What are some causes of orofacial pain
- maxillary sinusitis
- TMJ
- angina pectoris
- referred pain
- **trigeminal neuralgia
- herpes zoster
- cluster headaches
- hutchinson’s sign**
Where does dental pain of pulpal origin come from
nerve, vascularized connective tissues
pulpalgia: inflammatory changes to pulp
What are some periodontal origins of dental pain
gingivitis, periodontitis, acute periodontal abscess
What are some post-extraction complications (dental)
- infection
- bleeding
- pain
- swelling
- dry socket
How do you treat dry socket
anesthesia, irrigation, packing, pain meds
How is enamel repaired/rejuvinated
With fluoride
Describe the 3 major layers of a tooth and what is inside
Enamel, dentine, pulp cavity
in the pulp cavity: root canal, nerve & blood vessels
What is the function of the gums
keep tooth in place and to prevent cavities to the underlying dentine from food/microbes
What are the tissues that make up the periodontium
gingiva, periodontal ligament, alveolar bone
What is the function of saliva
- natural defense against cavities
- removes carbs & neutralizes low pH caused by acid formation
Describe the diagnostics for dental concerns
Attempt to replicate dental symptoms
- percuss with tongue depressor
- palpate
- thermal (ice water)
- biting pressure
(put gloves on and then wash them off so they don’t taste gross)
When should kids first go to the dentist
- 6 mos (with a tooth)
- eruption of first tooth
- or when they can sit up in the chair
What can you store an avulsed tooth in
- milk
- saline
- mouth
- NOT WATER
Describe the sxs of dry socket
- loss of clot/exposed bone in socket
- usually mandibular molars
- increase in acute throbbing pain after 2-5 days
- pain radiating to ear
- analgesics ineffective until irrigation procedure/packing done
- fetid odor
What are some oral pathologies related to derm
- pyogenic granuloma
- oral leukoplakia
- SCC
- angular cheilitis
- tumors of the mucosa
- HSV 1
Describe the etiology of pulpalgia
Inflammatory changes to pulp
Secondary to dental caries, cracked teeth, trauma, hyperocclusion (high filling), recent dental restorations
Describe the clinical presentation of pulpalgia
Reversible: sharp hypersensitive reaction precipitated by thermal stimulus or function
Irreversible: prolonged, unstimulated, spontaneous, pain persisting after removal of thermal stimulus
Describe the etiology/RF for dental caries
Aka tooth decay
Bacterial infection, commonly strep mutans causing destruction of the calcified tooth structure
Can lead to rampant decay (RF: children, vasoconstricting drugs, dry mouth)
Describe the clinical presentation of dental caries
3 stages
1. Early: within enamel, reversible with fluoride, watch tooth in adults or fill in kids/people who don’t go to the dentist often
2. In dentine layer: needs filling, +/- symptoms
3. Into pulp: toothache, requires extraction or root canal
Describe the treatment for dental caries
Fluoridated toothpaste, fillings, extraction or root canal
Extensive treatment for rampant decay
Refer to dentists
Give NSAIDs (ibuprofen 400mg q 6hr)
Describe the treatment for a tooth avulsion
Wash then reposition or bite gauze until dental consult, can store in milk, saline, mouth, avoid water
Emergency dental tx within 1 hr
Tetanus booster, systemic abx (penicillin, amoxicillin)
Describe the clinical presentation of dental abscesses
Acute pain to palpation, fluctuant mass, purulent exudate, bad taste in mouth
+/- sinus tract coming out to the cheek
Describe the treatment for a dental abscess
Abx (PCN, amoxicillin), pain meds, I&D if appropriate
Dental consult
Describe the etiology of odontogenic space infection
Can be secondary to an untreated dental abscess, usually from a mandibular molar
Sublingual, submandibular, and bilateral buccal space infections at the same time
