Toothache , also known as toothache , is a toothache and/or supporting structure, caused by tooth disease or pain referred to the tooth by a non-dental disease. When it is severe it can have an impact on sleep, eating, and other everyday activities.
Common causes include pulmonary inflammation, usually in response to tooth decay, tooth trauma, or other factors, dentin hypersensitivity (short, sharp pain, usually associated with open root surface), apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the apex of the roots) , dental abscess (localized pus collection, eg apical abscess, pericoronal abscess, and periodontal abscess), alveolar osteitis ("dry socket", possible tooth extraction complications, loss of blood clots and bone exposure), acute ulcerative ulcerative gingivitis (gum infection , also called "trenchmouth"), temporomandibular disorders and others.
Pulpitis is classified as reversible when the pain is mild to moderate and lasts for a short time after the stimulus (eg, cold or sweet); or irreversible when the pain is severe, spontaneous, and lasts long after the stimulus. If left untreated, pulpitis may become irreversible, then develop into pulp necrosis (pulp death) and apical periodontitis. Abscesses usually cause pain to throb. Apical abscess usually occurs after pulp necrosis, pericoronal abscess usually associated with acute pericoronitis in lower wisdom teeth, and periodontal abscess is usually a complication of chronic periodontitis (gum disease). Less commonly, non-dental conditions can cause toothaches, such as maxillary sinusitis, which can cause pain in the upper back teeth, or angina pectoris, which can cause pain in the lower teeth.
Toothache is the most common type of pain in the mouth or face. This is one of the most common reasons for emergency dental appointment. Correct diagnosis can sometimes be challenging. Dental pain treatment depends on the exact cause, and may involve filling, root canal treatment, extraction, drainage of pus, or other remedial actions. Toothache relief is considered to be one of the primary dental responsibilities. In 2013, 223 million cases of dental pain occur due to dental caries in permanent teeth and 53 million cases occur in baby teeth. Historically, the demand for dental pain treatment is thought to have led to the emergence of dental surgery as the first specialty of medicine.
Video Toothache
Cause
Toothache can be caused by a dental condition ( odontogenic ) (such as those involving dentin-pulp or periodontium complexes), or by non-dental (< i> non-odontogenic ) conditions (such as maxillary sinusitis or angina pectoris). There are many possible non-dental causes, but most toothaches come from teeth.
Pulp and periodontal ligaments have nociceptors (pain receptors), but the pulp has no proprioceptors (mechanical receptors or position) and mechanoreceptors (mechanical pressure receptors). As a result, pain originating from the dentin-pulp complex tends to be less localized, whereas pain from the periodontal ligament will usually be well localized, though not always.
For example, a periodontal ligament can detect a given pressure when biting something smaller than a grain of sand (10-30 μm). When the tooth is intentionally stimulated, about 33% of people can correctly identify the teeth, and about 20% can not narrow the stimulus site to a group of three teeth. Another distinctive distinction between pulp and periodontal pain is that the latter is usually not exacerbated by thermal stimulation.
Dental
Pulpal
Most pulp toothaches fall into one of the following types; However, other rare causes (which do not always fit into this category) include galvanic pain and barodontalgia.
Pulpitis
Pulpitis (inflammation of the pulp) can be triggered by various stimuli (insults), including mechanical, thermal, chemical, and bacterial irritants, or rarely barometric changes and ionizing radiation. Common causes include tooth decay, tooth trauma (such as cracks or fractures), or filling with imperfect seals.
Since the pulp is encased in a rigid outer shell, there is no space to accommodate inflammation caused by inflammation. Inflammation therefore increases the pressure in the pulp system, potentially compressing the blood vessels that supply the pulp. It can cause ischemia (oxygen deprivation) and necrosis (tissue death). Pulpitis is called reversible when the inflamed pulp is able to return to a healthy state, and irreversible when pulp necrosis is inevitable.
Reversible pulpitis is characterized by short-term pain triggered by cold and sometimes heat. The symptoms of reversible pulpitis can be lost, either because the harmful stimulus is removed, such as when tooth decay is removed and replenishment is placed, or because a new layer of dentine (tertiary dentine) has been produced inside the pulp chamber, isolation against the stimulus. Irreversible pulpitis causes spontaneous or lingering pain in response to cold.
Dentin hypersensitivity
Dentin hypersensitivity is a sharp, short-lived dental pain that occurs in about 15% of the population, triggered by cold (such as liquid or air), sweet or spicy foods, and beverages. Teeth usually have some sensation for this trigger, but what separates the hypersensitivity from ordinary dental sensation is the intensity of the pain. Hypersensitivity is most often caused by a lack of isolation from a trigger in the mouth because a gingival recession (gums recedes) exposes the tooth root, although it can occur after scaling and root planing or teeth whitening, or as a result of erosion. The dental pulp remains normal and healthy on dentin hypersensitivity.
Many topical treatments for dentin hypersensitivity are available, including desensitizing toothpastes and protective varnishes that line open dentine surfaces. Treatment of root causes is very important, because topical actions are usually short. Over time, the pulp usually adapts to producing a new dentine layer inside the pulp chamber called tertiary dentine, increasing the thickness between the pulp and the open dentine surface and reducing hypersensitivity.
Periodontal
In general, chronic periodontal conditions do not cause pain. Rather, it is an acute inflammation responsible for pain.
Apical periodontitis
Apical periodontitis is an acute or chronic inflammation around the top of the tooth caused by the immune response to bacteria inside the infected pulp. This does not occur because of pulp necrosis, which means that the tooth tested as if vital may cause apical periodontitis, and the pulp becoming vital because sterile and non-infectious processes (such as trauma) may not cause apical periodontitis. The bacterial cytotoxin reaches the area around the tooth root through the apical foramen and lateral canal, causing vasodilation, nerve sensitization, osteolysis (bone resorption) and potentially abscess or cyst formation.
Periodontal ligaments become inflamed and there may be pain when biting or tapping. In X-rays, bone resporption appears as a radiolucent area around the root tip, although this does not immediately materialize. Acute apical periodontitis is characterized by local pain, spontaneous, persistent, moderate to severe. The alveolar process may be gentle to palpate over the roots. Teeth can be lifted in the socket and feel more prominent than the adjacent teeth.
Food impact
Food impaction occurs when food scraps, especially fibrous foods such as meat, are trapped between two teeth and pushed into the gums during chewing. The usual cause of food impaction is a normal interproximal contour interruption or dental drifting so that a gap is created (open contact). Decay may cause collapse of parts of the tooth, or dental restorations may not accurately reproduce the point of contact. Irritation, local discomfort or mild pain and pressure feeling from between two dental outcomes. Papilla gingiva is swollen, tender and bleeding when touched. Pain occurs during and after meals, and may slowly disappear before being resurrected to the next meal, or relieved immediately by using a toothpick or dental floss in the area involved. Gingival or periodontal abscesses can develop from this situation.
Periodontal abscess
Periodontal abscess (lateral abscess) is a collection of pus formed in the gingival cracks, usually as a result of chronic periodontitis in which the sac is pathologically deeper than 3mm. A healthy gingival pocket will contain bacteria and some calculus stored by the immune system. As the pouch deepens, the balance is disturbed, and the result of an acute inflammatory response, forms pus. The debris and swelling then disrupt the normal flow of fluid into and out of the pocket, rapidly accelerating the inflammatory cycle. Larger pockets also have a greater likelihood of collecting leftovers, creating additional sources of infection.
Periodontal abscesses are less common than apical abscesses, but they are frequent. The main difference between the two is that the tooth pulp tends to live, and will usually respond to the pulp test. However, untreated periodontal abscesses can still cause dead pulp if it reaches the apex of the tooth in a periodontic-endodontic lesion. Periodontal abscesses may occur as a result of tooth fracture, packing of food into periodontal pockets (with bad filling), calculus loading, and decreased immune response (as in diabetes). Periodontal abscess may also occur after periodontal scaling, which causes the gums to tighten around the teeth and catch debris in the pocket. Toothache caused by periodontal abscess is generally deep and pulsed. The oral mucosa that covers the initial periodontal abscess appears erythematous (red), swollen, shiny, and painful to the touch.
A variant of a periodontal abscess is a gingival abscess, limited to gingival margins, has a faster onset, and is usually caused by trauma from items such as fish bones, toothpicks, or toothbrushes, rather than chronic periodontitis. Periodontal abscess treatment is similar to general dental management (see: Treatment). However, since teeth usually live, there is no difficulty in accessing the source of infection and, therefore, antibiotics are more commonly used in conjunction with scaling and root planing. The occurrence of a periodontal abscess usually indicates an advanced periodontal disease, requiring proper management to prevent recurrent abscesses, including daily cleansing below the gum line to prevent plaque buildup and subgingival calculus.
Acute necrotizing ulcerative gingivitis
Common marginal gingivitis in response to subgingival plaque is usually a painless condition. However, the acute form of gingivitis/periodontitis, called acute necrotizing ulcerative gingivitis (ANUG), can develop, often suddenly. It is associated with severe periodontal pain, bleeding gums, "stressing" ulcers, loss of interdental papillae, and possibly halitosis (bad breath) and discomfort. Predisposing factors include poor oral hygiene, smoking, malnutrition, psychological stress, and immunosuppression. This condition is not contagious, but several cases can occur simultaneously in populations sharing the same risk factors (such as students in the dormitory during the examination period). ANUG is treated through multiple visits, first with necrotic gingival debridement, homecare with a hydrogen peroxide dye, analgesics and, when the pain has subsided considerably, it cleans beneath the gum line, both professionally and at home. Antibiotics are not indicated in ANUG management unless there is an underlying systemic disease.
Pericoronitis
Pericoronitis is an inflammation of the soft tissues around the crown of some erupted tooth. Lower wisdom teeth are the last tooth erupting into the mouth, and therefore, more often affected, or attached to other teeth. This makes the teeth partially erupted into the mouth, and there are often folds of gums (operculum), above the teeth. Bacteria and food waste accumulate under the operculum, which is a difficult area to keep clean because it is hidden and far behind the mouth. The opposite upper wisdom teeth also tend to have sharp and over-erupt bulges because they do not have opposing teeth to bite, and vice versa the trauma of the operculum further. Periodontitis and dental caries may develop in the third or second molar, and chronic inflammation develops in the soft tissues. Chronic pericoronitis may not cause pain, but episodes of acute pericoronitis are often associated with pericoronal abscess formation. The signs and symptoms of a typical pericoronal abscess include severe pulsed pain, which may spread to adjacent areas of the head and neck, redness, swelling and tenderness of the gums above the teeth. There may be trismus (difficulty opening the mouth), swollen face, and rub (flushing) of the cheek covering the jaw angle. People usually develop pericoronitis in late teens and early 20s, as this is the age of the wisdom teeth erupting. Treatment for acute conditions includes clearing the area under the operculum with antiseptic solutions, pain relievers, and antibiotics if indicated. After an acute episode has been controlled, definitive treatment is usually with tooth extraction or, less frequently, soft tissue is removed (operculectomy). If the tooth is stored, good oral hygiene is required to keep the area free of debris to prevent recurrence of infection.
Occlusal trauma
Occlusal trauma results from excessive biting of the teeth, which weigh on the periodontal ligament, causing periodontal pain and a reversible increase in tooth mobility. Occlusal trauma can occur with bruxism, parafunctional (abnormal) clenching and grinding the teeth during sleep or while awake. Over time, there may be friction (tooth wear), which can also cause dentine hypersensitivity, and possibly the formation of periodontal abscess, because occlusal trauma causes adaptive changes in the alveolar bone.
Occlusal trauma often occurs when newly placed dental restorations are built too "high", concentrating the strength of biting on one tooth. Differences in altitude less than one millimeter can cause pain. Dentists, therefore, routinely check that any new restorations aligned with bites and strengths are distributed correctly to many teeth using articulated paper. If the high point is quickly removed, the pain is gone and there is no permanent damage. Over-tightening braces can cause periodontal pain and, occasionally, periodontal abscesses.
Alveolar osteitis
Alveolar osteitis is a complication of tooth extraction (especially low wisdom teeth) in which the blood clot is not formed or lost, leaving the socket where the used tooth is empty, and the bone is open to the mouth. The pain is moderate to severe, and boring, sick, and throbbing in character. The pain is localized to the socket, and may spread. It usually begins two to four days after extraction, and can last 10-40 days. Healing is delayed, and treated with local anesthetic dressings, which are usually required for five to seven days. There is some evidence that chlorhexidine mouthwash is used before extraction prevents alveolar osteitis.
Combined pulpal-periodontal
Tooth trauma and cracked tooth syndrome
Cracked tooth syndrome refers to a series of highly varied pain sensitivity symptoms that may accompany tooth fracture, usually sporadic, sharp pain that occurs during biting or by releasing biting pressure, or decreases by releasing pressure on the teeth. This term falls into dislike and has given way to a more general description of fractures and tooth fractures, allowing for wide variations in signs, symptoms, and prognosis for traumatized teeth. Tooth fractures may involve enamel, dentine, and/or pulp, and can be oriented horizontally or vertically. Cracked or cracked teeth can cause pain through several mechanisms, including dentin hypersensitivity, pulpitis (reversible or irreversible), or periodontal pain. Thus, there is no single test or combination of symptoms that accurately diagnose fractures or cracks, although when pain can be stimulated by causing cusp tooth splitting, it is highly suggestive of the disorder. Vertical fractures can be very difficult to identify because cracks rarely can be checked or seen on radiography, because fractures run in the conventional film field (similar to how the split between two adjacent glass panels is not visible when facing them).
When toothache results from dental trauma (regardless of pulpal or periodontal diagnosis), treatment and prognosis depend on the extent of tooth decay, tooth development stage, displacement level or, when the teeth are avulsed, the timing out of the socket and the initial health of the tooth and bone. Due to the high variations in treatment and prognosis, dentists often use trauma guides to help determine prognosis and treatment decisions directly.
The prognosis for cracked teeth varies with extent of fracture. Cracks that irritate the pulp but do not extend through the pulp chamber are acceptable to stabilize dental restorations such as crowns or composite resins. If the fracture extends into the pulp chamber and to the root, the prognosis of the tooth is hopeless.
Periodontic-endodontic lesions
Apical abscesses may spread to involve periodontal pockets around the teeth, and periodontal pocket causes pulp necrosis through the accessory or apical foramen at the bottom of the tooth. These lesions are called periodontic-endodontic lesions, and they may be very painful, sharing the same signs and symptoms with periodontal abscesses, or they can cause mild pain or no pain at all if they are chronic and free to dry. Successful root canal therapy is required before periodontal treatment is attempted. Generally, the long-term prognosis of poor perio-endo lesions.
Non-dental
The cause of toothache is non-tooth is much more common than the cause of teeth. In toothache of neurovascular origin, pain is reported in the tooth along with migraine. Local and remote structures (such as the ear, brain, carotid artery, or heart) may also refer to dental pain. Other non-dental toothache causes include myofascial pain (muscle aches) and angina pectoris (which classically refers pain to the lower jaw). Very rarely, toothache can be psychogenic.
Maxillary sinus errors may be referred to upper back teeth. The superior posterior, middle and anterior alveolar nerves are all closely related to the sinus lining. The bone between the maxillary sinus floor and the root of the upper back teeth is very thin, and often these teeth disturb the sinus floor contours. As a result, acute or chronic maxillary sinusitis may be considered a maxillary toothache, and sinus neoplasms (such as adenoid cystic carcinomas) can cause the same toothache to be felt if a malignant invasion of the superior alveolar nerve occurs. Classically, sinusitis pain increases in the Valsalva maneuver or tilts the head forward.
The painful condition that does not originate from the tooth or its supporting structure can affect the oral mucosa of the gums and is interpreted by the individual as a toothache. Examples include gingival or alveolar mucosal neoplasms (usually squamous cell carcinomas), conditions that cause gingivostomatitis and desquamative gingivitis. Various conditions may involve the alveolar bone, and cause non-odontogenic toothache, such as Burkitt's lymphoma, jaw infarction caused by sickle cell disease, and osteomyelitis. Various trigeminal nerve conditions can masquerade as toothache, including trigeminal zoster (maxillary or mandibular division), trigeminal neuralgia, cluster headache, and trigeminal neuropathy. Very rarely, a brain tumor can cause toothache. Another chronic pain syndrome that may resemble a toothache is a temporomandibular disorder (joint pain syndrome joint dysfunction), which is very common. Toothaches that do not have identifiable dental or medical causes are often called atypical odontalgia, which, in turn, are usually regarded as a type of atypical facial pain (or persistent idiopathic facial pain). Atypical odontalgia can present very unusual symptoms, such as pain that move from one tooth to another and across the anatomical boundary (such as from the left to right teeth).
Establishing a diagnosis of a nondental toothache is initially done by asking cautiously about the location, nature, aggravating and eliminating factors, and pain referral, then overriding the cause of the tooth. There is no special treatment for nondental pain (each treatment is directed at the cause of pain, rather than toothache itself), but the dentist can assist in offering a potential source of pain and directing the patient to proper care. The most important nondental sources are radiation angina pectoris to the lower teeth and the potential need for urgent heart care.
Maps Toothache
Pathophysiology
The tooth consists of the outer shell of the calcified hard tissue (from the hardest to the softest: enamel, dentine, and cementum), and the inner soft tissue core (pulp system), which contains nerves and blood vessels. The tooth part is visible in the mouth - the crown (covered by enamel) - anchored to the bone by the root (covered by cementum). Below cementum and enamel layers, dentine forms most of the tooth and surrounds the pulp system. The portion of the pulp inside the crown is the pulp chamber, and the soft tissue nutrient ducts within each root are the root canals, coming out through one or more holes at the root end (foramen apikal/foramina). Periodontal ligaments connect the roots to the bone socket. Gingiva covers the alveolar process, the jaw arches.
Enamel is not a vital tissue, because it has no blood vessels, nerves, and living cells. As a result, pathological processes involving only enamel, such as shallow or cracked cavities, tend not to cause pain. Dentine contains many fluorescent microscopic tubes and odontoblast cell processes, which communicate with the pulp. Mechanical, osmotic, or other stimuli cause the movement of this fluid, triggering the nerves in the pulp ("hydrodynamic theory" of pulp sensitivity). Because of the close relationship between dentine and pulp, they are often considered shared as a dentin-pulp complex .
Teeth and gums show a normal sensation in health. Such sensations are generally sharp, lasting during the stimulus. There is a continuous spectrum of physiological sensations to pain in disease. Pain is an unpleasant sensation caused by intense or destructive events. In toothache, the nerves are stimulated by exogenous sources (eg, bacterial toxins, metabolic byproducts, chemicals, or trauma) or endogenous factors (such as inflammatory mediators).
The pain track is mostly transmitted through myelinated A? (Sharp or piercing pain) and non-bermyelin C nerve fibers (slow, dull, sick, or burning pain) of the trigeminal nerve, which supplies sensations to the teeth and gums through multiple divisions and branches. Initially, pain is felt when dangerous stimuli are applied (such as cold). Continuous exposure lowers the threshold of nerve shooting, allowing a usually painless stimulus to trigger pain (allodynia). If contempt continues, harmful stimuli result in greater release in the nerves, perceived as a greater pain. Spontaneous pain can occur if the shooting threshold decreases so it can burn without stimulus (hyperalgesia). The physical component of pain is processed in the spinal cord and is felt in the frontal cortex. Because the perception of pain involves overlapping sensory systems and emotional components, individual responses to identical stimuli vary.
Diagnosis
Diagnosis of toothache can be a challenge, not only because of a broad list of potential causes, but also because toothaches may vary widely, and pain can be referred and from teeth. Tooth pain can simulate almost all facial pain syndromes. However, most toothaches are caused by tooth sources, not teeth. As a result, the saying "horse, not zebra" has been applied to the differential diagnosis of orofacial pain. That is, the causes of daily tooth (such as pulpitis) should always be considered before unusual non-dental causes (such as myocardial infarction). In the wider context of orofacial pain, all cases of orofacial pain may be considered to have a tooth origin until proven otherwise. The diagnostic approach to dental pain is generally done in the following order: history, followed by examination, and investigation. All of this information is then collected and used to build a clinical picture, and differential diagnosis can be done.
Symptoms
The main complaints, and the onset of complaints, are usually important in the diagnosis of toothache. For example, key differences between reversible and irreversible pulpitis are given in history, such as pain after stimulus in the first, and lingering pain after stimulus and spontaneous pain in the latter. History is also important in recent filling or other dental care, and trauma to the teeth. Based on the most common causes of dental pain (dentin hypersensitivity, periodontitis, and pulpitis), key indicators become the localization of pain (whether the pain is thought to be from a particular tooth), thermal sensitivity, pain during bite, spontaneity of pain, and factors making the pain worse. Various qualities of toothache, such as the effects of biting and chewing pain, the effects of thermal stimulation, and the effects of sleeping pain, are orally established by doctors, usually systematically, such as using Socrates' pain assessment method (see table).
From history, pulp indicators, periodontals, combinations of both, or non-dental causes can be observed. Periodontal pain is often localized to certain teeth, which is exacerbated by biting teeth, suddenly in onset, and associated with bleeding and pain when brushing. More than one factor may be involved in toothache. For example, pulp abscesses (which are usually severe, spontaneous and localized) can cause periapical periodontitis (which causes pain when biting). Cracked tooth syndrome can also cause a combination of symptoms. Lateral perioditis (usually without heat sensitivity and sensitivity to biting) can cause pulpitis and teeth to be sensitive to cold.
The source of non-tooth pain often causes many sick teeth and has an epicenter above or below the jaw. For example, heart pain (which can make lower teeth pain) usually radiates upward from the chest and neck, and sinusitis (which can make the back teeth hurt) is aggravated by bending. Since all of these conditions may resemble a toothache, it is possible that dental care, such as patching, root canal treatment, or tooth extraction may be undertaken unnecessarily by the dentist in an attempt to relieve the pain of the individual, and as a result the correct diagnosis. postponed. A sign is that there is no obvious cue tooth, and signs and symptoms elsewhere in the body may exist. Since migraines are usually present for many years, the diagnosis is easier to make. Often the character of pain is the difference between dental pain and non-teeth.
Irreversible pulpitis develops into pulp necrosis, where the nerves do not work, and the pain-free period after severe pain from irreversible pulpitis can be experienced. However, it is common for irreversible pulpitis to develop into apical periodontitis, including acute apical abscess, without treatment. As irreversible pulpitis produces an apical abscess, the character of a toothache can only change without a pain-free period. For example, the pain becomes well localized, and biting teeth becomes painful. Hot drinks can make teeth feel worse as they expand the gas and also, the cold can make it feel better, so some people will sip cold water.
Checkout
Clinical examination narrows the source to a particular tooth, tooth, or non-tooth cause. Clinical examination moves from the inside out, and from the general to the specific. Outside the mouth, sinus, facial and neck muscles, temporomandibular joints, and cervical lymph nodes palpated for pain or swelling. In the mouth, the soft tissues of the gingiva, mucosa, tongue, and pharynx are examined for redness, swelling or deformity. Finally, the tooth is checked. Each diseased tooth is clothed (tapped), palpated at the root base, and examined by tooth explorers for dental caries and periodontal probe for periodontitis, then stretched for mobility.
Sometimes symptoms reported in history are misleading and direct the examiner to the wrong mouth area. For example, sometimes people may mistake pain due to pulpitis in the lower teeth as pain in the upper teeth, and otherwise . In other cases, clear examination findings can be misleading and lead to false diagnoses and incorrect treatment. The pine from the pericoronal abscess associated with the lower third molar may flow along the submucosal plane and discharge of fluid as a parulis above the root of the tooth toward the front of the mouth ("migration abscess"). Another example is tooth root decay which is hidden from view below the gum line, giving a casual look of healthy teeth if careful periodontal examination is not performed.
Factors that indicate infection include fluid movement in the tissues during palpation ( fluctuation ), swollen lymph nodes in the neck, and fever with mouth temperature greater than 37.7 Ã, Â ° C.
Investigation
Each identified tooth, either in a history of pain or a basic clinical examination, as a source for toothache may undergo further testing for the vitality of the dental pulp, infection, fracture, or periodontitis. These tests may include:
- The pulp susceptibility test, usually done with cotton wool pledget sprayed with ethyl chloride for use as a cold stimulus, or with an electric pulp tester. Air spray from three-in-one syringe can also be used to indicate areas of dentin hypersensitivity. Hot tests can also be applied with hot Gutta-percha. A healthy tooth will feel cold but the pain will feel light and disappear once the stimulus is removed. The accuracy of these tests has been reported as 86% for cold testing, 81% for electrical pulp testing, and 71% for heat testing. Due to a lack of test sensitivity, a second symptom should be present or a positive test before making a diagnosis.
- Radiography is used to find dental caries and bone loss laterally or at the peak.
- Individual teeth biting (which sometimes helps localize the problem) or separate valves (may help detect cracked crack syndrome).
Less commonly used tests may include trans-illumination (to detect maxillary sinus congestion or to highlight dental cracks), dyes (to help visualize cracks), test cavities, selective anesthesia and laser doppler flowmetry.
Differential diagnosis
When it becomes very painful and rotting, the teeth can be known as hot teeth.
Prevention
Since most toothaches are the result of plaque-related diseases, such as tooth decay and periodontal disease, the majority of cases can be prevented by avoiding cariogenic diets and maintaining good oral hygiene. That is, a reduction in the number of times the purified sugar is consumed per day and brushing twice a day with fluoride and flossing paste. Regular visits to the dentist also increase the likelihood that problems are detected early and avoided before a toothache occurs. Dental trauma can also be significantly reduced with regular use of mouthguard in contact sports.
Management
There are many causes of toothache and the diagnosis is a specialist topic, which means that a dentist's presence is usually necessary. Because many cases of dental pain are inflammatory, non-steroidal anti-inflammatory drugs (NSAIDs) may help (except contraindications, such as with peptic ulcers). Generally, NSAIDs are as effective as aspirin alone or in combination with codeine. However, simple analgesics may have little effect on some causes of toothache, and severe pain may encourage individuals to exceed the maximum dose. For example, when acetaminophen (paracetamol) is taken for toothache, an accidental overdose is more likely when compared to people taking acetaminophen for other reasons. Another risk in people with toothache is painful chemical burns of the oral mucosa caused by holding caustic substances such as aspirin tablets and dentifrice drugs containing eugenol (such as clove oil) against chewing gum. Although the logic of placing tablets against painful teeth is understandable, aspirin tablets need to be swallowed to have pain-relieving effects. The caustic toothache drug requires careful application of the tooth alone, without too much contact with the soft tissues of the mouth.
For dentists, the goal of treatment is generally to relieve pain, and as much as possible to maintain or restore function. Treatment depends on the cause of toothache, and often clinical decisions about the current state and the long-term prognosis of affected teeth, as well as the individual's desire and ability to cope with dental care, will influence treatment options. Often, intra-oral local anesthesia such as lidocaine and epinephrine are indicated for painless treatment. Treatment can range from simple suggestions, removal of tooth decay with dental drill and filling placement, root canal treatment, tooth extraction, or debridement.
Pulpitis and its sequel
In pulpitis, an important difference in treatment is whether inflammation is reversible or irreversible. Reversible pulpitis treatment is to eliminate or correct the underlying cause. Usually, the decomposition is removed, and the tamper is used to push the pulp to return to a healthy state, either as a base under permanent filling or as a temporary charge intended to last for the period while the tooth is observed see if pulpitis is lost. Irreversible pulpitis and its sequelae pulp necrosis and apical periodontitis require treatment with root canal therapy or tooth extraction, since the pulp acts as a nidus of infection, which will lead to chronic infection if not removed. In general, there is no difference in outcomes between whether root canal treatment is completed in one or more appointments. The regenerative endodontic field is now developing ways to clear the pulp chamber and regenerate soft and hard tissues to regenerate or simulate pulp structures. This has proven to be very helpful in children where dental roots are not yet developed and root canal treatment has a lower success rate.
Reversible/irreversible pulpitis is a different concept than whether the teeth are restored or can not be underestimated, eg. the tooth may have only reversible pulpitis, but structurally it has been weakened by decay or trauma at the point that it is impossible to return the tooth in the long run.
Tooth abscess
The general principle of dental abscesses is yam pus, ibi evacua ("where there is pus, drain"), which applies to any case where there is a collection of pus in the tissues (such as periodontal abscess, pericoronal abscess, or apical abscess). The pine in the abscess is under pressure, and the surrounding tissue changes shape and stretches to accommodate the swelling. This causes a throbbing sensation (often with a pulse) and constant pain. The pine can be evacuated through the tooth by drilling into the pulp chamber (endodontic access cavity). Such treatment is sometimes called open drainage. Drainage can also be done through tooth socket, after which the extracted tooth is extracted. If neither of these measures succeeds, or is unlikely, incision and drainage may be required, where a small incision is made in the soft tissue directly above the abscess at the most dependent point. Surgical devices such as a pair of tweezers are gently inserted into the incision and opened, while the abscess is massaged to push pus outward. Usually, pain reduction when the pus channel immediately and marked as pressure is built relieved. If pus flows into the mouth, there is usually a bad or offensive taste.
Antibiotics
Antibiotics tend to be widely used for emergency dental problems. As a sample for microbiological culture and sensitivity that is almost never done in general dentist practice, broad-spectrum antibiotics such as amoxicillin are commonly used for short courses of about three to seven days. Antibiotics are seen as "quick fixes" by both dentists, who generally have only a very short time to deal with dental emergencies, and by patients, who tend to avoid treatment (such as tooth extractions) that are considered negative. However, antibiotics usually only temporarily suppress infections, and the need for definitive treatment is only postponed for an unpredictable period. It is estimated that 10% of all antibiotic prescriptions are made by the dentist, a major factor in antibiotic resistance. They are often used improperly, under ineffective conditions, or their risks outweigh the benefits, such as irreversible pulpitis, apical abscesses, dry sockets, or mild pericoronitis. However, the fact is that antibiotics are rarely needed, and they should be of limited use in dentistry. Local measures such as incision and drainage, and removal of infectious causes (such as necrotic tooth pulp) have a greater and far more important therapeutic benefit. If abscess drainage has been achieved, antibiotics are usually unnecessary.
Antibiotics tend to be used when local action can not be done immediately. In this role, antibiotics suppress infections until local action is feasible. Severe trismus can occur when chewing muscles are involved in odontogenic infections, making any surgical treatment impossible. Individuals are immunocompromised less able to fight infection, and antibiotics are usually given. Evidence of systemic involvement (such as fevers higher than 38.5 ° C, cervical lymphadenopathy, or malaise) also indicates antibiotic therapy, as well as rapid spread of infection, cellulitis, or severe pericoronitis. Eating saliva and difficulty swallowing are signs that the airway can be threatened, and may precede breathing difficulties. Ludwig's angina and cavernous sinus thrombosis are rare but serious complications of odontogenic infections. Severe infections tend to be managed in hospitals.
Prognosis
Most dental pain can be treated with routine dentistry. In rare cases, toothache can be a symptom that represents life-threatening conditions, such as deep neck infections (airway compression by the spread of odontogenic infections) or something more distant like a heart attack.
Dental caries, if left untreated, follows a predictable natural history as it approaches the dental pulp. First it causes reversible pulpitis, which transitions into irreversible pulpitis, then becomes necrosis, then becomes necrosis with periapical periodontitis and, finally, becomes necrosis with periapical abscess. Reversible pulpitis can be stopped by removing the cavity and placement of the tranquilizers of any portion of the cavity close to the pulp chamber. Irreversible pulpitis and pulp necrosis are treated with therapy or root canal extraction. Periapical tissue infections will usually improve with pulp treatment, unless it has spread to cellulitis or radicular cysts. The success rate of restorative treatment and sedative sedation in reversible pulpitis, depending on the extent of the disease, as well as some technical factors, such as the tranquilizers used and whether the rubber dam is used. The success rate of root canal treatment also depends on the level of disease (root canal therapy for irreversible pulpitis has a higher success rate than necrosis with periapical abscess) and many other technical factors.
Epidemiology
In the United States, about 12% of people report that they experience toothache at some point within six months before being questioned. People aged 18-34 report higher dental pain than those aged 75 and older. In a survey of Australian schoolchildren, 12% had had a toothache before the age of five, and 32% at age 12. Dental trauma is very common and tends to occur more frequently in children than adults.
Toothache can occur at any age, in any gender and in any geographic area. Diagnosing and relieving toothache is considered one of the primary dental responsibilities. Irreversible Mimbsi is considered the most common reason people seek emergency dental care. Because dental caries associated with pulpitis is the most common cause, toothache is more common in populations at higher risk of dental caries. The prevalence of caries in a population depends on factors such as diet (refined sugars), socioeconomic status, and fluoride exposure (such as areas without water fluoridation).
History, community and culture
The first mention of teeth and toothache is known to occur on Sumerian clay tablets now referred to as the "Worm Legend". It was written in a tapered, recovered from the valley of Euphrates, and dating from about 5000 BC. The belief that tooth decay and toothaches were caused by the worms found in ancient India, Egypt, Japan, and China, and continued into the Age of Enlightenment. Although toothaches are an ancient problem, it is thought that ancient people suffered less tooth decay due to lack of refined sugar in their diet. On the other hand, diets are often more rough, causing more tooth decay. For example, the hypothesis states that the ancient Egyptians had many teeth that were used because of the desert sand blown by the wind mixing with their bread dough. The ancient Egyptians also wore a talisman to prevent toothache. The Ebers papyrus (1500 BC) details the recipe for treating "gnawing blood in the teeth", which includes the fruits of the gust plants, onions, cakes, and dough, to chew for four days.
Archigenes of Apamea describes the use of mouthwashes made by boiling gallnuts and hallicacabum in vinegar, and a mixture of roasted earthworms, spikenard ointment, and spider crushed eggs. Pliny advised dental pain sufferers to ask frogs to relieve pain with moonlight. Doctor Claudius, Scribonius Largus recommends "fumigation made with hyocyamus seeds scattered on burning charcoal... followed by mouth rinse with hot water, in this way... small worms are removed."
In Christianity, Saint Apollonia is the patron saint of toothaches and other dental problems. He was an early Christian martyr who was persecuted for his convictions in Alexandria during the Roman Empire. A mass hit him repeatedly in the face until all his teeth were destroyed. He was threatened with being burned alive unless he abandoned Christianity, but instead chose to throw himself into the fire. Supposedly, the dental sufferer who calls his name will feel relieved.
In the 15th century, priest-doctor Andrew Boorde described the "deworming technique" for teeth: " And if that [toothache] comes with a worm, make a candle wax with Henbane seeds and turn it on and let its perfume from the wax go into the tooth and gawk at a plate of cold water and then you can take the worms out of the water and kill them in your nails. "
Albucasis (Abu al-Qasim Khalaf bin al-Abbas Al-Zahrawi) uses a cauter for toothache, inserting a hot red needle into the dental pulp. The medieval surgeon Guy de Chauliac used a mixture of mothballs, sulfur, nuts, and asafetida to fill the teeth and cure the worm gear and toothache. French anatomist Ambroise ParÃÆ' Â © recommend: "Toothache, of all others, the most terrible pain that can torture a person, followed by death Erosion (ie tooth decay) is the effect of acute and sharp humor. To Fight this, one must seek castration... by using cautery... one burns the nerves, thus making it incapable of feeling or causing pain. "
In the Elizabethan era, toothache is a disease associated with lovers, as in the game Massinger and Fletcher The False One . Toothache also appears in a number of William Shakespeare's dramas, such as Othello and Cymbeline . In Lots of Ado About Nothing , Round III scene 2, when asked by his colleagues why he feels sad, the character replies that he has a toothache so it does not recognize the truth that he is in love. There is a reference to "toothworm" as the cause of toothache and tooth extraction as a drug ("picture"). In Act V, scene 1, another character statement: "Because no philosopher has ever been able to bear a toothache patiently." In modern language, this translates to the observation that philosophers are still human and feel pain, even though they claim they have surpassed human suffering and misfortune. As a result, the character rebuked his friend for trying to make him feel better with philosophical words.
The Scottish poet, Robert Burns wrote "Address to the Toothache" in 1786, was inspired after he suffered from it. The poem describes the toughness of a toothache, describing it as a "hellish disease" (hell all disease).
A number of plants and trees include "toothache" in their common name. Prickly ash (Zanthoxylum americanum) is sometimes called "toothache tree", and its skin, "toothache bark"; while Ctenium Americanum is sometimes called "grass toothache", and Acmella oleracea is called "toothache plant". Pellitory (Anacyclus pyrethrum) is traditionally used to relieve toothache.
In Kathmandu, Nepal, there is a temple for Vaishya Dev, the god of Newar's toothache. The temple is made up of parts of an old tree where the toothache sufferers nail the rupee coins to ask the gods to relieve their pain. The wooden lump is called "tree teeth" and is said to have been cut from the legendary tree, Bangemudha. On this road, many traditional dental pullers are still working and many urban dentists put an ad next to the tree.
The phrase toothache in the bone is sometimes used to describe pain in some types of diabetic neuropathy.
Note
References
External links
- Definition of dictionary from tootache in Wiktionary
- WebMD Dental Health & amp; Toothache
- Mayo Clinic Toothache First Aid
- US. National Medical Library: Toothache
Source of the article : Wikipedia
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