Tooth Ache (Possible Causes of Tooth Ache (Cracks, Food impaction (could…
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
Periodontal problems (perio abscess, gingival abscess, perio pockets, perio infection, mobility)
Pulpitis – reversible or irreversible
Pulp necrosis and tooth infection
Dentine hypersensitivity (exposed dentine from tooth wear/recession)
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?
Check muscles of mastication
Check for open contacts, overhangs, leaking margins
Check extra-orally for tenderness and swelling and lymphadenopathy
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 perio by probing to find any pockets
EPT test (remember that false positives can occur due to pus)
Check for high spots with bite paper
Take a PA radiograph
Check for cracks using a cotton roll or a frac finder