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Tooth Ache (Possible Causes of Tooth Ache (Food impaction (could be due to…
Tooth Ache
Possible Causes of Tooth Ache
Food impaction (could be due to an open contact, or just by chance that they ate something and it got stuck)
Clenching and grinding
Sinusitis
Trigeminal neuralgia
Periodontal problems (perio abscess, gingival abscess, perio pockets, perio infection, mobility)
Cracks
Pulpitis – reversible or irreversible
Pulp necrosis and tooth infection
Trauma
Dentine hypersensitivity (exposed dentine from tooth wear/recession)
High restorations
Questions to ask Patients
Type of pain? Dull, sharp, throbbing?
Temperature sensitivity? Hot and cold?
How long has it been sore?
When did they first notice it?
Duration of pain? Constant, occasional?
Does it wake them up at night?
Sore to bite on?
Relieving/exacerbating factors? Hot, cold, leaning forward, pressing on it, chewing?
Do painkillers help?
History of trauma? Did anything happen to the tooth in the past, did they knock it or eat something really hard?
Clinical Exam
E/O
Check muscles of mastication
Check extra-orally for tenderness and swelling and lymphadenopathy
I/O
Check if there is tenderness in the sulcus
Check if teeth are TTP and sore to apical pressure
Check for caries
Check for recession/ exposed dentine
Check for wear facets (grinding/clenching)
Check for open contacts, overhangs, leaking margins
Check perio by probing to find any pockets
Special Tests
EPT test (remember that false positives can occur due to pus)
Cold test
Check for high spots with bite paper
Take a PA radiograph
Check for cracks using a cotton roll or a frac finder