Toothache, or toothache, is one of the most common symptoms of dental disease in dentistry. Many dental diseases can cause toothache, and common are dental caries, acute pulpitis, chronic pulpitis, periodontitis, and gingivitis. In addition, certain neurological diseases, such as trigeminal neuralgia, peripheral facial neuritis, etc.; some chronic diseases of the body, such as hypertensive patients with pulp congestion, diabetic patients with pulp vascular inflammation and necrosis can cause toothache.
Cause of toothache
Infection is the main cause. The infection can be secondary to deep squats and other serious tooth defects. It can also occur due to periodontal tissue disease. The infection is retrograde into the pulp through the apical or accessory root canal, causing inflammation of the pulp. At the same time, blood-borne infections can also cause, the drugs used to treat the cavity when squatting, will stimulate the pulp, causing acute pulpitis, when using high-speed wind-driven electrical rotation when grinding teeth, when the local temperature exceeds the pulp tissue The tolerance (20-50 °C) can make the pulp tissue congestive and inflamed. Therefore, it is necessary to use cooling measures when using dental drills. When the teeth are traumatized, it can cause acute pulpitis.
Oral endoscopic oral X-ray examination of children's caries prevention and care of dental pulp electrical activity determination of pulp temperature test (cold fever diagnosis)
Pain is the main manifestation of it. It is characterized by severe and unbearable pain. The nature of pain has the following characteristics: spontaneous pain, paroxysmal aggravation, intermittent seizures, severe pain in the teeth without any external stimulation. Early pain onset time is short, and remission time is longer. As the disease progresses, the pain is prolonged in the late stage, the remission time is shorter, and finally there is no remission period; the nighttime pain is heavier than the daytime, especially when lying down; Cold and hot stimuli can cause pain, and late cold stimulation not only does not stimulate pain, but temporarily relieves pain. Therefore, patients with clinical common mouths contain cold water or cold air to relieve pain. People often say that "toothache is not a disease, it hurts to kill people." ", refers to the symptoms of advanced period of acute pulpitis (suppurative phase); in addition, the pain can not be located, often along the trigeminal nerve distribution area to the ipsilateral upper and lower jaw teeth and adjacent sites, patients often can not point out the exact location of the diseased teeth .
Differential diagnosis of toothache
1, trigeminal neuralgia: three branches of the trigeminal nerve distributed in the forehead, upper jaw, jaw skin and upper and lower gums. Trigeminal neuralgia often manifests as upper and lower jaw, facial pain and even toothache. Timely identification of toothache and trigeminal neuralgia is very important for treatment.
Analgesic effect: If the toothache does not improve after taking the ordinary painkiller, it can be ruled out that it is inflammatory pain of the teeth, but nerve pain.
Local manifestations: Cavities, periodontitis and other related inflammations can cause toothache to be a persistent episode, which can be aggravated by cold and heat. If the teeth do not have the above performance but are still painful, it may be caused by trigeminal neuralgia.
The nature of pain: the pain caused by inflammation of the teeth usually shows persistent pain, and the trigeminal neuralgia often has no aura at the time of the attack, but the sudden lightning is like a knife, a burning, acupuncture, an electric shock, and it is extremely unbearable. It usually lasts for a few seconds and it is unbearable to make several episodes a day. Sometimes you can find the "trigger point", the trigger point, which can cause painful episodes, but the attack just past, and then stimulate the "trigger point" does not cause an attack.
2, acute pulpitis: more common in patients with deep molars, the bacteria from the cavity into the pulp cavity, causing congestion and inflammation of the teeth. Toothache is often spontaneous, and the pain at night is aggravated. The pain is more severe after hot and cold stimulation. Pain can also be radiated to the face, ankles and ears. In the case of suppurative pulpitis, the patient experiences heat irritation and the pain is aggravated, while the cold irritation pain is reduced or disappeared.
3, acute apical inflammation: caused by the development of acute pulpitis or trauma and other factors. The sick tooth is persistently painful, has a floating feeling, and does not dare to chew. The patient can correctly point out the sick tooth. For example, if the sick tooth is damaged, the nerve is necrotic and there is no stimulating pain.
4, acute periodontitis: the nature of toothache is similar to acute periapical inflammation. The sick teeth not only have chewing pain and floating feeling, but also have formed periodontal pockets and loose teeth. Repeated swelling and bleeding can occur in the gum tissue.
5, periodontal abscess: further development of periodontal tissue inflammation can cause suppurative inflammation. Pain is severe when the abscess is formed, and local fluctuations occur after the abscess is formed. After the formation of periodontal abscess, the pain can be significantly alleviated or alleviated.
6, tooth allergy: often due to gum atrophy, tooth neck dentin exposure and tooth defects. At this time, cold, heat, sweetness, acid and other stimuli can cause pain, but the pain can disappear after the stimulation stops.