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
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?
• Extraoral and intraoral inspectio. Signs of the
inflammation. Tumor calor, rubor, functio
• Palpation of the laesion, lymphatic nodes,
TMJ, periapical areas
• Biting, cold, hot, percussion, bend forward
- 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
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
• No visible alteration exept of less saliva, thin
• Reasons are unclear. (immune-hormone-nerve
• Therapy B vitamins, reassurance.

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