Differential diagnostics of pain in the Head and Neck
region.
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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
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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?
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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
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Caries Pain - food penetration - esthetic disorder - bad smell
and taste - gingivitis Big lesion - X-ray, fiberoptic - change of
tha approximal contour
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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
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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
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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 s submucosus abscessus - serious general and local
inflammation, with symptoms - pain can eliminate by forming
abscessus
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Jg -20 o C Spray -40 o C Sznsavh -70 o C
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TMI
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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.