if it can be detected with typical tooth testing. Maybe it’s non-odontogenic or unclear, in which case it may not be possible to locate and either more time or a referral to a physician is appropriate. If a tooth tests ‘different from the others’ or the painful inflammation can be stimulated, ask yourself, what ‘scratched’ this tooth/area and how severe is it? Was it like a scratch that doesn’t break the skin like heavy bite forces from clenching? An occlusal interference from a fresh filling? Is the patient wearing braces and they were just tightened? Does the person have a history of sinus infections causing the molars to be sensitive? Or was the ‘skin broken’ recently and now bacteria is getting in? Examples of this would be like pain after a deep filling, decay under a crown, cracks in the marginal ridges, or leaky old amalgam fillings. If there is nothing close to the chamber but a clear apical lucency, then a dreaded crack is suspected to be the scratch. It isn’t always possible to tell but looking for the usual suspects is a good start. After seeing enough scratches you can begin to see patterns. The nice thing about seeing patterns is the ability to predict these patterns. One of the main instances of this is noticing if anything is close to the pulp. It’s like seeing if the tooth has been ‘scratched’ deeply, by something like decay or the preparation necessary to remove the decay. The benefit of this information is using it to predict the scratch on a tooth with a large chamber on the radiograph. Look at the size of the tooth’s chamber prior to drilling and let the person know if it’s big. Turn the patient from ‘you hurt my tooth when it was fine’ to ‘the doctor told me this was going to happen.’ This is a much better outcome since you tried to help and no one was surprised by the outcome. Pain is not a fun thing to experience or have develop in the mouth. You as the dentist are the first person a patient usually sees and without an understanding of inflammation as the source of pain, it can leave us feeling insecure about diagnosing what’s going on. After playing the ‘find the inflammation’ game enough times however, you may find you are good at figuring things out and can resolve the problem for your patient and be their hero. If not, your local endodontist is happy to help and they will no doubt help you learn as time goes on. I hope this helps and makes pain less challenging to understand. dentistry issues Q KeystoneExplorer | Fall 2023 5 References 1. Correlation between Clinical and Histologic Pulp Diagnoses; Ricucci, Domenico et al.; Journal of Endodontics, Volume 40, Issue 12, 1932–1939
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