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Jg -20 o C Spray -40 o C Sznsavh -70 o C

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TMI

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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.