Toothache is included here not only because dentists might read this book but also because physicians are occasionally called on to manage toothache until a dentist can be reached. A histologic analysis of the tooth and surrounding structures will supply the differential diagnosis. Most commonly, the pulp may be exposed by dental caries, but then the pain is intermittent. When the pulp is infected (pulpitis) the pain is continuous, and the pulp may subsequently become abscessed. The periapical tissue may be inflamed, and an alveolar abscess may ensue. Finally, osteomyelitis of the jaw or maxillary bones may occur. The gingiva may be inflamed, and pyorrhea will result. What is often not appreciated by physicians is that the tooth can be sore and inflamed without objective evidence on examination. A common cause of this situation is a filling that is close to or in apposition with the pulp. Referred pain is as important here as it is in other structures of the head. Thus, sinusitis, otitis media, and temporomandibular joint disease may cause pain in the tooth. Trigeminal neuralgia and other neurologic disorders must occasionally be considered.
This is simple. Refer the patient to a dentist. If infection is suspected, an antibiotic may be started if there is a delay in getting an appointment. If the dentist cannot find the cause, referral to a neurologist is appropriate.
Review other book chapters online related to Dental caries:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8 
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