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
- 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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