Transcript Pain
Differential diagnostics of pain in the Head and Neck region. Detecting, monitoring pain • Which number sign of your pain? • Which number represent the pain strongest and lightness cases? Which number represent the pain now? • Which number represent the tolerable level of pain? • 0 = No pain 1-3 = Mild pain: Only a little modify the everyday life 4-6 = Middle pain: Every day life much more difficult 7-10 = Severe pain: The pain is the strongest effect in your life Important questions • • • • • • Localization When started? How changed it? Is there any change of intensity in a time of day? Continious or fluctuating the pain? What kind of your pain? Sharp or blunt, deep or superficial, convulsive, burning? • When stronger the pain? Moving, sitting, in bed, bend forward, sport? • Which factors can eliminate the pain : hot, cold, drogs, massage? Examination • Extraoral and intraoral inspectio. Signs of the inflammation. Tumor calor, rubor, functio laesa. • Palpation of the laesion, lymphatic nodes, TMJ, periapical areas • Biting, cold, hot, percussion, bend forward Caries Pain - food penetration - esthetic disorder - bad smell and taste - gingivitis Big lesion - X-ray, fiberoptic - change of tha approximal contour Pulpal pain Reversible alteration in the pulp : 1. Before pulpitis (hyperaemic pain) - sharp pain for stimuli. It stop immediately when the stimulus stop. - hot cold and osmotic sensitivity no spontaneous and night pain 2. Reversible acute pulpitis (partial, serous) - spontaneous and stimulated pain with sharp caracter, wich no eliminate immediately after stimuli stop radiating pain, hard to localisation - no sensitivity to percussion - more sensitive to cold - no pain at night Pulpal pain Irreversible alterations 1. Irreverzible acute pulpitis - specific pain for pulpitis, mainly at night, radiating pain - pain for percussion, and biting - more sensitive for hot (purulent) 2. chronic pulpitis - mild, long time pain with billowy charecter (hot!) - pulpitis chr. ulcerosa, polyposa 3. Gangraena of the pulp (simplex or complicata) - No spontaneous pain, but sensitivity for hot and percussion Pulpal pain After gangrena: 1. Periodontitis acuta (parodontitis apicalis acuta) - spontaneous pain and sensitivity for biting, well localisation (it seems longer than the other tooth) - discoloration, sensitivity for hot, but not alive - we can see symtoms of general inflammation 2. Periodontitis chronica (parodontitis apicalis chronica) - discolorated, non vital, no symptoms, but X-ray! - fistula and focal infection can appear 3. Periostitis és submucosus abscessus - serious general and local inflammation, with symptoms - pain can eliminate by forming abscessus Jég -20oC Spray -40oC Szénsavhó -70oC TMI The burning mouth syndrome • Long history (months, years) of burning sense and pain mainly on the tongue (just like scald with something –without pyhisical injuries). • The patients are mainly women after menopause. • No visible alteration exept of less saliva, thin mucosa. • Reasons are unclear. (immune-hormone-nerve system) • Therapy B vitamins, reassurance.