TOOTHACHE
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.
Approach to the Diagnosis
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.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Dental symptoms
Read excerpts from these other book chapters related to Dental symptoms:
Medical Books Excerpts
- JAW PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- TOOTHACHE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Jaw pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Jaw pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Jaw pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Jaw pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Jaw pain
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- TOOTHACHE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Dental symptoms
» Next page: SWOLLEN GUMS AND GUM MASS (Differential Diagnosis in Primary Care)
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